Commemorating a difficult year for older adults & their caretakers

Over the past year, many of us have encountered milestones we never expected to experience: a first holiday season alone; an entire school semester online; nearly a year without hugging friends or family. This week marks another sad COVID-19 milestone – the one-year anniversary of the first confirmed death from COVID-19 in the U.S., which happened here in King County. 

From that week on, our lives changed unimaginably.  

More than 1,300 people in King County have lost their lives to COVID-19, and over 500,000 people nationwide have died. They must be remembered. Life for the families and loved ones of those lost will never be the same. And for the nearly 80,000 COVID-19 survivors in King County, many continue to feel the long-term impacts of their illness. 

Others lost or had to step down from jobs, or had wages cut. Families took on double-duty as homeschool teachers. Educators switched gears on a dime to master new technology and keep kids learning.  

For those fortunate enough not to have experienced major losses, the long-term change of routine, lack of human touch, and increased uncertainty has increased stress and mental health challenges.  

Communities of color have disproportionately borne the burden of COVID-19.  

In King County, the rate of COVID-19 hospitalizations and cases have been significantly higher for Hispanic/Latinx, Native Hawaiian/Pacific Islanders, Blacks and American Indian/Alaskan Natives as compared to Whites. And, when you account for the fact that the White population skews older than Black, Indigenous and People of Color (BIPOC),  communities of color also have a higher rate of death compared to White residents.  

 The tragic reality is that COVID-19 highlighted and exacerbated existing structural and health inequities in our society. Communities experiencing longstanding poor health outcomes from lack of access to health care and from social, economic, and environmental disadvantage continue to be hit hardest. They also make up a large portion of the essential workers who keep our society functioning. 

Amidst all this suffering, we saw many examples of community coming together to support one another. People sewed masks for healthcare workers. Essential workers – from supermarket staff to childcare providers to paramedics – risked their lives to keep communities running. Food banks and their volunteers expanded efforts amidst rising food insecurity, including providing culturally appropriate food options. Young and old hit the streets – or aided protestors in other ways – to call for an end to police violence and declare racism a public health crisis.  

And all these efforts did make a difference – King County has had one of the lowest rates of COVID-19 infection  for regions nationwide. 

Impacts on older adults 

COVID-19 has had a particular burden, both in terms of isolation and morbidity, on older adults and the people who care for them. Nearly 80% of COVID-19 deaths locally have been among people age 70 and older. This population has also been cared for and supported by in-home caregivers, families and staff who have shown amazing resilience in light of these challenges. 

Today, as we mourn a year of lives lost to COVID-19, we also revisit the hardships, perseverance, and advancements that have been made in fighting COVID-19 among older adults.  

Long-term care facilities 

Over 58% of King County’s COVID-19 deaths have been among residents, staff or visitors to long-term care facilities (LTCF).  

For this reason,  LTCFs (which include skilled nursing facilities, assisted living, and in-home group care called adult family homes) have been a major focus of Public Health’s COVID-19 response.   

As the outbreak continued, Public Health implemented systems to help LTCF secure emergency Personal Protective Equipment, particularly for small Adult Family Homes that faced challenges in ordering. Public Health joined with state and local partners to create mobile testing and technical support teams that quickly visit facilities with confirmed cases and test all residents, helping prevent larger outbreaks. Today, nearly every skilled nursing or assisted living facility tests all staff at least weekly – a huge step toward infection control.  

As a result of this work, we’ve seen a major decline in cases at LTCF. In fact, last week marked a milestone: The first week in the past year with no new cases in LTCF. It also means Public Health is better poised to support LTCF in prevention control in the future. 

Older adults living at home 

Many other older adults, many within Black, Indigenous, and People of Color communities, live at home or with extended family. Some share multigenerational homes with essential workers, making infection control in the home difficult. Others faced challenges obtaining clear and reliable information about COVID-19. Older adults living alone faced extreme isolation, recognizing that any in-person interaction could be a death sentence. 

