Tim Lash on the Challenges of Administering the COVID-19 Vaccine to Older Adults

In this podcast, Tim Lash talks about overcoming the challenges of administering the COVID-19 vaccine to older adults, including access to technology, creating a "senior-friendly" vaccination site, and reaching seniors who are homebound. 

Additional Resource:

• What older adults need to know about COVID-19 vaccines. Centers for Disease Control and Prevention. Updated March 13, 2021. Accessed March 25, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/older-adults.html

Timothy A. Lash, MBA, is chief strategy officer and executive vice president at West Health, president of the West Health Policy Center, and chief executive officer of Gary and Mary West PACE. 

TRANSCRIPTION: 

Jessica Bard: Hello, everyone. Welcome to another installment of "Podcast 360," your go‑to resource for medical news and clinical updates. I'm your moderator, Jessica Bard, with Consultant360 Specialty Network.

According to the CDC, the risk of severe illness from COVID‑19 increases with age. It's recommended that adults aged 65 and older are the first to receive the vaccine, but there are some major challenges reaching that population.

Tim Lash is here to speak with us about that today. Tim is the chief strategy officer at West Health and the chief executive officer of Gary and Mary West PACE. Thank you for joining us today, Tim.

West PACE launched a seniors‑only vaccination site at its facility for vulnerable seniors. To better understand what you're doing, give us some background on Gary Mary West PACE and how the pandemic has affected operations.

Tim Lash: Jessica, great to be here. PACE is the program for all‑inclusive care for the elderly. It provides comprehensive medical and social services to senior population that is quite frail and that would otherwise be in a skilled nursing environment.

Jessica: You bring vaccinations to older adults in this community. Can you tell us a little bit about how you rolled that out?

Tim: Sure. The vaccination program followed the broader response that PACE had to advance to meet the needs of these frail, older adults in the context of the pandemic. When we take a macro look at healthcare, there's no doubt that COVID‑19 and our ability to respond to it exposed many fractures, flaws at a system level, particularly failures that specifically relate to seniors.

Not all seniors have the same level of medical needs. There are some groups of seniors ‑‑ those that qualify for PACE ‑‑ that really require much more hands‑on and comprehensive approach to their need. That's why PACE programs exist.

Even programs like PACE that are designed to really be agile and to meet the comprehensive needs of a senior experienced challenges in the very beginning of the pandemic. Healthcare is generally based in a physical setting. PACE, historically, was based in a physical day center and medical clinic and that had evolved very quickly.

Jessica: You mentioned some things that COVID‑19 really exposed when it comes to healthcare and treating older adults. Can you go into a little bit more in‑depth about some of those examples?

Tim: The first, it just relates to the ability to project care into the community. When the pandemic hit, healthcare largely shut down except for acute needs. Seniors that have ongoing medical conditions, comorbidities that need to be addressed, really had challenges in accessing the care that they needed.

One of the first things that we did at PACE was look at our staffing to ensure that we had the staff and the protocols to keep the staff safe but that we had the staff that was willing and able to go into the community, to go into the home, and deliver necessary services.

We also moved very quickly from a center‑based model to a model that really relied on telehealth for us to maintain a continuity of the relationship between our participants and the center, as well as access specialty care when needed. That was successful for our population.

If you look more broadly at the response across the healthcare system ‑‑ organizations like accountable care organizations or other models that are risk‑based who had already made investments to be able to maintain that continuity of care that had the telehealth, that were already advancing value‑based models ‑‑ they fared much better in terms of their ability to provide the necessary care to the community.

Vis‑‡‑vis, more fee for service‑based health systems that weren't necessarily incentivized before COVID to have that infrastructure in place.

Jessica: Going back to talking about the vaccines, what are the challenges in vaccinating older adults, for example, has access to vaccines in an issue for older adults?

Tim:  The rollout of the vaccines, while getting better, is still complicated. One of the things that we did for PACE very early on is that we made the decision that we would go at risk to have all of the equipment in place so that we could be a certified vaccination site.

This would allow us, rather than need to try to schedule city or county‑based appointments for this frail population, that we would take possession of the vaccine ourselves and leverage our transportation system and our medical clinic to be able to deliver the vaccines to our participants in a very safe way.

We quickly realized that the need for that higher‑touch model was not restricted just to our population.

Many seniors in the community, it's challenging for them to gain access to appointments either because they simply weren't available, or they didn't know where to look, or even more often, because of the digital divide. They just didn't have access to Internet or computers to be able to schedule them.

We partnered with a local agency after we vaccinated our staff at 211 system which is accounting information online to stand up a community‑based pod ‑‑ we call it a vaccination site ‑‑ that would focus exclusively on seniors over 75.

The first step was just ensuring that seniors were aware of it and that they could access the appointments via the platforms like a telephone that most seniors have access to.

One of the opportunities that co‑travels with vaccinating seniors is the ability to maintain that relationship or potentially maintain that relationship after the vaccination. Some seniors don't routinely interact with the healthcare system, and many don't interact with it at all unless they need to.

