“There Was No ‘That’s Not My Job’”: New York Area Agencies on Aging Approaches to Supporting Older Adults During the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has disrupted many older adults’ traditional sources of formal and informal supports, increasing demand for Area Agency on Aging services (AAAs). This study examines strategies used by AAAs to support older adults’ health and well-being during COVID-19 and identifies contextual influences on AAA pandemic response activities. Semi-structured interviews were conducted with representatives of 20 AAAs in New York State. A combined inductive and deductive approach was used to code and thematically analyze the data. AAAs rapidly expanded capacity and dramatically modified program offerings, communications activities, and service delivery protocols to address emergent needs and minimize COVID-19 exposure risk for clients. AAAs’ trusted relationships with older adults and community partners improved their capacity to identify priority needs and coordinate appropriate supports. Policymakers should ensure that AAAs receive sustained financial and technical support to ensure critical community-based services are available for older adults throughout pandemic response and recovery.

Keywords

home- and community-based care and services qualitative methods policy

Introduction

The COVID-19 pandemic presents novel health risks and magnifies existing threats to health and well-being for older adults. COVID-19’s impact on an aging population reflects older adults’ heightened vulnerability to the virus itself, as well as the disruption of older adults’ traditional formal and informal supports created by pandemic response measures (Landry et al., 2020). Older adults are not a homogeneous group; individual demographic and health risk factors as well as geographic, social, and policy contextual factors come together to shape older adults’ risk and resilience during COVID-19 (Lee, 2020). While media, policy, and research attention has rightfully focused on the risks COVID-19 poses to the nursing home population, community-dwelling older adults are also extremely vulnerable to COVID-19 health risks and service disruptions (Cohen & Tavares, 2020). The widespread and prolonged disruption of older adults’ traditional sources of support during COVID-19 suggests a need for local social service organizations to play a central role coordinating resources and services to ensure community-dwelling older adults’ health, safety, and social connectedness (Berg-Weger & Morely, 2020).

Given the disproportionate health risks that older adults experience in disasters, including pandemics, there is growing research and policy interest in building capacity to support community-dwelling older adults during disaster preparedness, response, and recovery (Gibson & Hayunga, 2006). Aging services organizations are increasingly recognized as valuable partners in disaster response efforts, creating opportunities to ensure disaster-related activities address the unique needs of an aging population (Pendergrast et al., 2020; Shih et al., 2018; Straker et al., 2009). A recent paradigm shift in the field of public health preparedness has motivated an interest in building “community resilience” to disasters through engaging community organizations to deliver targeted support of vulnerable populations such as older adults (Chandra et al., 2011; Shih et al., 2018). This growing focus on community resilience further supports the need for understanding aging services organizations’ role in supporting older adults during disaster situations such as pandemics.

As the local component of the Aging Network established by the Older Americans Act (OAA), Area Agencies on Aging (AAAs) and Title VI tribal aging programs operate in virtually every community across the United States, coordinating home- and community-based services that play a key role in supporting Americans age 60 and older to live longer in their homes and communities (Colello & Napili, 2020). No recent peer-reviewed research has examined AAAs’ disaster-related activities (Cohen & Poulshock, 1977; Straker et al., 2009), although the COVID-19 pandemic has demonstrated the wide array of essential services AAAs provide for older adults in disaster-impacted communities, including expanded nutrition programming, information and referral services, and social support activities such as telephone reassurance (National Association of Area Agencies on Aging [N4A], 2020a). The National Association of Area Agencies on Aging’s May 2020 survey found that 93% of AAAs have served more clients since the pandemic began, and 69% have seen an increased need for supports and services among existing clients (N4A, 2020a). Researchers and policy experts have called attention to AAAs’ prominent role in COVID-19 response, although no empirical research has examined AAAs’ pandemic response activities (Hoffman et al., 2020; Wilson et al., 2020).

This research examines how AAA COVID-19 response activities align with and complicate the “Levers of Resilience” framework, a public health preparedness theoretical framework that presents a typology of activities that aid communities in withstanding and mitigating the stress of disasters and minimizing disaster-related negative health consequences (Chandra et al., 2011). The framework identifies the following eight “levers,” or key disaster resilience-building activities (Table 1).

Table 1.

Levers of Resilience Framework.

Levers of resilience	Description
Wellness	Promoting population health and behavioral health
Access	Ensuring access to high-quality health and social services
Education	Ensuring ongoing information to the public about disasters
Engagement	Promoting participatory decision-making in disasters
Self-sufficiency	Enabling individuals and communities to assume responsibility for their preparedness
Partnership	Developing partnerships with governmental and nongovernmental organizations
Quality	Collecting, analyzing, and using data on building community resilience
Efficiency	Leveraging resources for multiple use and maximum effectiveness

This study operationalizes the Levers of Resilience framework to examine the following research questions:

Research Question 1: What strategies do AAAs use to support older adults’ health and well-being during the COVID-19 pandemic?

Research Question 2: What contextual factors facilitate or limit AAAs’ capacity to support community-dwelling older adults during pandemic response?

Aging Services and COVID-19 in New York State

New York State has 59 AAAs spread throughout every county, New York City, and two tribal reservations. New York AAAs provide a core set of services, including nutrition and home-delivered meals, information and assistance, in-home and community services, and caregiver support services, as well as additional programs tailored to address local service needs (Association on Aging in New York, 2020). New York State was heavily affected by COVID-19 in the early months of the pandemic, although severity varied widely between counties. COVID-19 restrictions reflected a combination of state and local policies that evolved rapidly over the period covered by this study (March–July 2020) and were intended to reflect local risk levels (New York State Governor’s Office, 2020).

