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Tip Sheets

Resources for reporting the impact of COVID-19 on older adults

By Liz Seegert

We know that older adults and those with serious underlying medical conditions are among the most susceptible to complications from COVID-19, the disease caused by the novel coronavirus. The Centers for Disease Control and Prevention and the World Health Organization have issued warnings to those in the 60-plus demographic to take special care to minimize their risk of contracting this disease. Many of those who have died lived in a Seattle-area nursing home

There are plenty of story angles and resources for reporters to tackle as cases continue to climb.  

As I wrote in this story for Next Avenue, the CDC has updated its risk management guidelines for all facilities. The American Health Care Association, which represents 13,500 long term care facilities, now recommends no social visits to nursing homes. CDC estimates about 4 million people are admitted to or reside in long-term care facilities and another one million live in assisted living residences. As several media outlets already have reported, many facilities struggle with infection control procedures.

During President Trump’s March 11 Oval Office briefing on the virus, he stressed, “The highest risk is for elderly populations, with underlying health conditions. The elderly population must be very, very careful. In particular, we are strongly advising that nursing homes for the elderly suspend all medically unnecessary visits. In general, older Americans should avoid non-essential travel and crowded areas.”

The majority of the 52 million Americans age 65 or older live in community settings. About one in four of those age 60 and older live alone, according to Pew Research. They are more vulnerable to issues of social isolation and loneliness, which can lead to depression, exacerbate existing health conditions and worsen cognitive decline. Even so, former FDA Commissioner Scott Gottlieb told The Washington Post that “everyone over 60 should become a hermit for a month.”

“Starting at 60, there is an increased risk of death, and the highest risk of severe illness is in people older than 80, and especially in people who are older who have serious chronic medical conditions like heart disease, diabetes and lung disease,” said Nancy Messonnier, M.D., director of the CDC’s National Center for Immunization and Respiratory Diseases, during a March 10 AARP webinar

“It is those individuals, we think, who are at greatest risk and those individuals who we are asking to take special precautions,” Messonnier said. The briefing also featured Admiral Brett Giroir, M.D., HHS assistant secretary for health, and Seema Verma, administrator for the Centers for Medicare & Medicaid Services.

Among the suggestions:

  • Avoid congregant settings

  • Stay at home, or close to home

  • Have extra supplies of routine prescriptions on hand, especially for conditions like hypertension and diabetes, as well as medical supplies and over-the-counter medications; Messonnier subsequently clarified that she wasn’t encouraging “stockpiling,” but rather keeping a several weeks’ additional supply on hand. 

    • Although insurers often only allow a 30-day supply at a time, older adults should call their insurance company for a waiver 

  • Defer travel on cruise ships or long plane rides

  • Keep food, medical supplies, other necessities on hand to minimize trips to the store.

  • Leave the masks for those at highest risk and for health care workers. Most people don’t need them.

  • Family caregivers need to have a plan if they get sick or if their loved one gets ill. They should identify backups to care for older loved ones if they can't.

  • Verma said any older adult can get a coronavirus test, if warranted, with no cost-sharing. All insurers, including Medicare, Medicaid and private plans, will pay for the test. She also encouraged beneficiaries to use telehealth services (now covered under Medicare) to avoid potentially unnecessary visits to a physician’s office or emergency room. 

    • Note that as of this writing, there’s a significant shortage of test kits. If someone is hospitalized, remember that traditional Medicare has deductibles (which may or may not be covered under a Medigap policy). Also, private MA plans may have high deductibles or other cost-sharing requirements.

Some story ideas to get you going

  • Cost: Many older adults live on fixed incomes. It is often difficult, if not impossible, to keep extra groceries or supplies on hand. How is your community responding to this need?

  • Medication: Are older adults having difficulty getting recommended extra prescriptions?

    • Are pharmacies running short on certain medications? 

    • Have shipments of drugs or ingredients from China been delayed or canceled? How is this affecting the supply chain?

  • Elective procedures: Are hospitals postponing some elective surgeries such as knee or hip replacements? 

    • Is it advisable to delay such procedures? 

    • During the telebriefing, Giroir mentioned there have been severe shortages of blood in the Seattle area, which has been particularly affected by the pandemic. Is that happening in hospitals in other hard-hit areas? 

  • Staffing: Do nursing home/assisted living workers at local facilities have paid sick leave?

    • What are administrators doing to encourage potentially exposed/ill workers to remain at home? 

    • Is there enough backup staff to care for residents? (Check out Jordan Rau’s excellent article on issues with infection control in nursing homes)  

    • Are hospitals adequately staffed? 

