COVID-19 Vaccine Examples from the Field

The following set of examples from the field showcases the ways n4a’s members have stepped up to support older adults and help them access the COVID-19 vaccine. Our compilation document notes the common services offered by AAAs on this issue but you asked for more peer examples. Would you like to see your agency’s vaccination support efforts or innovations spotlighted by n4a? Tell us at membership@n4a.org!

Direction Home Akron Canton Area Agency on Aging & Disabilities | Uniontown, OH
From all reports, Ohio’s AAAs have really stepped up to use their local relationships to forge strategies that are right for their communities. Successfully managing a vaccine rollout of this size is bound to present unique challenges, and Direction Home Akron Canton Area Agency on Aging & Disabilities (Direction Home Akron Canton) has taken a multi-pronged approach to support COVID-19 vaccine efforts throughout its service area. To go a little deeper, we spoke with Direction Home Akron Canton, to learn how they did it.

Following the governor’s announcement that Ohio’s AAAs can help the state’s older adults with vaccine registration, call volume has tripled. Through the care management teams, Direction Home Akron Canton staff are contacting clients directly, helping them register for the vaccine and helping coordinate transportation to vaccine appointments. In some counties with centralized scheduling, staff have even been able to register clients directly. The provider relations team is also supplying technical assistance to its home health agency partners on how they can advocate to get their staff registered for the vaccine and is now sharing information to get home health aides vaccinated.

The Direction Home Akron Canton community engagement team is working closely with partners such as health departments, senior housing, the state unit on aging and local hospitals to help coordinate available vaccine appointments, fill appointment slots to avoid wasted vaccines, and coordinate vaccine clinics onsite at local senior housing or public housing buildings.

Organizing and advocating at both the local and state level has been a crucial component of vaccine efforts undertaken by Direction Home Akron Canton and all Ohio’s AAAs. In addition, the communication among all Ohio’s 12 AAAs and the Ohio Association of Area Agencies on Aging has helped make it easy for agencies to share emerging practices and advocacy at the state level, as the state association can bring trends and issues that are occurring across county lines to the attention of state officials who have informed insight. AAAs have unique capabilities that make them valuable assets during this process but having a state association that can help them advocate for themselves, their partners and the clients they serve is invaluable.

Chautauqua County Office for the Aging | Mayville, NY
Chautauqua County Office for the Aging (OFA) wasted no time getting involved in COVID-19 vaccine distribution. Thanks to support from county officials, OFA was included in early local emergency operations meetings. Partnering with the local Department of Health (DOH) to help in any way that they can, OFA staff have been answering calls about vaccines, and, on behalf of DOH, are providing meals and supplies to people who are quarantining, including using a separate delivery system to serve those temporary clients. For this quarantining clientele, OFA provides two meals per day: shelf-stable breakfast and lunch items along with eight frozen meals from OFA kitchens.  

OFA has also made sure to present a unified front with other partners on the issue. Providing the same information, using the same voice and including others in OFA press releases has helped ensure everyone stays on the same public-facing page.

OFA’s knowledge of its clients’ needs has been instrumental as it assists with the rollout of the vaccine. OFA worked with their state unit on aging to integrate information about COVID-19 into PeerPlace, the statewide data management system, which has allowed it to gather pertinent vaccination information—such as medical conditions and whether a client wants a vaccine—and compile it in one place. OFA is also keeping track of who has received the first dose of the available vaccines, allowing staff to easily determine which clients still need a first shot and which clients need a second dose. Having this information in one place has allowed OFA to sort this data by numerous data points, and has greatly enabled both outreach to clients, as well as coordination between OFA and its local partners.

One of OFA’s best lessons learned is the importance of voicing the value, assets and support AAAs bring to the table—early and often. OFA leaders got in front of the process by conveying to partners the ways they knew their agency would be able to support the vaccine distribution process. As OFA Director MaryAnn Spanos said, “It’s hard to argue with someone who is helping you get your work done.” OFA staff were allowed early access to DOH vaccine clinic sign ups because the importance of their work is well understood. AAAs know what needs to be done to reach older adults, and that expertise is crucial in making sure those most vulnerable get vaccinated. For information on what all of New York’s AAAs are doing on vaccinations, contact their state association, AgingNY.