Method

This analysis used in-depth semi-structured interviews with representatives of Area Agencies on Aging in New York State. Qualitative interviews allowed for the collection of rich and detailed information from representatives of a diverse sample of AAAs and enabled the researcher to capture the nuances of participants’ experiences and perceptions (Rubin & Rubin, 2012).

Recruitment

All 59 AAAs in New York State were initially contacted by telephone and invited to participate in the study. Thirteen accepted, four refused, and 42 did not respond to the initial invitation. A follow-up invitation was sent by email and by phone to a purposive sample of nonrespondents; follow-up outreach aimed to achieve geographic diversity and a range of organization sizes in the sample and resulted in the recruitment of seven additional AAAs for a total of 20 participants in the final sample. Recruitment efforts ceased when no new themes emerged from interviews and a range geographies and organization sizes were represented (Morse, 2015). Reasons for nonparticipation included failure to respond to recruitment invitations or lack of capacity due to staff reductions and increased workload.

Data Collection

Data were collected in June and July 2020. All interviews were conducted by phone, and interviews lasted between 37 and 70 min with an average duration of 51 min. All but one interview was audio-recorded and professionally transcribed; one interviewee declined to be recorded and detailed notes were taken during the interview for analysis in lieu of transcribed text. This study was approved by the Syracuse University institutional Review Board on May 29, 2020.

After participants provided verbal informed consent, a semi-structured interview guide was used to elicit data (Online Appendix I). The interview guide included open-ended questions inviting participants to describe their organizations’ approach to pandemic response. Sample interview guide questions included the following: “What has your organization’s response to COVID-19 looked like?” and “What challenges has your organization faced during COVID-19?” Participants also provided information on their professional role and their organization’s size and structure.

Data Analysis

A thematic analysis of the data was conducted using Braun and Clarke’s (2006) techniques. The researcher read and reread the data to become familiar with their content and identify relevant concepts and recurring topics for inclusion in the codebook. Data were analyzed using a combined inductive and deductive approach, with codes reflecting both the study’s a priori theoretical framework components (e.g., education/communication, self-sufficiency, partnership) and emergent topics (e.g., volunteers, furloughs/staffing, needs assessment).

The researcher and a research assistant double-coded two transcripts using a preliminary codebook, and a consensus-building approach was used to adjudicate minor discrepancies in code application and modify the codebook as appropriate (Hill et al., 1997; Online Appendix II). Using Atlas.ti version 8 software (Scientific Software Development GmbH, Berlin), the researcher then independently coded the entire data set with the updated codebook. During the coding process, analytic memos were created for each interview and code (Miles & Huberman, 1994). Coded data were then organized into themes and subthemes, resulting in a thematic map reflective of the study’s theoretical framework and demonstrating the relationships between central concepts identified during data analysis (Braun & Clarke, 2006).

Study Rigor

A number of strategies were used to increase study rigor. All interviews were conducted by the same researcher and in the same mode to maximize consistency. The researcher maintained an audit trail of document decisions and changes during data collection, coding, and development of themes. A segment of the data was double-coded to ensure clarity and consistency in code applications. The researcher documented personal perceptions and biases in field notes and revisited these during data analysis in an effort to reduce the influence of unconscious bias on the study’s findings (Morse, 2015).

Sample Description

For this study, 20 interviews were conducted with AAA staff serving in a leadership or program manager position. All demographic characteristics for research participants and their respective organizations appear in Table 2. Seventeen participants served in executive leadership roles. Job titles for participants in program management roles included New York Connects program coordinator, aging services program coordinator, and special projects assistant. One participant was interviewed per organization, representing 19 county AAAs and one tribal AAA. Participants’ time in their current role ranged from less than 1 year to 34 years, with an average of 6 years. The study sample represented diversity in AAA organization size, geography, and severity of COVID-19 impact. AAA staff size ranged from eight to 65, with an average of 24 staff. Participating AAAs were located in eight of New York’s 10 regions. Eleven of the 20 AAAs in the sample served rural counties (rural was defined as a Rural-Urban Continuum Code [RUCC] of 4 or greater). Counties in the sample varied widely in the severity of COVID-19 in their communities, with rates ranging from 62 to over 4,000 confirmed cases per 100,000 persons as of July 1, 2020 (Sun & Monnat, 2020). The average confirmed case rate for counties in the sample was slightly lower than the state as a whole, with 602 for the sample versus 813 (per 100,000 persons) for New York State.

Table 2.

Demographic Characteristics of Participants and Organizations Represented in Sample.

Participant job title (N = 20)
Director/commissioner/administrator	15
Deputy director	2
Program manager	3
Participant time in role (N = 20)
1–4 years	12
5–9 years	5
10+ years	3
AAA County Population (N = 20)
0–49,999	6
50,000–99,999	6
100,000–299,999	5
300,000+	3
AAA County Rurality (N = 20)
RUCC 1–3 (metro)	9
RUCC 4+ (nonmetro)	11
AAA Staff Size (N = 19)
1–14	5
15–30	9
30+	5
Confirmed Case Rate in County as of July 1, 2020 (per 100,000) (N = 20)
0–499	13
500–999	4
1,000+	3

Note. COVID-19 data for New York was accessed through the Lerner Center COVID-19 Tracker for NYS Counties. AAA = Area Agency on Aging; RUCC = Rural-Urban Continuum Code.

Results

AAAs supported a wide range of activities during COVID-19 response. Participants described diverse approaches to service delivery during the pandemic, reflecting differences in AAAs’ geographic and political context and the individual needs and preferences of their service populations. AAA COVID-19 response strategies and challenges as they aligned with the Levers of Resilience concepts of wellness, self-sufficiency, engagement, access, education, partnership, quality, and efficiency are summarized in Table 3 and described below.

