Tomorrow, communities around the world will take a stand for the rights and dignity of older adults when we mark World Elder Abuse Awareness Day (WEAAD). This year, WEAAD comes at a time when COVID-19 vaccines are giving communities some much-needed hope for the future.
As part of ACL’s commemoration of WEADD, Deputy Assistant Secretary for Aging Edwin Walker recently spoke with Alaska Long-Term Care Ombudsman Stephanie Wheeler and Alaska Adult Protective Services (APS) Program Manager Sandra Jenkins about the experiences of Alaska’s older adults during the pandemic, how each of their programs adapted to serve Alaskans, and what the two leaders have learned about reaching Alaskan Native and remote communities.
State APS programs investigate reports of abuse, neglect, and exploitation of older adults and people with disabilities, provide support and case-management, and connect people facing abuse to a variety of protective, emergency, and support services. Ombudsman programs work to resolve problems affecting the health, safety, welfare, and rights or residents living in nursing homes, board and care and assisted living facilities, and other residential care communities. This blog and the video clips in the links below capture their revealing conversation and shed light on issues important to everyone in the aging network.
Walker began the conversation by sharing that he often heard residents of long-term care facilities say, "I feel like I'm in prison," a sentiment Wheeler found all too familiar.
In March of this year, when many around the country were talking about "pandemic fatigue" and trying to "move on," the Ombudsman program resumed in-person visits and found that residents really wanted to talk about their pandemic experience.
"They're not past this because they haven't had the opportunity to talk about their experience," Wheeler said, adding that many felt trapped. She believes that the lack of human interaction during the pandemic has been “really devastating for residents."
Wheeler recalled a resident who loves to wear her hair in a particular style of braids and had not had her hair washed, conditioned, or braided in six months because staff didn't know how to do her hair. After hearing from a family member, the Ombudsman program set up a FaceTime call with staff at the facility so a family member could walk them through the process.
Wheeler also discussed the emotional toll of losing so many fellow residents to COVID-19 and feelings of guilt from residents who survived when their friends did not.
In addition to concerns around isolation, Jenkins said that older Alaskans living in the community often struggled to keep or find caregivers. Older adults and adults with disabilities had to decide what to do if a family member had to quarantine due to exposure to COVID-19 or an in-home service provider didn't have access to personal protective equipment.
(Watch: Wheeler and Jenkins discuss the experiences of older adults during the pandemic.)
The pandemic required the programs to rapidly change their models while meeting new and increased needs.
Jenkins explained one adapted approach: "if we had COVID, we could take it into the home and really do damage to the individuals in that home," so the APS program used flexibilities provided to conduct investigations virtually and through phone calls. The Ombudsman program also replaced in-person visits with virtual communication and hosted virtual town halls and information sessions to talk to residents about topics including stimulus payments, using assistive technology to stay connected, and voting in the 2020 election.
In response to the pandemic, the federal government provided additional funding for Ombudsman programs and for the first time awarded formula grants to every state and territorial APS program in the country. The impact of these federal investments was felt on the ground in Alaska.
Jenkins said the increased funding will help APS address immediate needs in the community, including purchasing PPE for caregivers and funding short-term assisted living stays for adults whose caregiving arrangements had been disrupted by the pandemic. According to Wheeler, the funding is helping the Ombudsman program "play catch-up" after being unable to do in-person visits for a year. Since March, the Ombudsman program has visited over 100 long-term care facilities. The funding also helped both programs adjust to the demands of the pandemic by supporting protective equipment for staff and volunteers, providing access to technology to enable remote work, and allow for the hiring of additional temporary full-time APS staff members to conduct phone check-ins with older adults and adults with disabilities.
"Alaska is not just a big state, it is a huge state," Walker noted as he reflected on a site visit he made to villages in the state. The visit gave him "a new definition of remote.” Jenkins and Wheeler both pointed to respect and long-term relationships as two keys to reaching and supporting Alaska’s older adults in native and tribal communities.
"The first thing our state has done is respect the villages," Jenkins said. "When they want to shut down and say 'no one comes in,' then we respect that."
Both programs have also worked to develop culturally-responsive resources and training in different languages. Wheeler said that technology (including virtual talking circles) helped residents stay connected. Traditional music and outdoor activities like fishing helped elders maintain intergenerational bonds.
The other reoccurring theme was the importance of practices and relationships that predate the pandemic. For example, having the same APS investigator consistently serve a community allowed that person to develop strong relationships within the community and better gauge the community's needs during the pandemic.
Practices that the programs have long used to reach remote and rural villages that are difficult to travel to in the winter also proved useful during the pandemic. For example, APS has used designees, generally from within the community, to act as "eyes and ears" for APS and help start investigations in remote communities. This approach was successfully employed during the pandemic when COVID-related lack of access was the issue. And both the APS and the Ombudsman programs have used virtual communication tools for years to reach more remote communities.
"We've learned so much from our remote and rural communities," Wheeler said.
As a result of these relationships and practices, Jenkins said that rural and remote villages "didn't see much of a change in our behavior" during the pandemic. They just kept “doing what we were doing." She believes this consistency signals to villages that APS is committed to keeping adults safe during good times and bad times alike.
(Watch: Jenkins and Wheeler discuss outreach to Alaska Native and remote communities.)
Similarly, Jenkins and Wheeler said that having long-standing relationships between the two programs, as well as with other state agencies, proved pivotal during the pandemic.
"I think Stephanie and I are kind of just stepping out there and saying, “we're going to forge this alliance and be one … for this community," Jenkins said. "If we show our greater force together, then we can get other individuals and state agencies to join us and we become stronger."
Reflecting on the last year and a half, Jenkins and Wheeler are impressed by their staff and the volunteers who have worked throughout the pandemic, as well as the many relationships and partnerships, at every level, that have allowed the state to serve older adults and adults with disabilities without interruption. Jenkins points to a vaccination partnership between the state and tribes as an example of a notable success.
At the same time, both leaders are committed to critically examining, and learning from, what worked and what did not work.
“We can only grow from there,” Jenkins said. “We’re up for the challenge.”