With adults older than 65 at greater risk of serious COVID-19 complications, providing information and resources to that population is imperative, local leaders say. But they have found many barriers to getting resources to people while maintaining social distance during the coronavirus pandemic, particularly older adults living alone.
The main barriers are finding and getting access to older adults who are aging in place and have never previously asked for help, said Jamie Bergmann, vice president of impact policy and advocacy for United Way of Greater Chattanooga.
"Older adults who are not receiving any type of services are not on anyone's radar," she said.
Data such as the number of 211 calls placed from a particular area to United Way asking for assistance can be useful in helping to identify areas with the greatest needs, but the data does not account for the people in need who may need help but do not request assistance.
"Some people don't know how to ask for help," said Bergmann, adding that when they do accept help, it's from people they know and trust, such as church and neighborhood leaders.
To help find those older adults, community advocate Dr. Everlena Holmes created a system.
As a community advocate, Holmes said she works to develop neighborhood leadership and to give those leaders a voice that represents their interests. Prior to the pandemic she had helped develop a network of block leaders in the Glenwood, Avondale and Glass Farms neighborhoods.
When the pandemic began, Holmes started calling older adults she already had connections with in Glenwood.
"They were so happy," Holmes said. "I know some of them live alone. Asked if they needed anything and if they had any questions."
After talking to them, she created a list of questions on a form that others could use when calling older adults in their neighborhoods.
She reached out to Dr. Eileen Robertson-Rehberg, director of data analysis and strategy for United Way of Greater Chattanooga, who compiled data from a variety of sources to map out where other pockets of older adults might be living alone.
Holmes then approached Cathy Scott, director of the bachelor of social work program at University of Tennessee at Chattanooga, who helped her coordinate neighborhood block leaders back in 2015. Holmes asked Scott whether her students could help call older adults.
(READ MORE: UTC students adjust to COVID-19 boomerang life)
With the help of Hamilton County Commissioner Katherlyn Jeter, Chattanooga City Councilwoman Demetrus Coonrod and neighborhood leaders, Holmes compiled lists of names in Avondale, Bushtown, Boyce Station, Battery Heights, Gaylon Heights, Riverside, Lincoln Park, Orchard Knob, Glenwood, Glass Farms, Churchville and Highland Park.
Older adults in need can call the Southeast Tennessee Area Agency on Aging and Disability’s toll-free number 1-866-836-6678 or 211 to be connected to local resources.
The students call the older adults on the lists using Holmes' form. They identify needs and send them to Holmes, who passes those along to Kristi Wick, the Vicki B. Gregg chair of gerontology at UTC. Wick then attempts to meet those needs through partners and resources available to the Mayor's Council on Aging and Livability, of which Holmes is a part and Wick is the chair.
"There are a lot of questions and concerns; sometimes they're lonely and want to talk to someone," Holmes said. "Whatever they need, we try to help them through that process."
For the older people the students cannot reach, they leave a message for them to call Holmes. Those who do not call within two days are put on a list given to the president of their neighborhood association to check on them.
Many faith-based organizations are calling their own members and offering volunteers to make those phone calls as well, Wick said, but they still had trouble getting phone numbers for many older adults.
"We were looking at upwards of 20-30% who, in any given neighborhood, didn't have an active or available phone number," Wick said. "In a normal situation we would just canvass a neighborhood and visit people, but we can't do that with the social distancing guidelines."
To help reach people without phone numbers, the city of Chattanooga helped map some of the most vulnerable addresses, where they sent a postcard of COVID-19 information and a few of the top resources they could contact for services.
On March 18 the COVID-19 Older Adult Community Response Task Force was established in an effort to ensure the needs of older adults in the community would be met, including meeting basic needs such as food, prescriptions, transportation and health care access, as well as looking at ways to address social isolation, Wick said.
Composed of 30 to 40 community leaders and representatives from local organizations engaged with the community's older adults, the task force holds calls on weekdays to discuss any problems organizations are having in meeting needs or gaps in services that have been identified and need to be filled.
Food has continued to be a focus from the beginning, and need tends to wax and wane depending on when older adults receive checks they rely on for income, Wick said.
The task force is also addressing prescription access for those who cannot get their prescriptions delivered. Whether prescriptions can be delivered depends both on the pharmacy and the prescription itself; prescriptions requiring refrigeration, diabetic supplies and controlled substances are among the prescription items that cannot be delivered.
Wick said they have worked with insurers such as BlueCross, Cigna and Humana as well as primary care physicians and asked to contact patients about switching to receiving medications through mail order or allowing them to pick up a 90-day refill.
While she said CARTA has done a great job of providing transportation, that remains an issue for the 25% of older adults in Hamilton County who don't have cars, according to the health department's 2019 snapshot on aging.
Health care access is also a challenge, including making sure people who are uninsured and who do not have a primary care provider are able to get care, while trying to keep people with chronic diseases out of the hospital and emergency room to keep it open for COVID-19 patients.
"Our older population by default is at risk," said Wick, adding that 38% in Hamilton County have four or more chronic diseases, according to the 2019 report.
The federal Centers for Medicare & Medicaid Services recently relaxed rules for telehealth, and for the first time Medicare recipients were able to get mental health care via telehealth.
"That was huge for that group, and so we've been trying to maximize that opportunity," Wick said. "The gap is that many older adults don't have access to a phone or iPad or computer that has video capability."
To address that need, the Enterprise Center has been working to put up Wi-Fi hotspots, and has an application process available for devices for people who need them.
Aside from meeting basic needs, social isolation continues to be a big concern.
"The health outcomes of social isolation are not good — anything ranging from chronic diseases which become uncontrolled to mental health issues with loneliness or depression, functional decline, mental decline."
The task force is looking at ways to help stimulate the brains of older adults, encouraging them to move and get some sunshine.
Task force members have been putting together activity bags of puzzles, books, crossword puzzles, crafts and yarn using donations from churches, the Chattanooga Public Library and others.
When Holmes was not able to get names and numbers for pockets of older people living in other areas of town, such as South Chattanooga, Westside and North Chattanooga, she sent a letter to all the local leaders letting them know what they were doing in East Chattanooga. The Rev. Requetta Dotley of Westside Missionary Baptist Church was already doing something similar in that part of town, and Holmes said she's still concerned about those living in North and South Chattanooga.
She also worries that there is not a COVID-19 testing site that the older people she works with are able to access. The Clinica Medicas site on 23rd Street is difficult to get to for those without cars, she said.
"One thing about COVID-19, it has uncovered a lot of the disparities and inequities in the Latinx and African American communities, and I am hoping they will address that," Holmes said of the city's committee working to reopen Chattanooga.
Contact Emily Crisman at firstname.lastname@example.org.