Technology poses vaccine barrier for seniors in affordable housing

Collaborator: Streetlight
Published: 02/11/2021, 2:32 PM
Edited: 03/11/2021, 10:22 AM
Written by: Jeremy Martin (NATIONWIDE) As the rollout for the covid-19 vaccine continues, some senior advocates have expressed concerns that elderly residents living in affordable housing have had trouble accessing this vital resource. According to a survey from the Harvard Joint Center for Housing Studies, most residents in an affordable housing program for adults 62 and older had little access to technology last year. Just 36% had the internet, and 15% didn’t have a phone. That’s created challenges for seniors attempting to sign up for a vaccine appointment through an online portal, said Michelle Missler, president and CEO of the American Association of Service Coordinators, whose members help seniors in affordable housing communities access support resources “The digital divide has persisted for years, but it wasn’t until covid-19 pushed a number of our daily activities online that many noticed just how far older adults, especially lower-income older adults, had fallen behind and why that’s harmful for their health and well-being,” Missler said by email. “Shopping for basic necessities, keeping in touch with friends and family and attending medical appointments have all moved online in the past year. Without access to the internet and devices and without the technical knowledge required to use them, older adults are not able to do these necessary activities.” Mary Brinkley, executive director for LeadingAge Oklahoma, said lack of internet access has been a serious barrier for seniors in the state, where vaccination clinics held in non-medical settings like churches have been successful. “We really have to rethink how we’re going to get our seniors vaccinated,” Brinkley said. “If they don’t have the internet, if they don’t have computer capabilities, we have to meet them where they are.” As COVID disproportionately affects people of color, Oregon, California and Tennessee have all explored ways to allocate more vaccines for vulnerable citizens. Dallas County officials rescinded a plan to prioritize disadvantaged zip codes — primarily Black and Latino neighborhoods — after Texas state officials threatened to reduce its weekly vaccine supply. West Virginia led the country in administering vaccines to residents after opting out of the national pharmacy partnership with Walgreens and CVS and distributing the vaccine through smaller independent pharmacies instead. Los Angeles County also opted out of the federal plan and told nursing homes to distribute the vaccine themselves. Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care, said the varied approaches to vaccination may be working, but the results of a piecemeal, localized approach are more difficult to track. “There’s this gap of information, which leads to a lack of communication and coordination between what’s happening at the federal level, the state level and the facility level,” Grant said. “It really may be that there are places where it’s going really, really well, but it’s hard for us to identify where that is. … It feels chaotic and inconsistent, and the fact that we don’t know what’s happening, that says something.” Eligible on paper, but not always in practice The US Department of Housing and Urban Development’s (HUD) Section 202 program provides low-income people who are 62 or older with low-cost housing and supportive services to allow them to continue living independently. Seniors in the subsidized housing program have been included in a Centers for Disease Control and Prevention (CDC) program that provides on-site vaccinations for long-term care residents and staff. Individual states, however, have been free to set their own priorities for vaccination scheduling, and these priorities have begun to vary more widely as the rollout advances. Linda Couch, LeadingAge’s national vice president for housing policy, said that being included in the CDC’s on-site vaccination program has been vital for communities providing affordable housing to seniors, because these facilities don’t have health care workers on staff. According to 2016 estimates from the Government Accountability Office (GAO), Congress’ nonpartisan watchdog arm, about half of Section 202 properties had service coordinators that were funded by HUD. Some of the main reasons property managers said they didn’t have service coordinators were that they couldn’t afford it or they didn’t have enough units to warrant the hire. “Where there’s not a service coordinator,” Couch said, “those communities have struggled more to connect residents to really basic things like food and medication and anything that can be done to combat social isolation or get on the telehealth bandwagon. We’ve been screaming for more service coordinators for years, and now I think it’s really obvious that having a service coordinator in these communities really matters.” Like long-term care facilities, Section 202 housing communities have shared living spaces. “Because affordable housing residents live in congregate settings where they’re required to share common spaces such as lobbies, hallways and elevators, they may be at an increased risk of contracting covid-19,” Missler said. Nancy Zionts, chief operating and program officer for the health advocacy organization Jewish Healthcare Foundation, said that seniors in low-income housing without access to the resources provided by long-term care facilities or telehealth services are having considerable difficulties getting the help they need. “They are now, to a large degree, isolated and fending for themselves, trying to get on vaccination lists to be prioritized,” Zionts said by email. “On paper, they qualify, but they need help maneuvering the systems to get scheduled and transported. Others have been too afraid to have services brought in to them for fear of catching the