Region IV Area Agency on Aging | St. Joseph, MI
Like other AAAs around the country, the Region IV Area Agency on Aging has been rapidly distributing information about vaccination clinics and ways to register for vaccination appointments, as well as reaching out to their clients to determine their needs and what support they might need to get vaccinated. Region IV AAA has gone beyond these important outreach tasks and tackled vaccine rollouts in its community by leveraging established relationships with public health departments, Federally Qualified Health Centers, hospitals and other direct care providers.
 
When vaccines first emerged, Region IV AAA began meeting regularly with these entities, providing a wide range of data on the older adults in its community who were most in need of vaccination, offering their support services—and advocating for their clients. The AAA successfully advocated that older adults requiring in-home care be prioritized for vaccination, along with AAA staff, caregivers and direct care workers, and for HCBS waiver and PACE program clients to be able to receive the same priority as nursing home residents. Even with its longstanding relationships, Region IV CEO Lynn Kellogg was frank about the increased level of understanding these efforts required. To help health partners fully understand the populations served by her agency, she said “imagine a nursing home full of residents and take away all the staff—that’s who we are serving.”
 
Region IV AAA’s collaborations with partners in its community extended to administering the vaccinations as well. The agency provided names and phone numbers of people who were able to get to a clinic for priority scheduling. In the case of older adults who were homebound, the agency’s ability to identify and group individuals in need of in-home vaccinations by geographic location, allowed health care providers to reach these vulnerable people. The local public health department established clinics in PACE facilities, senior centers and targeted non–assisted living senior housing complexes, with AAA serving as a rapid-response source of last-minute appointments to ensure no vials were wasted. All of this has only been possible due to the mutual understanding and trust between local health care networks/health departments and Region IV AAA.

San Francisco Department of Disability and Aging Services | San Francisco, CA
In California, the San Francisco Department of Disability and Aging Services (DAS) has been actively engaged in supporting the roll out of the COVID-19 vaccine. After being approached by the community services branch of the San Francisco COVID Command Center, the city’s emergency COVID operations base, DAS deployed its deputy director to serve as a subject-matter expert who could address the needs of older adults and people with disabilities. This direct involvement allowed DAS to utilize its expertise to identify challenges its client base may experience in accessing the vaccine and provide solutions. As part of this work, DAS developed a document in collaboration with the University of California, San Francisco identifying barriers to equitable vaccination rollout and providing recommendations to overcome them.
 
As the city plans its roll-out strategies, DAS has also helped ensure that the city’s leadership takes into account issues that are central to the population the agency serves—including the transportation needs of older adults and people with disabilities, the best ways to reach homebound individuals and how best to use mobile vaccination teams for those individuals living in congregate housing settings. As part of its outreach efforts, DAS staff pushed to be included in call center design discussions and is sending text messages to its Medi-Cal (California’s Medicaid program) recipients, including those receiving in-home care, to ensure they receive up-to-date information on vaccines. DAS is advocating for senior centers to be utilized as pop-up vaccination sites, as the centers are trusted locations in their communities, can help with wrap-around services on site and can offer age-friendly physical locations. While San Francisco is dealing with the same vaccine supply difficulties as many other regions, DAS, like all AAAs, is remaining vigilant in the fight to make sure that older adults in its community remain a priority.

City of Los Angeles Department of Aging | Los Angeles, CA
Since 2016, the City of Los Angeles Department of Aging and the Los Angeles County Department of Public Health (DPH) have collaborated on Purposeful Aging LA, an age-friendly initiative aimed at preparing the Los Angeles region for a rapidly aging population. This longstanding partnership helped facilitate the Los Angeles Department of Aging’s coordination of regional COVID-19 vaccine efforts with the Los Angeles County DPH and seamlessly add vaccines to the diverse wellness areas the two are already working on together. Providing education on vaccines, assisting older adults in registering for appointments, organizing transportation and identifying homebound adults are natural ways for AAAs to get involved, and the Los Angeles Department of Aging has partnered with various city and public officials to make sure it all gets done.
 