Table 3.

AAA Strategies for COVID-19 Response and Challenges Encountered During the Response Period.

Levers of resilience		Challenges
Wellness	• Adapt wellness checks to ensure still keeping tabs on clients with health risks • Maintain socialization programs if possible to reduce social isolation health risks • Conduct tailored outreach to clients with medical conditions increasing their vulnerability (e.g., dementia clients) • Support telehealth and medical transport	• COVID precautions may reduce opportunities for AAA staff to identify or address health issues • AAA COVID restrictions limit older adults’ access to health-promoting services (e.g., fitness programming, Medicare enrollment, elder abuse prevention)
Access	• Modify activities to allow for staff working remotely, minimize risks to clients, and expand services to meet emergent needs • Prioritize maintaining and expanding essential service access over modifying educational/social programming for COVID conditions • Balance trade-offs between COVID-19 exposure risk of in-person services and long-term health and social risks of limiting services	• Minimal advance planning for pandemic response required much on-the-fly planning activity during COVID-19 • AAAs noted a concerning reduction in the use of certain services during COVID-19 (e.g., Medicare enrollment, reports of elder abuse)
Education	• Distribute COVID-specific health and service information through websites, mailings, and by phone • Use trusted messengers to reach older adults with information specific to them • Support county-wide COVID-19 information hotlines	• Transitioning education activities to online format only reaches older adults with access to technology • Face-to-face communication is the best way to reach AAAs’ the most vulnerable clients
Engagement	• Consult senior clubs and advisory councils for input on AAA COVID-19 response • Administer survey to clients to identify preferences for AAA policies • Use staff insights from interactions with clients to identify priorities for AAA activities	• Older adults’ mixed perceptions of COVID-19 risk and support for safety measures may mean older adults’ policy preferences would result in unacceptable COVID-19 risk • AAAs face logistical challenges to engaging older adults to solicit input compared with traditional in-person public input activities
Self-Sufficiency	• Support older adults’ long-term health and independence by providing supportive services prepandemic, reducing risks of health crises during COVID-19 • Support older adults in developing a strategy to maximize use of informal social support or go without nonessential services	• Older adults’ value of self-sufficiency makes some hesitant to reach out to AAA for support even when support is clearly needed • COVID-19 risks and restrictions for public transportation use, grocery shopping, and running errands produced barriers to older adults’ self-sufficiency
Partnership	• Participate in social services organization meetings to coordinate response and information • Obtain guidance from public health to inform response planning • Coordinate with state Office for Aging and other AAAs to discuss policy and planning decisions • Coordinate with contractors to adapt services and protocols	• Differing resources between local service providers made some collaborations challenging • Local elected officials may limit AAA capacity through restricted funding, personnel, and space allocations
Quality	• Use local, state, and federal data sources to identify risk levels and inform policy response • Implement evidence-based interventions to address social isolation	• Insufficient data available for COVID-19 early in the pandemic to inform urgent decision-making around closures and service modifications • Limited data available on efficacy of specific safety protocols for reopening offices and congregate meals
Efficiency	• Waive assessment requirements • Adapt protocols to respond to changing volunteer availability • Modify services to reduce cost (e.g., transition from daily hot meals to weekly frozen meals) • Eliminate nonessential AAA programs when staff capacity is limited	• COVID-related drop in state and local tax revenue caused some furloughs and layoffs of AAA staff • Increasing efficiency of AAA programs may come at the cost of social support available for clients and associated health benefits

Note. AAA = Area Agency on Aging.

Wellness

Participants noted wide variation in older adults’ vulnerability to negative health and social consequences during the COVID-19 response period. AAA staff’s existing knowledge of clients’ health issues and support needs allowed for tailored outreach to older adults to address challenges due to COVID-19 restrictions. AAA staff prioritized outreach to clients with mental health conditions, those with little family support, and clients and caregivers of individuals with dementia.

Several participants described the challenge of navigating trade-offs between minimizing COVID-19 exposure risk and reducing supportive services that offer long-term health benefits for clients. For example, one participant transitioned the home-delivered meal program from daily hot meals to weekly frozen meals to reduce potential COVID-19 exposure for clients. However, as she described,

We’d go to deliver them and we would look in the freezer and there’d be eight or ten meals from the week before. If you have dementia, you don’t remember that you have meals in the freezer. And if they’re not eating, there’s a whole host of other things that can go wrong. And so at the beginning of June, we decided to go back to daily meal delivery. (p. 9)

Participants noted that COVID-19 restrictions presented challenges for accessing health care and health promotion resources, as medical appointments were postponed or transitioned to telemedicine, and health promotion events were either canceled or moved online. Interestingly, participants did not describe observing an increase in clients’ health problems in the early months of the pandemic, although many noted that they anticipated that prolonged COVID-related disruptions would eventually have health consequences.

All participants discussed the concern of older adults experiencing social isolation and lacking in social support due to pandemic response measures limiting traditional social interactions. However, several participants from rural AAAs noted that in rural areas where prepandemic social interaction was infrequent for many older adults, pandemic-related social disruption may be less detrimental. Many discussed older adults seeking social support from AAA staff through brief interactions at drive-through meal pick-ups, mask distribution events, or case management calls.