    • Are any physicians or nurse practitioners making house calls rather than having patients travel to an office?

  • Nursing homes/assisted living facilities: What risk management and infection control procedures are in place? 

    • What training are staff and per diem workers receiving? 

    • Is there a “no visitor” policy in place? 

    • How are residents and family members coping with increased isolation

      • Are they helping residents set up Facetime or Skype chats with loved ones?

    • Are facilities closing to the public or refusing to admit new patients?

  • Home care: More than 12 million older adults receive care in the home, according to the National Association of Home Care and Hospice. How are local home care agencies coping with potential increased demand, and how are they ensuring their workers use proper risk management procedures?

  • Community-dwelling older adults: What, if any, special steps should caregivers of people with Alzheimer’s or other dementias take? 

    • What community resources are available for caregivers in the event of self-quarantine or if someone they’re caring for exhibits COVID-19 symptoms? 

    • What role(s) are public health nurses and nurse practitioners taking, especially in rural areas, to assess older adults and ensure they have enough medicine? 

    • Have senior centers closed? 

      • Many older adults rely on them for a hot meal and social interaction. How is this being addressed? 

    • What arrangements are in place for those seniors who must rely on public transportation to medical appointments? 

      • Are experts in your community advising them to skip non-essential visits? 

      • Have ride-sharing services stepped up to fill in the gaps?

  • Supplies: We know there’s been a run on everything from hand sanitizer to toilet paper in some areas. Do facilities like nursing homes have adequate cleaning and disinfecting supplies?

    • How about basics like gowns and masks? 

    • Are they making do without? 

    • How much at risk does that put residents? 

  • Social isolation: How are older adults coping if they are avoiding settings like senior centers or religious institutions? 

    • Some churches are starting to offer virtual services. What’s going on in your community?

  • Immigrants: How is this virus affecting older immigrants? Are they and their families getting the necessary information? In particular, has there been any backlash against older Chinese-Americans? 

  • Deaths: It may sound morbid, but is the funeral industry prepared for a potential wave of coronavirus-related deaths? Talk to some professionals in your community. 

Resources

Experts

  • UCLA Fielding School of Public Health has several faculty experts who can speak to specific concerns of older adults. Contact Brad Smith, senior public relations officer, at bssmith@support.ucla.edu, 310-825-0148 (office) or 424-832-6408.

  • Eileen Crimmins, associate dean, USC Leonard Davis School of Gerontology, USC Andrus Gerontology Center. Contact Orli Belman, chief communications officer, at obelman@usc.edu or 213-821-9852.

  • XinQi Dong, M.D., M.P.H., director, Rutgers Institute for Health, Health Care Policy and Aging Research; can discuss specifics around older immigrants. Contact Jenny Wagner Noonan, sr. editor/media specialist, at jnoonan@ifh.rutgers.edu or 848-932-6636.

  • Michael T. Osterholm, Ph.D., M.P.H., director, Center for Infectious Disease Research and Policy, University of Minnesota. Contact Bradley Robideau at brobidea@umn.edu or 612-625-8431.

  • Michael Fischer, M.D., M.P.H., has worked for the Texas Department of State Health Services (DSHS) for over six years in the Infectious Disease Control Unit (IDCU); also served as a medical epidemiologist, during outbreaks involving high- consequence pathogens. Contact at Michael.Fisher@dshs.texas.gov or 512-776-7676.

  • Lewis A. Lipsitz, M.D. chief of gerontology, Beth Israel Deaconess Medical Center and associate director, Claude D. Pepper Older Americans Independence Center; professor of medicine, Harvard Medical School. Contact Beth Israel, media relations representative, at 617-667-7300.

  • Elsa S. Strotmeyer, Ph.D., M.P.H., University of Pittsburgh School of Public Health; associate professor in the Department of Epidemiology and a Co-Director of the NIA T32 Epidemiology of Aging Training Grant. Contact at strotmeyere@edc.pitt.edu or 412-383-1293.

  • Charles Maddow, M.D., director, Emergency Geriatrics, Texas Medical Center/Memorial Herrmann Hospital, Houston. Contact via media relations at tmcmedia@tmc.edu or 713-791-8803.

  • Amy Kind, M.D., Ph.D., associate professor at the UW School of Medicine and Public Health, founding director of the UW Department of Medicine Health Services and Care Research Program and director of the Madison VA Dementia and Cognitive Care Clinic, Contact at ajk@medicine.wisc.edu or (608) 265-0852.

Please email me if you have more resources or additional ideas to add to this list. For additional reporting resources when covering COVID-19, check out AHCJ’s Infectious Diseases Core Topic page.