It’s clear to Laura Trejo, General Manager of the Los Angeles Department of Aging, that the interdisciplinary collaborations and groundwork that had already been established prior to the pandemic has proven to be priceless. The importance of messaging has also been a critical immediate takeaway, as her agency has seen the value in sharing honestly how it can help and what it can or cannot do. With her mind on the future, Trejo was asked to write an article with a DPH director, Dr. Tony Kuo, about how the pandemic has illustrated the need for updated models of care for older adults. While the community’s pandemic-related needs are far from over, it is important to capture lessons learned from this year in order to build better aging services, policies and partnerships in the future.

­Kentucky State Association of Area Agencies on Aging 
Kentucky’s AAAs have been working with state and local officials on myriad aspects of the COVID-19 vaccination process. The Kentucky Department of Aging and Independent Living (DAIL) is moving forward with a new homebound vaccination initiative, branded A Shot of Hope at Home, and the Kentucky AAAs are collaborating with DAIL as well as the Kentucky Department of Public Health to strategize ways to make the program more accessible. All 15 of the state’s AAAs are also meeting with local public health officials to determine how the AAAs can help coordinate the actual in-home vaccinations.
 
Of course, implementation of in-home vaccinations does not mean that work on vaccination sites in the community can cease. Kentucky AAAs have continued to work with the state Cabinet for Health and Family Services and regional health departments to educate and inform community members about the vaccine’s availability and how to access it. Across the state, AAAs are strategizing ways to boost local accessibility to the vaccine, including organizing transportation for those who need it and identifying possible vaccination sites, such as senior centers, that are available and easy to access. Fifteen AAAs navigating the different processes of multiple individual health departments is a daunting task, but Kentucky AAAs have maintained their multi-level collaborations to continue to serve their clients with excellence.

Idaho State Association of Area Agencies on Aging
Idaho’s AAAs are all sharing information on the COVID-19 vaccine through Information and Assistance and a variety of different methods across the state. Some are utilizing their social media platforms to post where, when and how to sign up for and receive vaccinations. Others are tapping into their existing meal supply chains by providing flyers to local food banks and meal sites so vaccine information can be posted and distributed with food boxes and home-delivered meals. One AAA is partnering with the local health department to strategize mobile vaccinations for individuals receiving home-delivered meals. This is far from the only partnership, with two Idaho AAAs working with health departments and their local fire departments to coordinate the administration of vaccines to homebound older adults.

The core services provided by Idaho’s AAAs, such as direct client outreach and arranging transportation, have become even more critical during the process of assisting older adults with securing COVID-19 vaccinations. The Idaho AAAs are contacting their clients to assist in setting up appointments if necessary, as well as providing transportation to and from vaccination sites when needed. Not every AAA is approaching vaccination efforts in the same way, but they are all working tirelessly to get as many of their clients protected as possible.
 
San Bernardino County Area Agency on Aging | San Bernardino, CA
In December 2020, San Bernardino County began developing and implementing a distribution plan for the COVID-19 vaccine. County leadership immediately engaged the San Bernardino County Area Agency on Aging (PSA 20) to play an integral role in its plan due to the AAA’s established expertise in reaching the county’s older adults. Its robust plan, developed through strong multi-agency and departmental collaboration, is designed to expand vaccine access to all older adults across the county, with particular emphasis on reaching underserved, rural and mountain communities. San Bernardino County’s plan is divided into several phases. Phase I(a) mobilized one-day vaccination clinics throughout the county to provide 500-600 vaccinations per week at 25 different clinic sites located within core community buildings, like senior centers and congregate meal sites. Phase I(b) incorporated “pop-up” clinics using the county’s mobile units—fully equipped transport van clinics. This mobile option has increased access to vaccines for older adults in underserved areas. Phase II launched in early March 2021 and provides in-home vaccinations to homebound clients identified by PSA 20.