Self-Sufficiency

Participants felt that AAAs’ provision of external supports such as home-delivered meals or wellness checks benefited the health and well-being for older adults whose self-sufficiency was undermined by COVID-19 restrictions. Several participants also noted that receiving AAA services prepandemic increased older adults’ self-sufficiency during COVID-19 because supportive services put clients in less precarious social and health situations that enabled them to better withstand the stresses of pandemic disruptions. Many participants expressed hope that older adults who enrolled in AAA services during COVID-19 would stay engaged and gain access to services to improve their overall health and self-sufficiency postpandemic. Participants also described self-reliance as a common trait among older adults, especially those in rural areas, that enabled them to tolerate the inconveniences of the pandemic and avoid excessive dependence on AAA services. As one participant described,

A lot of the people here have a tendency to be self-sufficient, especially the people that live on the mountaintop. They’re more pioneer-type stock. So there wasn’t a lot of requests for shopping assistance. (p. 11)

Engagement

Participants described little direct engagement by AAA clients in pandemic response decision-making. AAA directors were the primary decision-makers in COVID-19 policy and planning activities, although many participants described AAA leadership engaging with staff to assess priority issues for clients to ensure decisions aligned with older adults’ unmet needs and priority service demands.

Most AAAs gathered information on priority needs for older adults from staff interactions with current clients and from calls to AAAs’ information and referral service. This information informed AAA prioritization of pandemic response programming options. A few AAAs more directly engaged older adults in decision-making; some organizations consulted their advisory councils (volunteer groups made up of older adults in their service area) and local “senior clubs” (social groups for older adults) to solicit input on how AAAs should adapt activities and expand services to address older adults’ unmet needs. One AAA director disseminated a survey for clients to assess their priorities, policy preferences, and risk tolerance around AAA services prior to inform AAA reopening decision-making. She described,

In their surveys I put a whole list of options we were looking at. “If we said that we couldn’t have any visitors under 55, are you OK with that or is it something, you know, you’re totally uncomfortable with? If we say we can only have 15 seniors for lunch every day, are you OK with that?” . . . then we’ll go back and we’ll look at the ones where they’re not quite OK with it, see if there’s nothing else we can do. (p. 14)

Access

Participants described AAAs devoting significant attention and resources to enabling older adults’ access to key social services in spite of pandemic risks and disruptions. Participants described a wide range of activities involved in AAA service delivery, including the creation of new service offerings, the modification of existing services, expanded service delivery, and cancelation of services (Table 4). All participants reported a significant increase in demand for AAA services due to COVID-19 restrictions. The greatest increase in demand was for home-delivered meals, as older adults’ traditional sources of support with grocery shopping or meal preparation were disrupted by COVID-19 restrictions. Participants also reported increased demand for information and referral, home health aides, wellness checks, and virtual fitness and educational programming.

Table 4.

Activities and Strategies used by AAAs to Modify Service Delivery Approaches During Pandemic Response.

Change in service approach	Activities supported by AAAs during COVID-19 response
Service creation	Creation of wellness call programs to address social isolation
	Purchase, donation coordination, and delivery of hygiene supplies
	Purchase and delivery of groceries
	Coordination or donations and delivery of emergency food
	Coordination of mask distribution events
	Dissemination of animatronic pets to address social isolation
	Creation of senior nutrition hotline
	Purchase and delivery of tablets and provision of tech support
	Creation of directory of available community services and supports for food and medication access
Service modification	Transition of caregiver support groups from in-person to phone format
	Transition of educational and social programming to online format
	Transition to remote benefits counseling and case management (with some availability for socially distanced in-person service)
	Modification of home-delivered meal delivery practices to minimize exposure risk and address increased capacity demands
	Provision of 2-week shelf-stable meal supply to allow for potential 2-week kitchen closure
	Transition of congregate meals to home-delivered meals or take-out meals
	Modification of transportation program availability and seating protocols
	Provision of creative activities, games, and brain stimulation by mail and phone
	Modification of kitchen staffing schedules to accommodate increased demand alongside reduced capacity requirements
	Transition of high-risk volunteers to remote volunteering activities or modified programming to reduce volunteer demand
	Provision of options for counseling to support older adults unable to access in-home support due to aide shortage
	Modification of farmers’ market coupon delivery procedure
	Temporary elimination of assessment requirement for home-delivered meal recipients
Service expansion	Modification of staff responsibilities and recruitment of additional volunteers to address increased home-delivered meal demand
Service expansion	Increase in staff time spent providing informal social support during interactions with clients
Service cancelation	Cancelation of annual summer picnics, health fairs, and social events
	Closure of congregate meal sites and community centers
	Cancelation of in-home service provision and assessments (with exceptions for urgent need)

While a few participants referenced existing disaster plans that informed their approach, AAA leadership made the vast majority of COVID-related decisions and policies in real time, especially in the early weeks of the response period. Several participants expressed a need for more proactive and comprehensive disaster preparedness planning for AAAs. However, all participants emphasized that flexibility was central to AAAs’ capacity to support older adults’ access to necessary services and supports throughout COVID-19 response. Coordinating modified service delivery throughout the response period required significant time and attention from AAA leadership.

Many participants praised AAA staff for their support of rapid and significant changes in AAA functioning. A few noted that the norms of government requiring extensive documentation and cautious decision-making may disincentivize AAAs’ flexibility; they emphasized the importance of a shift in mindset toward a more innovative and fast-paced response during COVID-19 response. As one participant put it,

As director I really emphasize cross-training, and that we are public servants. We’re not a job title . . . In this case, I feel like that expectation was already established and there was no, “that’s not my job.” Everybody jumped right in to do what needed to be done. (p. 12)

Balancing trade-offs to maximize older adults’ overall well-being and provide equitable service access during COVID-19 often resulted in difficult decisions for AAA leadership. AAAs were responsible for weighing competing risks of social isolation and service disruption with that of potential COVID-19 exposure in their approaches to service delivery during pandemic response. A participant described their decision to permit limited in-person case management appointments, explaining,

They’re very high-risk clients. They just need a face-to-face . . . They need people to walk through to finish their paperwork, whether it’s for Social Security or for their insurance, they just need that handholding to get it done. (p. 9)

AAAs also balanced trade-offs between investing staff time into supporting basic needs services (e.g., home-delivered meals and case management) and developing nonessential but valued social and educational programming. Many participants described a priority on essential services in the early months of pandemic response but expressed a desire to focus on social programming in the coming months to address the prolonged disruption to traditional sources of social connection.

