COVID-19 Mitigation and Older Adults: Lessons from Seattle-King County

Editor's Note: The American Society on Aging continues to monitor the world's response to the COVID-19 pandemic and wishes to highlight resources on this page that are pertinent to our membership and those who work with older adults. 

The following article comes to the AgeBlog via the Aging and Disability Services division in Seattle, Washington and explores at great length the circumstances surrounding the response to the COVID-19 pandemic within the first community spread epicenter of domestic coronavirus spread.

By Andrea LaFazia-Geraghty and Cathy Knight

Abstract: Coronavirus Disease 2019 (COVID-19) is a virus strain that has only spread in people since December 2019. Health experts are concerned because little is known about this new virus and it has the potential to cause severe illness and pneumonia in some people. King County, Washington State had the first COVID-19 death and the case was not linked directly to outbreak in China or other international travel—meaning that that the virus began spreading though ‘community’ exposure. As the epicentre for the COVID-19 outbreak in the United States, the Seattle-King County Area Agency on Aging created and deployed messaging to the providers within the long-term services and support network to mitigate the spread of disease.

Background

The Seattle-King County Area Agency on Aging is one of 13 AAAs in Washington State. The Washington Association of Area Agencies on Aging (W4A) works with local Area Agencies on Aging (AAA) to create elder-friendly communities and to enhance the effectiveness of each AAA through a strong agenda of information, debate, advocacy, and education. The City of Seattle, Human Services Department, Aging and Disability Services division—the Area Agency on Aging for King County—is part of the Aging Network that was established in 1965 with the passage of the Older Americans Act. The Seattle-King County AAA serves over 48,000 older people, adults with disabilities, and family caregivers each year through a variety of services, many provided by a network of community-based organizations located throughout King County.

COVID-19 and older people

What can the Area Agencies on Aging (AAA) do to help inform and support the AAA community-based provider network during the COVID-19 public health emergency? Disseminating information and resources is a great way for the community-based provider network to plan and respond to the crisis. The following messaging was shared broadly with the Seattle-King County AAA provider network and the network of community-based organizations were asked to plan for closure, suspension and changes to their delivery of services (care) systems.

As you have likely heard, King County has its first cases of novel coronavirus (COVID-19) and these cases are not linked to the outbreak in China or other international travel. What this means, is that the virus is spreading though ‘community’ exposure. At this time, it is very important that we all take steps to prevent and reduce the spread of COVID-19.

Coronavirus Disease 2019 (COVID-19) is a virus strain that has only spread in people since December 2019. Health experts are concerned because little is known about this new virus and it has the potential to cause severe illness and pneumonia in some people.

Effective today, Monday, March 2, 2020, the Washington State Department of Health (DOH) has recommended implementing non-pharmaceutical interventions (NPI).

High-risk groups

Higher risk groups for complications associated with COVID-19 include adults over age 60, people with chronic medical conditions (e.g., heart disease, diabetes, lung disease) and people on immunosuppressant drugs. Most coronavirus illnesses are mild with fever and cough and do not require hospital care. People identified as high-risk can get severely ill with lung and breathing problems, like pneumonia, resulting in hospitalization.

Mitigation strategies

According to the US Centers for Disease Control (CDC), apart from getting vaccinated and taking medicine, people and communities can take action to help slow the spread of illnesses like pandemic viruses. Nonpharmaceutical interventions (NPIs) are also known as community mitigation strategies. When a new flu virus spreads among people, causing illness worldwide, it is called pandemic flu. Because a pandemic flu virus is new, the human population has little or no immunity against it. This allows the virus to spread quickly from person to person worldwide. NPIs are among the best ways of controlling pandemic flu when vaccines are not yet available (CDC, retrieved 3/15/2020).

The Washington State Department of Health NPIs guide provides interventions that are known to mitigate the spread of contagious disease, including the coronavirus (COVID-19). The interventions include:

1. Increase handwashing and use of alcohol-based sanitizer

2. Respiratory hygiene and cough etiquette

3. Keep distance from others (> 6 feet)

4. Frequently clean and disinfect surfaces

5. Remain home during a respiratory illness

6. Voluntary isolation of sick persons

7. Voluntary quarantine of contacts of sick persons

8. Involuntary isolation of sick persons

9. Involuntary quarantine of contacts of sick persons

10. Recommend or order cancellation of major public and large private gatherings

11. Recommend or order closure of schools, childcare facilities, workplaces, and public buildings

12. Prevent non-emergency travel outside of the home

13. Establish cordon sanitaire

Initial messaging to Home Care (direct care) providers from State of Washington, Department of Social & Health Services