PSA 20 has also played a significant and proactive role in the county’s rollout of the COVID-19 vaccines. PSA 20 conducted outreach to its client base of more than 65,000 older adults to help with securing appointments in their area. Due to PSA 20’s substantial participation in the planning and implementation of the project, this outreach has allowed staff to register clients quickly and seamlessly while simultaneously identifying transportation, translation or other accommodations needed during the vaccination process. Vaccination sites and pop-up clinics are staffed by various county departments, including PSA 20, public health, emergency services, behavioral health and state-deployed nurses. PSA 20 staff carries out several duties at these sites, including managing site check-in, registering older adults for a second dose and providing information on valuable resources available within their communities.

The implementation of the county’s vaccination plan has been well-received by the community—and has been highly effective at reaching as many older adults as possible. To date, over 4,000 individuals within PSA 20 have received the COVID-19 vaccine through the mobile and in-home vaccination effort with substantially more anticipated to obtain their vaccine by way of this project. This success is possible because of the strong collaboration between departments and other partners, as well as PSA 20’s breadth of expertise and understanding of how to reach and serve the most vulnerable individuals in its community.

Region VII Area Agency on Aging | Bay City, MI
The Region VII Area Agency on Aging has taken a hands-on approach to getting homebound older adults the COVID-19 vaccine. Building on the successful campaign it developed for the 2020-2021 flu season, Region VII AAA partnered with local health departments and special programs within the Michigan Department of Health and Human Services to become a direct vaccine provider. Working with the health department, Region VII AAA used its expertise on the front lines while administering doses through clinics and in-home vaccinations. 

While Region VII AAA’s direct access to vaccines has allowed it unprecedented access in the vaccine rollout in its community, it cannot wipe away every barrier between older adults and vaccination. The time limitation on thawed doses, as well as the necessity for follow-up shots, continue to make homebound vaccinations difficult, requiring careful coordination from staff to eliminate any chance of waste. Nathaniel Bergman, pharmacist for Region VII AAA, noted that “easier to administer” vaccines (in terms of protocols, frequency) would help mitigate some of these challenges. Additionally, with the increased staff travel and time necessary to facilitate homebound vaccinations, costs rise while funding does not necessarily follow (information on the need for local funding advocacy can be found here).

Despite these difficulties, the worth of Region VII AAA’s COVID-19 vaccine program can easily be seen in its results. Over an initial period of less than two weeks, Region VII AAA directly administered 400 doses of the vaccine, over 140 of which were in-home. Its initial run was such a success that the agency is preparing to receive additional doses, as well as partnering with other Michigan AAAs to reach even more older adults who need the vaccine. Additionally, Region VII AAA has developed a toolbox of information to assist other agencies interested in starting vaccine programs and has shared this information with other AAAs. Those interested in further information are encouraged to contact Region VII AAA at 989-893-4506 or bergmann@region7aaa.org.

Arizona Association of Area Agencies on Aging
The varying needs of each community results in the AAAs that serve them possessing different tools to support the vaccination of older adults. While there are differing local goals and methods in Arizona, there is a statewide focus on reaching homebound adults. Northern Arizona Council of Governments (NACOG) Area Agency on Aging contracted with the Northern Arizona University School of Nursing to assist with homebound vaccinations in myriad ways. Nursing students call NACOG AAA’s homebound clients to capture logistical information like vaccination status, desire for vaccines, need for scheduling assistance and whether they need transportation to a vaccine site or need someone to come to their home. NACOG AAA staff use this data to follow up with transportation providers and assist with appointments. Northern Arizona University works with the health department to assist with mobile vaccinations where needed.

Pima Council on Aging (PCOA), an Arizona AAA, partnered with Sun Vans, an arm of Tucson’s public transportation that services people with disabilities who cannot use fixed-route transportation. This partnership has resulted in vans being set aside each week for the purposes of safely taking older adults who are homebound or otherwise unable to drive to vaccination sites. Once there, a vaccinator boards the van, administers the doses inside and the newly vaccinated older adults are then brought back home.

Another AAA in Arizona, Area Agency on Aging, Region One in Maricopa County is putting its robust help line to use fielding calls about registration inquiries and helping set up vaccination appointments. Region One has also contracted with Uber Health, a partnership that it has utilized for health appointment transportation in the past. Region One is charged an hourly rate by Uber Health when it transports clients to vaccination sites. The drivers will sit and wait with the clients while they get vaccinated, and then drive them back home.

