Sustainability of the Aging Network's COVID-19 Responses: Isolated Impact or Transformative Change?

Abstract The COVID-19 pandemic mobilized individuals, organizations, and communities. Area Agencies and Aging (AAAs) and Title VI Native American Programs, core organizations of the network of community-based organizations (CBOs) that serve older adults and their families, pivoted their service delivery methods to provide life-sustaining services. Their long-standing expertise in community needs assessment, pre-existing cross-sectoral partnerships, and an infusion of emergency federal funding, enabled this rapid response. Recently concluded studies using key-informant interviews and national surveys of AAAs and Title VI programs highlight these service adaptations, from expansion of home-delivered meal programs to new partnerships in telehealth. These organizations also reported expansion of services offered and people served, and the emergence or strengthening of partnerships with other CBOs, businesses, and governmental organizations such as public health entities. For example, 78% of the respondents to the recent survey of AAAs reported that they have a role in vaccination outreach, scheduling support, or delivery. The papers in this symposium will use these new studies to describe the nature, origins, and potential sustainability of new and expanded services and partnerships. The Collective Impact Model for community change (introduced in the Stanford Social Innovation Review) will provide a framework for the discussion. Built on the importance of cross-sector coordination, the five pillars of success for collective rather than isolated impact are: a common agenda, mutually reinforcing activities, continuous communication, shared measurement, and a backbone organization. Each of these five pillars is relevant to the heightened community response during the pandemic, and to the likelihood of sustainability.

Healthcare Organization and Implementation Research,VA Boston Healthcare System,Boston,Massachusetts,United States,2. Tuscaloosa VA Medical Center,Tuscaloosa,Alabama,United States,3. Harvard Medical School,Boston,Massachusetts,United States,4. Hebrew SeniorLife,Roslindale,Massachusetts,United States,5. VA Providence Medical Center LTSS COIN and Brown University,Providence,Rhode Island,United States Spiritual care seeks to counter negative outcomes from spiritual distress and is notably needed in dementia.Such care needs disease-appropriate customization.Employing "cognitive apprenticeship" theory's focus on learning from contrast, we explored spiritual needs salient within dementia as related to other disease states; we aimed to inform future dementia-focused spiritual care design.Accordingly, we conducted semi-structured qualitative interviews with 24 providers who serve older adults inclusive of persons with dementia.We sampled participants purposively by discipline (chaplains, nursing staff, social workers, activities professionals) and religious tradition (for chaplains).Our interview guide inquired about the nature of spiritual needs in dementia and stakeholders' roles in addressing them.Hybrid inductive/deductive thematic analysis was employed.A thematic structure emerged with two themes: 1) spiritual experience in dementia compared to other medical conditions (sub-themes: the salience of (a) fear; (b) loss of self; (c) dementia's progressive and incurable nature; (d) dementia's impact on accessing faith); and 2) the need for spiritual intervention at the mild stage of dementia (sub-themes: (a) awareness in mild dementia and its influence on spiritual distress; (b) a window of opportunity).These findings pointed to possibilities for the "what" of spiritual needs and the "who" and "when" of implementing spiritual care.Implications included the imperative for dementia-specific spiritual assessment tools, interventions targeting fear and loss early in the disease, and stakeholder training.Researchers should study the "how" of dementia-appropriate spiritual care given recipients' cognitive and linguistic challenges.Conjointly, these efforts could promote the spiritual well-being of persons with dementia worldwide.

SUSTAINABILITY OF THE AGING NETWORK'S COVID-19 RESPONSES: ISOLATED IMPACT OR TRANSFORMATIVE CHANGE?
Chair: Suzanne Kunkel Discussant: Suzanne Kunkel The COVID-19 pandemic mobilized individuals, organizations, and communities.Area Agencies and Aging (AAAs) and Title VI Native American Programs, core organizations of the network of community-based organizations (CBOs) that serve older adults and their families, pivoted their service delivery methods to provide life-sustaining services.Their long-standing expertise in community needs assessment, preexisting cross-sectoral partnerships, and an infusion of emergency federal funding, enabled this rapid response.Recently concluded studies using key-informant interviews and national surveys of AAAs and Title VI programs highlight these service adaptations, from expansion of home-delivered meal programs to new partnerships in telehealth.These organizations also reported expansion of services offered and people served, and the emergence or strengthening of partnerships with other CBOs, businesses, and governmental organizations such as public health entities.For example, 78% of the respondents to the recent survey of AAAs reported that they have a role in vaccination outreach, scheduling support, or delivery.The papers in this symposium will use these new studies to describe the nature, origins, and potential sustainability of new and expanded services and partnerships.The Collective Impact Model for community change (introduced in the Stanford Social Innovation Review) will provide a framework for the discussion.Built on the importance of cross-sector coordination, the five pillars of success for collective rather than isolated impact are: a common agenda, mutually reinforcing activities, continuous communication, shared measurement, and a backbone organization.Each of these five pillars is relevant to the heightened community response during the pandemic, and to the likelihood of sustainability.
Association of Area Agencies on Aging surveyed the nation's 618 AAAs in February 2021, with a 27% response rate.As a result of COVID-19, most AAAs reported both increased numbers of new clients and needs of existing clients; threequarters of AAAs developed new external partnerships; and over half are implementing strategies to address equity and inclusion regarding their services and clients.Nearly 80% of AAAs are involved with COVID-19 vaccine outreach and delivery, from scheduling appointments to administering the vaccine to homebound clients.We will describe these and other transformations of services, partnerships, and client needs; discuss challenges and opportunities; and provide examples and video vignettes from AAA directors.

CASE STUDY ON THE COMMUNITY RESILIENCE WITHIN TITLE VI PROGRAMS DURING COVID-19: A QUALITATIVE ANALYSIS Abigail Bailey, Scripps Gerontology Center, Oxford, Ohio, United States
Health inequalities increased for Native Americans during the COVID-19 pandemic due to poor infrastructure, lack of electricity, health disparities, limited transportation, and rural location (Yellow Horse, 2021).Title VI programs-aging network organizations that serve tribal elders--had to be resourceful to meet increased needs and restrictions on service delivery options.Qualitative data from the national 2020 Title VI Native American Aging Programs Survey illustrated the challenges faced and the resiliency of these organizations and their communities.Two rounds of thematic coding of 479 open-ended responses to the survey revealed that communication across organizations, a sense of shared mission, and sharing of resources allowed these agencies to provide more services in innovative ways.Challenges included limited funding, regulatory barriers, and staff burnout.A video presentation by a Title VI program director will provide context for the results of the survey.

TELEHEALTH AS A RESOURCE FOR CONTINUITY OF CARE IN THE FACE OF DISASTER Chair: Walter Boot Co-Chair: Judith Robertson Phillips
This symposium co-sponsored by the Disasters and Older Adults and the Technology and Aging special interest groups of GSA aims to highlight the promise of, and barriers to, the use of telehealth to support continuity of care in the face of disasters and crises, such as the ongoing COVID-19 pandemic.M. Mattos will showcase a home-based medical care (HBPC) program to address chronically ill and homebound persons living with dementia and caregivers' needs during the pandemic.T. Wyte-Lake will present the results of a national survey on how changes were made to the Department of Veterans Affairs (VA) HBPC programs in response to the pandemic.G. Demiris describes a large caregiver study in which problem solving therapy and positive appraisal theory interventions designed specifically to support family caregivers of hospice patients during the COVID-19 pandemic were implemented via telehealth.D. Lindeman will specifically discuss challenges and implementation strategies for telehealth solutions applied to low-income older adults