virus.” Brinkley said that allowing seniors in independent living situations to struggle to obtain necessary healthcare resources such as vaccines risks putting more strain on already overburdened long-term care facilities that “have been pushed to the brink.” “If we can keep these individuals in senior housing, it saves the state and nation lots of money in the long run, but if we don’t take care of the little things — to make sure that people are getting mobile meals if they need it, and some in-home services and supports to check on them and things — then what happens is their health declines, they end up at a nursing home, and it costs us much, much more money,” Brinkley said. Supply short for affordable senior housing The majority of seniors who qualify for Section 202 housing do not participate in the program due to a lack of housing units. During the past decade, the number of elderly households facing housing problems has risen, but only 36% of seniors eligible for HUD assistance receive it. This problem is part of a national affordable housing shortage that has left millions of low-income families without viable rental options. Due to budget cuts and construction slowdowns caused by the pandemic, the problem is expected to get worse. Sarah Saadian, vice president of public policy for the National Low Income Housing Coalition, said the affordable housing shortage and eviction have increased the danger covid-19 poses to already vulnerable seniors. “Millions of households, including senior households, were right on the cusp — maybe one financial crisis away from falling behind on their rent and losing their homes and facing possible evictions and homelessness in worst cases,” Saadian said. “When you’re evicted from your home, you’re more likely to have to double or triple up with other households, or you’re more likely to be pushed into homelessness, both of which make it really difficult to practice social distancing.” Saadian said the coalition has been urging Congress to make housing assistance available to everyone who qualifies for it, instead of the current voucher system that can leave eligible renters waiting for years. The danger is compounded for seniors from low-income backgrounds, especially those of color, who face additional risk of infection, hospitalization and death from covid-19 due to discrimination and lack of access to health care. “It’s a crisis on top of a crisis on top of a crisis, and it all has enormous racial inequities built into it,” Saavid said. “I think that all points to how we need to make sure that resources are reaching marginalized populations, and when we’re thinking about longer-term solutions, we’re making sure that they directly address racial equity.” Racial and ethnic minorities may also be disproportionately harmed by the strain on nursing homes. Grant of National Consumer Voice said that facilities with limited resources have reported higher rates of infection and death among residents. Covid data from last May showed that nursing homes that cared for more people of color had higher numbers of covid cases and deaths. “There have been long-standing issues with nursing homes, understaffing being one of the major ones,” Grant said. “It’s been a problem for years and years, and this was like the earthquake that really just brought everything down. … We have got to make changes.” Poor funding for nursing homes endures While long-term care residents make up less than 1% of the United States population, they account for more than a third of deaths from covid-19. Zionts said that facilities that house seniors with medical conditions in congregate living situations could be expected to be hit harder by the pandemic, and these effects were amplified in facilities ill-prepared for the pandemic after years of being under-resourced. “What was really hard to take was the fact that these organizations that we knew would be harder hit were not very quickly prioritized for infection control support, for (personal protective equipment), for testing,” Zionts said. Many skilled-nursing facilities that rely on Medicaid reimbursements were inadequately funded before the pandemic, Zionts said, and they did not have the staff, equipment and other resources on hand to properly prevent the spread of infection. Help from the Federal Emergency Management Agency, the National Guard and partnerships with health care providers in many cases only arrived after an outbreak had occurred. Allison Hoffman, a University of Pennsylvania law professor who focuses on health care policy, said high rates of infection and death among nursing home residents stem from persistent issues that haven’t been addressed during the pandemic. “We still have a system that doesn’t pay sufficiently for long-term care, so that you get things like staff and caregivers in the facilities who are not making enough to live on and have to hold multiple jobs and then become, potentially, carriers of infectious disease from one place to another,” Hoffman said. “And then you still have the problem that a lot of the facilities are understaffed, so they’re housing large numbers of vulnerable populations together.” Hoffman said this situation is the result of a decades-long movement to prioritize in-home care over congregate living facilities for seniors. Neither option has received sufficient funding, leaving family members to bear the burden instead. People who take time off work or relocate to care for aging parents may put their own well-being and long-term financial stability at risk. “You see people suffering their own physical and mental health challenges from being in that kind of role,” Hoffman said. “We’re moving people into their homes and into their family members’ homes for long-term care, and we have no coherent structure to help pay for and provide support for that care.” Jeremy Martin is a news and arts writer living in Oklahoma City. Email him at


This story has no comments yet