These examples are not an exhaustive representation of the work that Arizona AAAs are performing but serve to highlight the strides that can be made by thinking creatively. Maddy Bynes of PCOA and the Arizona Association of Area Agencies on Aging said it well: “Thinking outside of the box, not being pigeonholed by the OAA or typical AAA roles in general is essential. Just because something has not been done before does not mean it cannot or should not be done.”

Trellis | Arden Hills, MN
With COVID-19 vaccinations well underway across the country, Trellis, a MN AAA, is utilizing a community-based approach to delivering vaccines. The agency’s efforts to reach those at higher-than-normal risk in underserved communities is critically important, says Dawn Simonson, President and CEO of Trellis, “Many of those who have not yet been vaccinated face difficulties with mobility, transportation or internet connectivity. Many immigrant older adults face language barriers, and trust is a challenging issue.” To this end, Trellis is serving as the link between the Minnesota Department of Human Services and various partner organizations that are already known and trusted within the community.
 
Trellis coordinated with Phoenix Cove, a pan-Asian organization that serves older adults and caregivers, to schedule three clinics, reaching approximately 1,000 older adults. Working with Open Arms of Minnesota, a nonprofit that delivers free and nutritious meals to individuals with life-threatening illnesses in the Twin Cities, Trellis arranged a community vaccination site that administered doses to 380 people—mainly individuals with HIV and other chronic conditions, volunteers and essential workers. And, through a partnership with the Muslim American Society of Minnesota, Trellis was able to reach 6,000 older adults in the Muslim community before Ramadan. Khadra Mohamed, a public health nurse for Hennepin County, remarked on the importance of getting community leaders like the imams on board as “it will bring the whole community around and build trust in those who are hesitant.”
 
Simonson had this to say: “We have been working for some time with the Minnesota Leadership Council on Aging, the Metropolitan Center for Independent Living and others to bring attention to the people who are falling through the cracks.” To date, Trellis has organized 38 community clinics, serving 11,385 people, and they are now shifting to smaller drop-in clinics in targeted areas, which will be funded largely by recent federal emergency funding from the CDC/ACL and the American Rescue Plan Act.

AgeOptions | Oak Park, IL
For older adults and others who are not able to get vaccinated at a mass vaccination site, pop-up clinics at senior centers or dining sites providing COVID-19 vaccinations are proving to be a valuable solution. AgeOptions, an IL AAA, has collaborated with the Cook County Department of Public Health and other local partners to vaccinate more than 2,500 older adults and caregivers at these pop-up clinics, many of whom are in groups that have been disproportionately affected by the virus, including people with disabilities, individuals without internet access or those who are socially and linguistically isolated. One AgeOptions’ Board member, who is a doctor, was able to help facilitate both the acquisition of vaccines and the securing of vaccinators to staff the pop-up clinics.

AgeOptions and partners intentionally reached out to older adults who receive home-delivered meals and other in-home services to sign them up for vaccination appointments. These individuals are considered homebound, but through proper accomodations like holding the clinics on weekends (allowing for family members to provide transportation more readily), and having medical professionals provide vaccinations while individuals remain in their cars, pop-up clincs have reached many older adults who have mobility limitations. These adaptations have allowed individuals to get vaccinated at these pop-up clinics rather than through in-home vaccinations, which can be lengthy, while additionally reducing the amount of in-home vaccinations that need to be carried out.
 
To help drive turn out and participation at the pop-up sites AgeOptions engaged local churches and other leaders in traditionally underserved communities. Staff from AgeOptions visited each site ahead of time to understand the logistical needs of the locations, organized registration and made volunteer assignments. Diane Slezak, President and CEO of AgeOptions, ran what she called the “vaccine mobile,” a vehicle that drives to each pop-up clinic fully stocked with wipes, clipboards, vaccine information sheets and consent forms.

Note: n4a is not endorsing any of the tools or strategies found on this page.