Education

AAAs’ COVID-19 communication activities included educational messaging around pandemic risks and protective measures, as well as information and referral to connect older adults with appropriate services and resources. AAA communication topics included public health guidance on hygiene and social distancing, updates on programming changes and service eligibility criteria, information on county-wide and partner organizations’ COVID-19 response activities and closures, educational and entertainment content, health information, scam alerts, and census reminders.

AAAs used a range of strategies to communicate with older adults during COVID-19. Many included printed communications materials with home-delivered meals or with deliveries of masks and hygiene supplies to clients. Nearly all participants discussed AAA newsletters as a vehicle for delivering information to clients during pandemic response. Several participants described AAA directors speaking on local TV or radio about COVID-19 risks and AAA supports. A participant described the value of this communication approach, saying,

You know, she’s the director of the Office for Aging for our county. She understands our population and our area, geographic area, so hearing it from somebody different [from standard media figures] I think was helpful . . . someone in that position and who is an advocate for older adults fulltime. (p. 19)

Several AAAs conducted broad outreach to all adults over a certain age to notify them of AAA services, either by mailing flyers or sending prerecorded phone messages. One AAA obtained a county-wide list of registered voters age 70+ and used the list to conduct phone outreach. Many participants also discussed AAA involvement in staffing county-wide COVID-19 information hotlines.

COVID-19 presented challenges for AAAs’ communications activities that traditionally involved face-to-face interaction. Many participants discussed the limitations of online communication, especially in rural areas where internet availability is often limited. Many participants acknowledged that communication through mail, phone, or online would be less engaging and effective than face-to-face communication, but that the benefits of in-person communication rarely outweighed the risks.

Partnership

AAAs frequently collaborated with partners at the community, county, and state level throughout the pandemic response period (Table 5), and participants described partnerships as key to facilitating coordinated and efficient service delivery.

Table 5.

AAA Partner Organizations and Collaborative Approaches to Service Delivery During Pandemic Response.

Organizational type	Partnership activities
State level
State-Wide Network of Area Agencies on Aging	Sharing policy resources and program materials
State-Wide Network of Area Agencies on Aging	Collaborative decision-making around COVID response strategies
Governor’s Office	Determining population-wide COVID-19 risk at state and regional levels (NY Forward phased reopening system)
	Creating policy related to workplace capacity, size of gatherings, and specific protections for vulnerable populations (Matilda’s Law)
	Providing funding from state budget for state-level and county-level aging services activities
NYSOFA	Determining requirements related to funding use by AAAs (or allowing flexibility in funding use and reducing assessment requirements)
	Providing policy guidance around AAA COVID response and reopening strategies
	Coordination (in collaboration with Association on Aging in New York) of state-wide AAA network
	Providing COVID-related supplies (masks, hand sanitizer, animatronic pets)
	Identifying AAA’s priorities and unmet needs and coordinating resources and supports to enable efficient operations
County level
County Executive/Legislature	Providing county funds to support aging services delivery
	Providing space for AAA activities and supporting modifications needed for COVID-related safety measures
	Disseminating information on AAA programs through connections with county media organizations
	Determining county-level government staffing changes due to risks of in-person office work and furloughs and layoffs due to COVID impact on local budgets
	Providing input or approval for AAA COVID response decision-making
	Coordinating county agencies in COVID response
	Providing centralized information online and through hotlines related to county-level COVID impacts, policy responses, and available services (including AAA services)
Public Health/Health Department	Providing supplies (hand sanitizers, masks) to AAAs Providing input or approval for AAA COVID response decision-making Providing support for AAA COVID-related communications (supporting press releases, providing health communications expertise) AAA supporting public health activities through involvement on public health councils or serving as contact tracers
Non-Health Government Agencies	Providing county staff from non-AAA departments to support wellness calls, deliver home-delivered meals, or address emergent needs to meet increase in demand
	AAA supporting EOC activities and manning COVID response call centers
	AAA supporting proactive testing activities in assisted living facilities
Subcounty level
Hospitals	Supporting AAA and county-wide decisions around COVID response strategies
Academic Institutions	Providing online social, educational, and health-related programming for older adults
Pharmacies and Grocery Stores	Providing delivery options and reserving specific hours for older adults to enable access to groceries, supplies, and prescriptions
Pharmacies and Grocery Stores	Providing up-to-date information on services available to AAA for dissemination to older adults
Senior Centers	Coordinating COVID closures and service changes with AAA and communicating up-to-date information on services available to AAA for dissemination to older adults
Senior Centers	Coordinating plans and activities to support older adults’ social connection in response to prolonged disruption to traditional social supports
AAA contractors	Coordinating COVID closures, expanded service demands, health and safety practices, and regulatory and funding requirements with AAA
Senior clubs and social groups	Providing input on older adults’ priority needs and interests to support AAA approach to COVID service delivery modifications
Local government and community-based human services organizations	Coordinating services to support emergent needs for older adults (emergency food supplies, volunteer support, social services, etc.) Coordinating up-to-date information on community-wide services and supports
	AAA supporting meal delivery for quarantined public housing residents

Note. NYSOFA = New York State Office for the Aging; AAA = Area Agency on Aging; EOC = emergency operations center.

