COA's provider network adapts to serve vulnerable older adults during the pandemic

As the Area Agency on Aging for southwestern Ohio, Council on Aging contracts with nearly 300 area businesses and organizations to deliver critical in-home care services to more than 27,000 older adults and people with disabilities in COA’s service area. COA’s service provider network includes home health aides, home-delivered meals producers and drivers, transportation providers, and more. 


During the pandemic, COA and its provider network have adapted programs and services to protect staff, providers and clients. While adult day care centers, senior centers and congregate meals sites were closed in accordance with state orders, other services, including home-delivered meals, transportation and homecare assistance, continued without interruption.  


But like many other businesses, COA’s providers were impacted by the pandemic and had to find ways to adapt to new realities. 


Teresa Winters, owner of Katy’s Home Care, said she got to work right away making masks for her staff and their clients. Winters said her biggest challenge was ensuring all her staff were following the same safety protocols. She provided training and showed staff a video about the 1918 flu pandemic. “That put the fear in everyone and they understood how serious this is,” she said.  


Winters stayed in contact with all clients – even those who temporarily suspended their services – to let them know what she was doing to keep everyone safe. Staff had clear guidelines to follow and clients knew who to contact if they ever felt concerned for their safety, Winters said. “We worked together through all this – our staff, our clients, everyone,” she said.  

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At Helping Hands Healthcare, services were adapted to be “contactless.” Clients’ laundry and to-do lists were left on the doorstep and Helping Hands’ staff took it from there. While this ensured clients’ basic needs were met, Beverly Ellis, director of nursing at Helping Hands, said this was a difficult time for staff and clients.  


According to Ellis, “What was sad though, was the increased amount of loneliness and fear we saw in each client. To say what our biggest change was, I would have to say the distancing of care and lack of closeness during delivery of care. It took a lot for us not to hold someone’s hands or give them that much needed hug.” 


Other providers noticed this as well. At Maple Knoll Communities, Director of Outreach Services and Affordable Housing, Joshua Howard, said, “It didn’t take long for the conversation about providing services during a pandemic to also include discussions about seniors’ mental health and how the isolation and lockdown was taking a different toll on our community.” 


To help, Maple Knoll engaged volunteers to make regular check in calls and to provide lessons on how to conduct Zoom calls with friends and family.  


Operationally, Helping Hands had to adapt to the impact of school and daycare closures on staff. Ellis said 90 percent of Helping Hands’ staff have school-aged children. To help employees and ensure they were still able to meet clients’ needs, Helping Hands developed a program called Daycare Share where employees took turns watching children and assisting with schoolwork while other employees focused on work. As a result, Ellis said, “We saw our staff relationships transform and it became a win-win for many.” 


Maple Knoll’s Howard said even though the pandemic impacted his organization’s operations, it never affected the mission. “Whereas the ‘how’ dramatically changed, the ‘why’ and ‘what’ were never in doubt,” he said. “We provide both home-delivered meals and transportation services to low-income seniors in Greater Cincinnati and our clients never saw an interruption in service. We continued to deliver food, supplies, social interaction and arrive at their homes on time and get them to and from appointments safely, but not without some changes.”  


While some clients did contact Maple Knoll at the start of the pandemic to cancel appointments, Howard said many more called with anxiety in their voices worried about how they would get to dialysis, therapy and other important appointments. For older adults that rely on Maple Knoll’s transportation services to do their grocery shopping and other errands, Maple Knoll adjusted trip times to align with special shopping hours that had been reserved for older adults at many area shopping destinations.  


“I don’t know if there is one right answer for navigating these challenging times,” Howard said. “It’s most likely a combination of a ‘can do’ attitude, thoughtful considerations, an abundance of caution and the ultimate commitment from our staff to be present and willing for our seniors.” 


During the pandemic, demand for certain services, like housekeeping and personal care, fluctuated based on spikes and declines in COVID-19 infection rates. But other services, such as home-delivered meals, saw an increase in demand. For example, COA service providers delivered nearly 1.8 million home-delivered meals in FY 2020 – a 32 percent increase over the previous year.  


Food security has been a focus of COA during the pandemic. Calls for food assistance increased when older adults were urged to stay at home to protect their health. COA’s provider network adapted operations to meet this need, converting congregate meal sites to drive-thru operations and distributing 15,600 emergency food boxes and nearly 34,000 restaurant comfort meals to older adults across COA’s service area from April – September. Some of this work continues today.


At Meals on Wheels of Southwestern OH & Northern KY (MOW), CEO Jennifer Steele said her team began overproducing meals and ordering shelf stable food right away. This kept them ahead of the supply chain crunch.  


Even with this preparation Steele and her team were shocked by the demand for services. “Demand tripled overnight,” she said.  “In one week in March, we delivered as many meals -- 50,000 -- as we would have in a typical month, pre-COVID.” MOW is a service provider for Council on Aging but also serves private pay customers in southwestern Ohio and northern Kentucky.  


According to Steele, MOW relies heavily on volunteers for meal deliveries. “Since March 2020, more than 600 volunteers have stepped up to help in every area of our operation, from food preparation to delivery and check-in calls,” Steele said. “Our drivers, kitchen and distribution staff were absolute heroes, risking their own health to ensure that the needs of seniors were met.” 


Steele said MWO drivers paid careful attention to the clients they delivered meals to – making note of trends and patterns that could indicate a change in mental or physical health. They also advocated for additional services and food when needed. A frequent request was hand soap and toilet paper, which MOW was able to add to their menu so clients could have it delivered with their meals.  


One of the ways COA worked to support service providers during the pandemic was through procurement and distribution of personal protective equipment (PPE). COA received PPE supplies from county emergency management agencies and the Ohio Department of Aging and used CARES Act funds to purchase PPE from other sources.  


During the spring and summer of 2020, COA distributed tens of thousands of PPE items to service provides and senior apartment buildings, including masks, hand sanitizer, face shields, gloves, booties, gowns and more. The PPE items were critical in protecting provider employees, and the older adults they serve, from COVID-19. “Quite frankly, I don’t know what we would have done without this program and [COA’s] assistance,” Helping Hands’ Ellis said.  


At Katy’s Home Care, Winters made PPE, shopped for her own supplies and also received supplies through COA. “If someone else could use the supplies, I was OK getting my own,” she said. “But then as we started getting down to no supplies and things got harder to find, I took the supplies from COA. It was a great help.” 


“I’m extremely proud of the work our provider network has done throughout this pandemic,” said COA's CEO, Suzanne Burke. “Despite this challenging environment, they have continued to provide services to our clients in a caring and safe manner – often responding to calls for help on short notice. Because of this teamwork, we’ve been able to help our clients weather the storm.”