For those that are engaging with the system because of the vaccine, can you leverage that contact information to provide a more routine link to some of the broader services, both medical and social services, that they might need?

Jessica: Can you break down some of those challenges a little bit further for us? Is there any specific populations that you've had trouble reaching? Have you seen challenges in vaccinating older adults of color, for instance, or maybe people depending on their ability, people who are homebound?

Tim: If you think about first those that have mobility issues, ensuring that transportation and the site is set up for a caregiver to be able to accompany them is really critical. When we look at the site that we stood up ‑‑ we actually put a blueprint together so that others can replicate it ‑‑ we ensured that it contemplated not only just a senior but a caregiver coming to the site.

Once they arrived, the amount of movement that the senior would have to do would be minimized to the greatest extent possible. When someone arrives at our site, we put them in a little pod within the pod. It's essentially two chairs where a caregiver to senior can sit.

From that point forward, everything including the paperwork which is pre‑populated, the vaccine, and even the monitoring time, it all happens there. They don't really have to move around it. Addressing the mobility both transportation to the site and then once they're there, you contemplate that this is a frail population is absolutely critical.

The second relates to health literacy. Within the senior community, this is one of the failures that we've experienced nationally. We've done this hyper‑parallel approach to drug development, but there really wasn't the parallel approach to public health education around vaccinations so that people would, one, be aware and have their questions answered. Two, be willing to get the vaccines.

Within the senior population, both seniors broadly and then specifically seniors within the Black and Brown communities, the hesitancy really needs to be addressed. We've sought to ensure that as we're thinking about rolling the vaccination program out, that you address that health literacy directly.

Jessica: Can you talk to us a little bit about people who are really willing to get the vaccine and maybe people who aren't still willing? Have you seen people who maybe just don't have that public trust in the vaccine? Is there anything that you all are doing to address that?

Tim: Great question. On the willingness, I will say vaccination sites are very happy places. You could compare it to a testing site where people might be quite alarmed. The smiles on people's faces despite their masks, you can see it in their eyes. It's really there.

The other day, there was a couple in there that got vaccinated together, and they high‑fived each other after they received their vaccination. There certainly is a segment of the population and a growing large segment of the population within the senior population that is ready, willing, and when they get the vaccine, quite excited about it.

As I said, there hasn't been as much proactive education around the safety of these vaccines, the efficacy of these vaccines, and specifically addressing the concerns that seniors might have. At our site, in addition to the nurses and the medical assistance, we have a physician on site.

They can answer any of those questions that seniors have. We make sure that anybody that shows up can be comfortable with what they're getting. At the end of the day, that we maximize the number of vaccinated seniors and that we don't have people leaving or not receiving a vaccine because they don't have access to the health information that they're requesting.

Jessica: As far as healthcare professionals are concerned, what would you say are the biggest take‑home messages from this conversation and from your experience that healthcare professionals should keep in mind when they're vaccinating older adults?

Tim:  The first is that you really need to think about how we're going to reach them. If you just assume that older adults, it's going to be more challenging and it's going to be slower because of mobility and transportation, that will become a self‑fulfilling prophecy.

If we think about the Black and Brown communities where they're documented that there's higher hesitancy to vaccination, if we just assume that that's therefore going to be the case, it will be the case.

You have to proactively develop strategies to reach out to your communities and your patient populations to address those mobility issues, to address the gaps in health literacy, to maximize the number of willing older adults that will come to the site. Once they're there, it isn't the bleeding edge of science that you need to pay attention to. That's happened with the vaccine development.

It's thinking about the simple things. Can you repopulate the paperwork for them? Can you think about minimizing the amount of times they need to move? Can you plan for them to have a caregiver with them? All of those things make it easier.

If it's easy, more seniors would be vaccinated. When we have more seniors vaccinated, we have more seniors that are safe. That really is the light at the end of the tunnel or their ticket out of this crisis that we've all been experiencing.

Jessica: Is there anything else that you'd like to add, Tim, that you think that I missed?

Tim: Jessica, we're at a tipping point where we have the vaccine and we're making good progress not only vaccinating seniors but making good progress vaccinating the broader population.

If we lighten the restrictions too quickly, this race between those that are vaccinated and the ability of the virus to continue mutating where we have greater and greater variants that are more infectious is a real concern.

We just need to encourage all of us to message to the communities and to our patients that we need a little bit more patience and to remain conservative so that we can get as many people vaccinated as possible.

The second big takeaway from this is, we've learned a lot about what historically doesn't work in the healthcare system that's been illuminated quite brightly by COVID, but we've also learned what does work.

To be able to reach out into the community, we've talked about telehealth and the ability to be more agile with healthcare. It's all of our responsibility to make sure that we take those learnings and make our healthcare system a stronger healthcare system with those learnings in hand.

Jessica: Thank you so much, Tim, for talking with us. We really appreciate your time. We learned a lot here.

Tim: Jessica, it was great to be here with you today. I appreciate everybody that tuned in to the podcast. It's the number of needles and arms that we're trying to maximize because that's what brings protection and smiles to faces.