Participants stressed the value of knowledge-sharing between the state’s network of AAAs in informing and supporting their organization’s activities during COVID-19. Participants described adapting plans and protocols from other AAAs, collectively brainstorming strategies for service modifications, and sharing experiences and lessons learned between directors as extremely helpful supports during pandemic response.

State-level support for AAAs from the New York State Office for the Aging (NYSOFA) was also viewed positively by participants. NYSOFA leadership was seen as responsive to AAA needs and committed to the mission of serving older adults. As one participant said,

Our state Office for Aging, along with the director of the state association, they have been phenomenal. Like weekly phone calls, and they’re doing food surveys, so they ask on a regular basis: where we are for capacity? Do we have the food we need? Do we have the volunteers we need? What do we need? And if there’s any unmet need there, they are working to fill them. (p. 6)

At the local level, AAAs described frequent collaborations with local government agencies and community-based organizations. Public health departments frequently provided insight and support for AAA decision-making. One participant described the value of working with public health during the response period, saying,

[Public health supported] every decision I made, like to close the congregate sites. And when I decide to reopen them, I’m working with our public health director to get advice from her . . . She’s the nurse. That’s her job. She’s a public health director, so it’s good to have that relationship and coordination. (p. 1)

Frequent communication with human services agencies and community organizations allowed AAAs to provide older adults with accurate information of available services such as delivery options for groceries and prescription medications. AAAs that contracted out services described unprecedented levels of communication and coordination with contractors to coordinate expanded services, modified safety protocols, and changes to staffing and volunteer supports.

Federal, state, and local funding and policy support strongly influenced AAA capacity during pandemic response. Many participants expressed appreciation for federal CARES Act funds supporting AAA pandemic activities, although several participants also expressed concern that a lack of federal stimulus to address state and local budget shortfalls would negatively impact AAA operations. Participants broadly expressed support for the governor’s pandemic response activities and funding decisions. At the county level, some participants described considerable support and leadership from elected officials, whereas others described a lack of administrative and financial support as detrimental to their pandemic response capacity.

Quality

Data-driven decision-making was identified as a priority by several participants, both as a holistic approach for AAA management and as an especially critical approach to pandemic response activities. Participants described making use of multiple sources of data during pandemic response, including COVID-19 surveillance data, state and Centers for Disease Control and Prevention (CDC) guidance on evidence-based measures to prevent exposure for staff and clients, and academic research on effective interventions to reduce social isolation.

However, participants acknowledged the unique challenges of COVID-19 response presenting barriers to purely data-driven decision-making. Given the unprecedented nature of the pandemic’s disruption and the lack of complete understanding of the virus, AAAs were often required to make decisions under conditions of uncertainty. Many participants felt extreme caution around exposure risks was warranted given older adults’ heightened risk, motivating total closure and cancelation of most in-person AAA services.

While many participants expressed interest in allowing some return to in-person services, they wrestled with the lack of clear data-driven guidance on safe approaches to in-person service delivery. As one participant said,

What we’re finding out is that because everything is new, and they’re still investigating and researching and like there is no decision. There’s no way to make one that you can say 100 percent sure it’s the right one. So we’re doing what know to do right now, which is no face to face, no touch, maintaining the distance. The things that we know works. (p. 14)

One participant expressed interest in seeing demonstrated effectiveness of protective measures in office settings before allowing in-person visits in her own office. Participants also expressed frustration with recommended protocols for reopening congregate dining sites that they saw as unfeasible with limited resources and misaligned with their clients’ needs. As one participant described,

They want the people to be six feet apart. Everybody has to wear a mask when they get out of their seat. Everything has to be thrown out . . . the amount of preparation for something like this, and then some sites, it’s never going to work, because they’re too small, it’s just unfeasible. (p. 8)

Efficiency

Given limited funds and widespread demand for services under normal circumstances, AAAs use a standardized assessment process to identify individuals in greatest need to prioritize for AAA services. Many participants also described a strong volunteer base as essential to allowing AAAs to meet service demands in spite of budgetary constraints. However, COVID-19 presented multiple challenges for AAAs’ traditional approaches to efficient budgetary management.

Participants described the challenge of meeting the increased demand for AAA services due to COVID-19 restrictions while operating at reduced staff capacity and navigating the logistical barriers of conducting assessments for new clients. AAA leadership chose to prioritize scaling up service delivery over screening for eligibility. This decision to expand services was enabled by increased flexibility authorized by NYSOFA. Many participants emphasized the positive impact of NYSOFA’s decision to pause assessment requirements and allow AAAs to provide services without demonstrating how they would be paid for, which enabled them to fully address community needs in a crisis situation.

AAAs also faced a reduced volunteer pool during COVID-19 because many AAA volunteers were themselves older adults and were prevented by state-wide COVID regulations from participating in in-person volunteering activities. Additional volunteers were recruited when possible; many AAAs required volunteer background checks, and participants noted that teachers and other furloughed government employees were ideal volunteers because they could begin volunteering immediately.