Public Health launched a direct mail campaign to BIPOC older adults throughout King County, featuring mailings in multiple languages with information on nearby COVID-19 test sites, mental health resources for older adults, and guidance for safer holiday gatherings.  

Much of the work to reach older adults wouldn’t  have been possible without the help of community partners – particularly to reach those who don’t speak English as a first language, or who have historical distrust of government practices. Public Health works with established community leaders representing 30 language and ethnic groups, and with more than 100 faith-based organizations to help spread information and resources. More than a dozen organizations representing community, education, housing, business and more formed the Pandemic and Racism Community Advisory Group, regularly meeting with Public Health leadership to inform them of community needs and offer guidance on strategic work. 

Amazing resilience 

Older adults and their caretakers have shown amazing resilience and creativity in the face of very difficult circumstances. Many caretakers put their own safety on the line to ensure patients received care, often working overtime as a result of staffing shortages as coworkers fell ill.  

LTCF staff got creative to find new ways for residents to feel a sense of connection given restrictions on visitation and social gatherings. Staff set up regular appointments to help residents use virtual tools to stay in touch with friends and family. Facilities hosted “hallway bingo,” walking up and down halls announcing bingo calls while residents played from separate rooms. 

Those on the outside stepped up, too. Mutual aid groups formed to deliver groceries and supplies to homebound seniors. Volunteers with the Washington State Long-Term Care Ombudsman Program sent thousands of letters and phone calls to residents to make sure they knew people were thinking of them. 

Vaccination begins 

Given their high-risk status, LTCF residents and staff and people over the age of 65 were some of the first groups eligible for vaccination in Washington. 

While most LTCF residents received vaccines through the Federal Pharmacy Partnership, many small Adult Family Homes did not enroll in this partnership. And many other older adults and their caretakers struggled to secure vaccination appointments through healthcare providers. Public Health has been working to fill these gaps, particularly among BIPOC elders in south King County. 

Public Health partnered with community organizations to schedule eligible seniors for vaccine appointments, including spots reserved for priority populations at our vaccination sites in Kent, Auburn and Redmond.  

In conjunction with City of Seattle and local fire departments across King County, we’ve established 17 mobile vaccination teams. They visit adult family homes, low-income senior housing and now are doing door-to-door appointments for homebound seniors. Said one senior when it was time for a home vaccination visit, “I wish I could hug you, but I know we’re not supposed to hug.” 

As a result of these efforts, today, all LTCFs – including Adult Family Homes – have received at least one vaccination visit.  

And, county-wide, 59% of adults over 75 have received at least one dose, and 52% of those 65-74 years old have received at least one vaccination dose.  

Despite this progress working with community organizations to prioritize BIPOC seniors for vaccination appointments and home visits, racial/ethnic disparities in vaccination rates remain. Among Hispanic and Black adults 65 and older, 38% and 30% have received at least one dose, respectively, compared to 49% of White adults 65 and older. We have much more work ahead of us to close these gaps. 

Reflecting on a difficult year 

This has been an incredibly difficult year for everyone. We at Public Health are grateful to older adults for the sacrifices they have made to stay safe this year as we’ve waited for vaccines, to the caretakers who’ve put themselves at risk to protect the health of others, and to the partners who’ve been integral to getting resources and messages to elders.  

Most of all, countless individuals across King County have sacrificed every day to prevent the virus from spreading and to protect their families, neighbors and community. And, it’s making a difference. King County has had one of the lowest case rates nationwide. 

But, these sacrifices and successes don’t replace the many lives that have been lost. They don’t erase the deep racial and ethnic disparities. And the pandemic still isn’t over. It has the potential to impact our mental health and wellness for a generation or more. There’s so much work still to be done, both to recover from COVID-19 and to build a more equitable, anti-racist society that supports and values the health and lives of all residents. 

Key Local and State partners supporting LTCF include: 

  • Aging and Disability Services, the King County Area Agency On Aging 
  • Washington State Long Term Care Ombudsman 
  • Adult Family Home Council  
  • Leading Age 
  • Seattle Fire Department 
  • Washington Health Care Association 

Originally published February 26, 2021