A summary of presentations from the weekly Summit partner webinars
April 22, 2021
- Virtual Summit Meeting Announcement – Carolyn Bridges (IAC)
- PACE Program–Successes and Lessons Learned in Vaccinating High-Risk People at Home – Timothy Farrell (American Geriatric Society)
- Local and National Resources to Support the Vaccination of Homebound Older Adults and People with Disabilities – Amy Gotwals (National Association of Area Agencies on Aging)
Virtual Summit Meeting Announcement – Carolyn Bridges (IAC)
The Summit will conduct a virtual meeting, Maintaining Influenza Prevention During the Ongoing COVID-19 Pandemic, on May 20 from 2–4:30 pm ET. This webinar will be held in place of the usual in-person Summit meeting held each spring. The agenda will include updates on influenza surveillance, influenza vaccine uptake, communications planning for the upcoming season, and presentations from vaccine manufacturers on their estimated vaccine supply for the 2021–22 influenza season. Registration information is available on the Summit website.
PACE Program–Successes and Lessons Learned in Vaccinating High-Risk People at Home – Timothy Farrell (American Geriatric Society)
Dr. Timothy Farrell, representing the American Geriatric Society, provided a presentation on the successes and lessons learned in vaccinating high-risk people at home.
There are two million homebound older adults in the U.S., 20% of whom are classified as “completely homebound.” Seventy percent (70%) of persons in this group report their health as “fair” or “poor,” and only 12% receive home-based primary care. These individuals are more likely than non-homebound older adults to belong to a disadvantaged group, have lower education and income, have more chronic conditions, and be hospitalized.
The Program of All-Inclusive Care for the Elderly (PACE) is an integrated system of care for the frail elderly that is community-based, comprehensive, capitated, and coordinated. The PACE model focuses on keeping individuals at home and honors what frail elders want by allowing them to stay in familiar surroundings, maintain autonomy, and maintain a maximum level of physical, social, and cognitive function. The program serves people 55 years of age and older who live in a PACE service area, are certified as needing nursing home care, and who are able to live safely in the community with PACE program services.
The program is supported through integration of Medicare, Medicaid, and private pay payments, with 90% of participants being dually eligible for Medicaid and Medicare. Services offered through an interdisciplinary team include medical care; physical, occupational, and recreational therapy; meals; social services; and personal care needs.
PACE began in 1986 through a successful Robert Wood Johnson demonstration project, and it was authorized by Congress in 1997. The first PACE program achieved permanent status in 2001. The PACE Innovation Act was signed into law in 2015. The program now consists of 272 non-residential PACE Centers in 30 states, with 138 sponsoring organizations. Since 2009 the program has undergone an impressive growth rate of 209% and has a current enrollment of almost 55,000 persons.
A recent survey of PACE member organizations indicated 71% of PACE participants have received at least 1 dose of COVID-19 vaccine. Although slightly lower than the overall U.S. population of adults, it is impressive given the PACE population, many of whom have cognitive and functional impairment. Two-thirds of PACE organizations had vaccinated at least 50% of their staff, which is slightly above the level reported in nursing homes.
PACE approaches COVID vaccination as both a vaccinator and a connector to other vaccinators. Centers performing vaccinations typically bring patients into the facility rather than going to the patient’s home.
One key to the program’s COVID vaccination success has been taking a personal approach to addressing vaccine hesitancy through activities such as 1-on-1 conversations and virtual town hall meetings. The other key component of success is to provide vaccine materials in a variety of languages well in advance of the vaccination.
Logistical barriers for vaccinating homebound older adults are significant. Geographic dispersion of participants and short window of vaccine viability result in the need for careful planning of travel routes and reduced time to answer patient questions. These barriers are compounded by difficulties in identifying homebound older adults and concerns about minimizing vaccine wastage.
A subpopulation of these older adults includes persons who lack decisional capacity to provide informed consent, have not executed an advance directive, and who lack family, friends, or legal surrogates to assist in the medical decision-making process. This provides a “perfect storm” of issues to be addressed. The prevalence of these “unbefriended” patients is 16% in ICUs and 4% in LTCFs.
Opportunities to intervene with the unbefriended are available in both inpatient and outpatient settings. However, barriers exist for distributing vaccine in this group, including difficulty in identifying and contacting these individuals who may lack internet access or caregivers to assist them with online registration. They also may lack transportation or may be homeless.
Dr. Farrell offered several “lessons learned” in vaccine distribution to homebound older adults, including:
- Approaches are needed from both national/state and local levels;
- A streamlined approach is beneficial to help overcome fragmentation of services;
- The public health infrastructure should be leveraged; and
- Advance preparation is essential.
He also offered several post-pandemic recommendations for vaccine allocation and distribution, such as:
- Conduct post-pandemic allocation reviews to consider strategies that were used and the ethical decisions involved;
- Maintain the spotlight on homebound older adults through short- and long-term community engagement and providing services to this population, with considerations for what strategies should be developed to prevent perpetuating inequities when the next pandemic occurs.
Summit partners with questions about the PACE program are encouraged to contact Dr. Timothy Farrell.
Local and National Resources to Support the Vaccination of Homebound Older Adults and People with Disabilities – Amy Gotwals (National Association of Area Agencies on Aging)
Amy Gotwals, Chief of Public Policy and External Affairs with the National Association of Area Agencies on Aging (n4a), returned to the Summit to present an update on information she had provided at the February 18, 2021 Summit meeting.
Local area agencies on aging (AAAs) coordinate activities with a wide variety of agencies within their community. To support vaccination of older adults, the AAAs provide education and outreach, assistance getting and keeping an appointment, and sometimes provide immunizations at vaccine clinics or in-home.
Recently these activities have expanded greatly. Funding increases in the Older Americans Act (OAA) allowed CDC to move $100 million to the Administration for Community Living (ACL) to supplement the ability of aging and disability networks to support vaccination efforts. This includes funding to the Eldercare Locator to build capacity to support older Americans who need assistance to be vaccinated. With this influx of funds, n4a will be able to more than double the capacity at its call center, increasing access to resources for assistance with services such as transportation and responses to general COVID-19 questions. One of the beauties of the call line is that it provides one national number (800-877-1116) that can be used to help connect the caller with local services, including vaccination. Ms. Gotwals reported that the call center should be fully ramped up within the next 2 weeks.
Persons needing additional information on this program may contact Amy Gotwals.