Given county-level budget shortfalls due to significant revenue losses during the pandemic, many participants described temporary or permanent staff reductions due to furloughs, layoffs, retirement incentives, and hiring freezes. With more limited staff, AAAs responded to ongoing service demand by increasing the number and type of responsibilities for the remaining staff or by eliminating activities that would exceed staff capacity. Many AAAs saw these strategies as necessary responses to the realities of the budgetary situation, but ultimately counterproductive to the efficiency of the AAA’s work. A participant described deciding against using volunteers for COVID-19 response activities, saying,

Everybody kept saying to me, “Well, why don’t you get volunteers to do that?” And I kept thinking to myself, my staff’s doing everything they can just to do their jobs from home, to reach seniors. And I’m doing everything I can to keep up. I don’t have someone that can find volunteers, train them, get them background-checked, get them trained on what we need them to do. It’s easier to just work 12 hours and do it yourself. (p. 1)

Another participant explained that as director, she was replacing batteries for clients’ emergency response systems herself as the person responsible for the program had been furloughed. She noted that the county’s decision to furlough her staff both decreased her efficiency as director and produced minimal savings for county budgets as funding for furloughed positions came from state and federal grants.

Discussion

This qualitative study shows that AAAs play an active role in supporting community-dwelling older adults’ diverse needs during pandemic response. Study findings show a clear alignment between AAAs’ COVID-19 response activities and the Levers of Resilience framework (Chandra et al., 2011), supporting the growing understanding of the central role of local social service organizations like AAAs in reducing the public health impact of disasters for vulnerable populations (Wulff et al., 2015). Results suggest that AAAs support older adults’ health and well-being during COVID-19 by providing health promotion activities, increasing social service access, supporting health education and risk communication, and leveraging partnerships to support older adults’ diverse support needs.

Collaborating with a range of partner organizations was central to AAAs’ ability to access critical resources and advocate for older adults’ unique needs during COVID-19 response. This aligns with Elman et al.’s (2020) findings that collaboration is key in supporting vulnerable populations during COVID-19. In the future, AAA leadership should be included in multidisciplinary disaster planning groups to ensure that older adults’ needs are considered in plans for diverse disaster situations and to allow AAAs to proactively identify opportunities for collaboration during disaster response.

Study findings suggest a need for funding and policy support to ensure that AAAs are fully equipped to provide adequate services for community-dwelling older adults during pandemics and other disasters. Specifically, financial support and technical guidance are needed to enable AAA leadership to devote time and resources to the proactive development of disaster preparedness, response, and recovery policies and programs. For example, funding could support disaster preparedness planning workshops for AAA leadership or training in first aid and other relevant disaster response skills for AAA staff. Funding could also support the development of model disaster preparedness, response, and recovery protocols and communications materials for specific disaster scenarios that AAAs could tailor to their specific organization’s needs, reducing the demand on individual AAAs to develop disaster-related materials from scratch. Given the combined challenges of reductions in government revenue and increased demand for services among high-risk populations during pandemics and other disasters, maintaining or expanding funding support and reducing administrative requirements for AAAs during disaster response are necessary to avoid undermining the availability and quality of aging services at a time when they are most critical.

Limitations

As the primary goal of this qualitative study is to provide well-grounded and rich description rather than population-wide generalizable knowledge, these findings should not be seen as representative of experiences of AAAs nation-wide during the COVID-19 response. This study was conducted in a state that was heavily affected by COVID-19 and with a unique state policy context and AAA structure, as New York’s county-level AAA structure is not typical (N4A, 2020b). Future research should examine the impact of state policy environment and service area size on AAA COVID-19 response in greater depth. Respondents volunteered to participate in the study, and results may not represent the perspectives of the most severely affected AAAs, as organizations with severe COVID-19 impacts in their service areas and reduced staffing due to furloughs and layoffs had less capacity to participate in an interview. Although a segment of the data was co-coded to ensure clarity and consistency in coding decisions, all transcripts were ultimately coded by a single researcher, introducing potential unconscious bias in the analysis. This research also presents data reflecting AAA experiences navigating the first 4 months of pandemic response. Given COVID-19’s prolonged response and recovery timeframe, further study of AAA activities throughout the response period is needed.

Conclusion

New York AAAs dramatically expanded service capacity and developed new service offerings during COVID-19 response to address emergent needs among community-dwelling older adults. AAAs strategically identified and responded to community need, balancing trade-offs between competing risks throughout pandemic response. Policy support is needed to equip AAAs to participate fully in pandemic response and to continue to identify and address unmet service needs among older adults. Further research is needed to support the development of feasible and evidence-based guidance to inform AAA response to pandemics and other disasters.

Supplemental Material

sj-pdf-1-jag-10.1177_0733464821991026 – Supplemental material for “There Was No ‘That’s Not My Job’”: New York Area Agencies on Aging Approaches to Supporting Older Adults During the COVID-19 Pandemic

Supplemental material, sj-pdf-1-jag-10.1177_0733464821991026 for “There Was No ‘That’s Not My Job’”: New York Area Agencies on Aging Approaches to Supporting Older Adults During the COVID-19 Pandemic by Claire Pendergrast in Journal of Applied Gerontology

Supplemental Material

sj-pdf-2-jag-10.1177_0733464821991026 – Supplemental material for “There Was No ‘That’s Not My Job’”: New York Area Agencies on Aging Approaches to Supporting Older Adults During the COVID-19 Pandemic

Supplemental material, sj-pdf-2-jag-10.1177_0733464821991026 for “There Was No ‘That’s Not My Job’”: New York Area Agencies on Aging Approaches to Supporting Older Adults During the COVID-19 Pandemic by Claire Pendergrast in Journal of Applied Gerontology

Footnotes

Acknowledgements

The author wishes to thank the AAA staff who generously shared their time and insights for this study. The author also thanks Dr. Shannon Monnat, Dalton Stevens, Kori VanDerGeest, and Katie Williamson for their assistance with study logistics, interview guide development, analysis, and manuscript review.