 As a direct care provider, you can help protect yourself, your clients and others by taking a few simple steps to help prevent the spread of the disease at home and at work:

  • Wash your hands often with soap and water. Use alcohol-based sanitizers when you cannot wash your hands.
  • Use personal protective equipment such as gloves and face masks when providing direct care, when appropriate. You can also access gloves through your home care agency employer. Medicaid and state-only-funded clients are also eligible to receive a supply of 200 gloves per month, or more if medically necessary, for use by their home care providers.
  • Stay home when you’re sick. Alert your home care agency employer and follow their notification procedures if you will be staying home.
  • Cover your coughs and sneezes with a tissue and dispose of the tissue right away.
  • Clean frequently touched surfaces and objects.
  • Get plenty of rest, drink fluids, eat healthy foods and manage your stress.

If you suspect a possible COVID-19 case, please report it to your local health jurisdiction.

Service Delivery Recommendations

The following recommendations were provided to AAA network community-based organizations:

AAA Service Area

Recommendation

Adult Day Services (facility based)

Closure of facility-based operations and switch to individualized care plans delivered by staff or family caregivers.

AAA Nurse reviews & provides input on all individual care plans and Case Managers follow-up with clients to check in on ADH 2.0 plan.

Implement ADH 2.0 - Intermediate Service Model for operating Adult Day Health during PH emergency

Caregiver Support

Pre-screen all clients.

Shift assessments and in-home visits to telephonic or web based.

Case Management (in-home assessments)

Pre-screen all clients.

Agency staff shift to teleworking.

Shift all in-home assessments to telephonic.

Use client flexible funding for emergency services/expenses, health related items and groceries/nutrition.

Information and Assistance (Community Living Connections)

Provide information and assistance providers daily updates on provider network closures, changes in services, etc.

Allow all providers to telework.

Evidence-based health promotion

Cancel all in-person classes, shift to web-based (webinar, Skype, Zoom or telephonic).

Legal Services

Provide all services remotely (telephonic or web-based).

Nutrition Services – Home Delivered Meals

Continue to provide home delivered meals.

Ensure drivers follow public health guidelines and limit contact with clients.

Nutrition Services – Senior Congregate Meals

Closure of meal delivery in a congregate meal setting and shift all meal services to the following: to-go, shelf-stable, frozen, or sack lunch.

Senior Centers

Closure of senior centers. Recommend checking in with members telephonically or web-based (phone or e-mail).

Provide linkages to nutritional services as needed.

Transportation

Pre-screen all clients prior to scheduling.

Provide essential medical transportation services. Ensure drivers follow public health guidelines and limit contact with clients.

All Businesses

Provide the CDC Interim Guidance for Businesses and Employers to all community-based providers.

Provide links to local public health jurisdiction (local public health jurisdictions provide daily updates on COVID-19). Public Health Seattle-King County can be found here.

Social distancing

Social distancing is a way for people who are not ill to limit or avoid contact with viruses that cause illness such as pandemic flu by spreading easily from person to person. Learning about and practicing social distancing can help the community delay or reduce the impact of a pandemic.

Why implement social distancing?

COVID-19 is considered an infectious disease, which can spread with lightning speed leading to widespread illnesses and even death. One measure that we can take to protect each other, our families and community is to prevent potential exposure to disease through social distancing.

Social distancing options:

  • Stay home: Do not come into the office if you have ANY flu-like symptoms (fever, cough, difficulty breathing, etc.). Essentially, if you don’t feel 100% healthy, stay home.
  • Teleworking: Provide working remotely from home as an option for anyone and especially for staff (or a family member) who are in a high-risk/vulnerable group. You may choose to stay home to reduce your risk of exposure (communicate your plans with your supervisor).
  • If you must go out, stay six or more feet away from others and practice good hygiene (hand washing for 20 seconds and do not touch you face).

Conclusion

Remember that most of us go through our everyday lives not ever worrying about catching a cold or the flu. The majority of us were vaccinated as children so we don’t even think about infectious diseases like the measles, TB, etc. We are now living through a worldwide pandemic. Coronavirus (COVID-19) is disproportionality impacting older adults and those with underlying health conditions. Just as we are worried about ourselves and families, as the service delivery system for older adults, our older adults are worried, scared, confused, and often times alone.  Even though this information may sound very scary to many, the premise behind widespread sharing of information and implementation of prevention approaches is to ensure that our community is informed and that we, as a community, can mitigate the risks associated with this infectious disease. Lastly, it is important to encourage, support, and practice self-care.

Andrea LaFazia-Geraghty is with the City of Seattle's Aging & Disability Services Division, Human Services Department and the School of Social Work at the University of Washington. Cathy Knight is with Seattle's Aging & Disability Services.