Author’s Note

This research was granted Institutional Review Board approval (IRB No. 19-348) by the Syracuse University Office of Research Integrity and Protections on May 29, 2020.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by a Syracuse University Maxwell School Roscoe Martin Dissertation Grant.

ORCID iD

Claire Pendergrast

Supplemental Material

Supplemental material for this article is available online.

References

Association on Aging in New York. (2020). Core services provided through area agencies on aging. https://www.agingny.org/aging-services.html

Berg-Weger

Morely

(2020). Loneliness and social isolation in older adults during the COVID-19 pandemic: Implications for gerontological social work. Journal of Nutrition, Health and Aging, 24(5). https://link-springer-com-443.web.bisu.edu.cn/content/pdf/10.1007/s12603-020-1366-8.pdf

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Chandra

Acosta

Howard

Uscher-Pines

Williams

Yeung

Garnett

Meredith

L. S.

(2011). Building community resilience to disasters. Rand Health Quarterly, 1(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945213/

Cohen

E. S.

Poulshock

S. W.

(1977). Societal response to mass dislocation of the elderly implications for area agencies on aging. The Gerontologist, 17(3), 262–268. https://doi.org/10.1093/geront/17.3.262

Cohen

M. A.

Tavares

(2020). Who are the most at-risk older adults in the COVID-19 era? It’s not just those in nursing homes. Journal of Aging & Social Policy, 32(4–5), 380–386. https://doi.org/10.1080/08959420.2020.1764310

Colello

Napili

(2020). Older Americans act: Overview and funding. https://crsreports.congress.gov/product/pdf/R/R43414

Elman

Breckman

Clark

Gottesman

Rachmuth

Reiff

Callahan

Russell

L. A.

Curtis

Solomon

Lok

Sirey

J. A.

Lachs

M. S.

Czaja

Pillemer

Rosen

(2020). Effects of the COVID-19 outbreak on elder mistreatment and response in New York City: Initial lessons. Journal of Applied Gerontology, 39(7), 690–699. https://doi.org/10.1177/0733464820924853

Gibson

M. J.

Hayunga

(2006). We can do better: Lessons learned for protecting older persons in disasters. AARP Public Policy Institute.

10.

Hill

C. E.

Thompson

B. J.

Williams

E. N.

(1997). A guide to conducting consensual qualitative research. The Counseling Psychologist, 25(4), 517–572. https://doi.org/10.1177/0011000097254001

11.

Hoffman

G. J.

Webster

N. J.

Bynum

J. P. W.

(2020). A framework for aging-friendly services and supports in the age of COVID-19. Journal of Aging & Social Policy, 32(4-5), 450-459. https://doi.org/10.1080/08959420.2020.1771239

12.

Landry

M. D.

Van den Bergh

Hjelle

K. M.

Jalovcic

Tuntland

H. K.

(2020). Betrayal of trust? The impact of the COVID-19 global pandemic on older persons. Journal of Applied Gerontology, 39(7), 687–689. https://doi.org/10.1177/0733464820924131

13.

Lee

Y. J.

(2020). The impact of the COVID-19 pandemic on vulnerable older adults in the United States. Journal of Gerontological Social Work, 63(6-7), 559-564. https://doi.org/10.1080/01634372.2020.1777240

14.

Miles

M. B.

Huberman

M. A.

(1994). Qualitative data analysis: An expanded sourcebook. Sage.

15.

Morse

J. M.

(2015). Critical analysis of strategies for determining rigor in qualitative inquiry. Qualitative Health Research, 25(9), 1212–1222. https://doi.org/10.1177/1049732315588501

16.

National Association of Area Agencies on Aging. (2020a). #AAAsAtWork for older adults: A snapshot of area agency on aging responses to COVID-19. https://www.n4a.org/covid19report

17.

National Association of Area Agencies on Aging. (2020b). 2020 AAA National Survey Report. https://www.n4a.org/blog_home.asp?Display=951

18.

New York State Governor’s Office. (2020). NY forward: A guide to reopening New York & building back better. https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/NYForwardReopeningGuide.pdf

19.

Pendergrast

Belza

Bostrom

Errett

(2020). Examining the role of ageing-in-place organisations in building older adults’ disaster resilience. Ageing & Society. Advance online publication. https://doi.org/10.1017/s0144686x20000653

20.

Rubin

H. J.

Rubin

I. S.

(2012). Qualitative interviewing: The art of hearing data (3rd ed.). Sage.

21.

Shih

Acosta

Chen

Carbone

Xenakis

Adamson

Chandra

(2018). Improving disaster resilience among older adults: Insights from public health departments and aging-in-place efforts. RAND Health, 8(1), Article 3. https://doi.org/10.7249/rr2313

22.

Straker

J. K.

Lackmeyer

A. E.

Kunkel

S. R.

Markwood

(2009). Emergency readiness and response: Area agencies on aging survey. Miami University.

23.

Sun

Monnat

S. M.

(2020). COVID-19 tracker for NYS counties: Syracuse University Lerner Center for Public Health Promotion. https://lernercenter.syr.edu/

24.

Wilson

T. L.

Scala-Foley

Kunkel

S. R.

Brewster

A. L.

(2020). Fast-track innovation: Area agencies on aging respond to the COVID-19 pandemic. Journal of Aging & Social Policy, 32(4-5), 432-438. https://doi.org/10.1080/08959420.2020.1774313

25.

Wulff

Donato

Lurie

(2015). What is health resilience and how can we build it? Annual Review of Public Health, 36(1), 361–374. https://doi.org/10.1146/annurev-publhealth-031914-122829

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