EOA update from Caroline Cadirao

TO:                  Stakeholders and Partners

FROM:             Caroline Cadirao

Director, Executive Office on Aging

Subject:           AGING NETWORK’S RESPONSE TO covid-19 – sTATUS UPDATE

While in the midst of a worldwide, fast-moving COVID-19 epidemic, the Executive Office on Aging (EOA) would like to provide the following status update of the resources, services, and supports that are currently being provided by the Executive Office on Aging and the Statewide Aging Network to assist and meet the needs of Hawaii’s older adults.

The EOA is the designated lead agency that administers and coordinates Hawaii’s statewide system of aging and caregiver support services as authorized by the federal Older American Act and chapter 349 of the Hawaii Revised Statutes. As a result, EOA is the recipient of federal and State funding for elderly services, nutrition services, preventive health services, elder rights protection, and family caregiver support services.

EOA’s direct service programs include the Long-Term Care Ombudsman Program, the State Health Insurance Program (SHIP), the Senior Medicare State Patrol (SMP), and the Veterans Directed Care (VDC) Program.

In-Home and Community-Based Services are provided locally by each of the county Area Agencies on Aging (AAAs) to assist older adults in remaining independent and active in their communities. Types of services that are provided include adult day care, assisted transportation, attendant care, case management, chores services, congregate meals, home delivered meals, homemakers/housekeeper services, information and assistance, legal assistance, nutrition education, personal care, and transportation. Support services for family caregivers are also available which include information assistance, individual counseling, support groups and training, respite, and other supplemental services.

To prevent further increase in the number of COVID-19 cases throughout the State of Hawaii, on March 21, 2020, the Hawaii State Governor David Y. Ige, issued a Third Supplemental Proclamation for the State of Hawaii ordering “all persons within the of Hawaii to stay at home or in their place of residence except as necessary…All persons may leave their home or place of residence only for essential activities or to engage in the essential business and operations identified…” Other essential businesses and operations identified as essential to continue to operate that affect older adults include, but are not limited to, health care services and facilities, organizations that provide charitable and social services, financial institutions, transportation, restaurants for consumption off premises, laundry services, and mail and delivery services, home-based care and services, residential facilities and shelters, professional services (legal services, accounting services, etc.), and government functions services, etc.

As a result of Governor Ige’s most recent proclamation, EOA partially activated their Continuity of Operations Plan (COOP) and reduced the number of employees that should physically report to the EOA Office to maintain social distancing. EOA will remain open during their regular business hours of 7:45 am – 4:30 pm daily however, a skeletal crew has been assigned to answer phones, process invoices, and direct the office. A large portion of the staff are working from home. EOA has been continually communicating with the Department of Health Executive Leadership, DOH program administrators, Area Agencies on Aging (AAAs), service providers, stakeholders, legislators, and our federal counterparts.

EOA PROGRAMS

Activities that EOA continue to operate are as follows:

1. State Health Insurance Program (SHIP) and State Medicare Program (SMP):

• SHIP continues to provide Medicare counseling with volunteer counselors and staff. The SHIP hotline is still open with an average of 20 to 40 calls daily. These calls are downloaded and assigned daily. Open enrollment for Medicare Advantage ended on March 31, 2020.
• SMP is taking calls and checking their website for anyone needing assistance in filing a Medicare claim fraud.

2. The Long-Term Care Ombudsman Program

The Long-Term Care Ombudsman Program also altered its operations considering COVID-19.  EOA suspended in-person visits by the Hawaii State Long-Term Care Ombudsman Program to better protect the health and safety of LTC residents, facility staff, and ombudsmen representatives. The Ombudsman is available for consultation by phone. The Ombudsman has answered calls from frantic family members who are unable to see their loved ones in nursing homes. In addition, the Ombudsman assisted in a discrepancy reported by a concerned citizen regarding a care home that was not taking precautionary steps. He assisted in the remedy of the situation.

3. Veteran Directed Care (VDC)

EOA is a provider of VDC. EOA provides the infrastructure to ensure that veterans can manage their care and supports.

• Procedures for assessments and ongoing coaching for participants in the program has been altered considering COVID-19.
• The Veterans Administration is allowing the work to be done telephonically instead of in person.

Kupuna Care, Kupuna Caregivers Programs, and Title III Services

The delivery of long-term services and supports has been modified because of COVID-19 with the safety and health of our kupuna at the forefront. In addition, we want to keep the staff of our provider agencies healthy.

• Adult Day Care Centers, senior centers, and congregate meals sites have closed to mitigate older adults from congregating.
• Transportation services has been modified to ensure social distancing.
• Emergency Meals: On March 2, 2020, EOA convened our Area Agencies on Aging to explore emergency meals for our older adults who are served by congregate dining and home delivered meals. We foresaw the closure of congregate sites and the need to ensure that our vulnerable older adults could shelter in place for a minimum of 14 days. MREs through a local company 6 Eagles and frozen meals thru Mom’s Meals have been ordered.

Food security seems to be the greatest need and is being addressed at the federal, state, and local level. The first allotment of stimulus funds was for congregate and home delivered meals in the amount of 1.2 million dollars.  EOA has provided the allotments to the AAAs thru contract amendments.

EOA will need to evaluate the impact of COVID-19 on services and supports.

TECHNICAL ASSISTANCE PROVIDED TO THE AAAs DURING COVID-19 

The EOA staff is providing on-going technical assistance to all the AAAs during COVID-19. Information from the Administration for Community Living and our national association, Advancing States (formerly the National Association of States United for Aging and Disabilities) has provided guidance on promising practices and creative ideas to address long-term services and supports. EOA provided the Area Agencies on Aging with guidance on how to implement some of these ideas. In addition, we have used the guidance to alter service delivery. For example, participants who had received congregate meals are now homebound because of COVID-19. Another example are Adult Day Care participants who use to receive a meal at the program. Participants in these examples were the individuals identified for the emergency meals and have been switched to ongoing home delivered meals as needed.

LEGISLATURE

The Hawaii State Legislature recessed in mid-March due to COVID-19 for up to eight weeks. EOA has received information that the Legislature may reconvene for a few days to address bills that are in limbo. EOA is keeping informed on the status and ensuring that the opportunity to advance our priorities are addressed.

EOA CHALLENGES

We faced challenges in technology to work from home. EOA inventoried equipment and deployed the equipment so that staff could work from home. Cells phones were already in process for management staff when COVID-19 escalated. We were fortunate to get our phones in a timely manner and were distributed prior to the stay at home/work from home order.

PUBLIC INTEREST IN THE AGING AND DISABILITY RESOURCE CENTER (ADRC) DURING COVID-19

The ADRC operated by the local Area Agencies on Aging assists older adults, individuals with disabilities, and family caregivers find options in their county for long term supports and services that fit their needs and are available to them. ADRC staff provides consumers assistance by first assessing the consumer’s service needs and then enrolling them in the appropriate Kupuna Care and/or Title III funded services that best meets their needs as well as provides consumers with information on options for other services that the ADRC may not directly provide.

The table below shows the number of consumer visits to the ADRC from March 16, 2020 to March 30, 2020.  In 15 days (3/16 to 3/20), there were 862 visits with 761 unique visitors.  Average 56 visits a day.  The number of consumer visits to the ADRC peaked at its highest on March 24, 20 and March 25, 20 which is around the time that Governor Ige issued the Third Supplemental Proclamation for the State of Hawaii ordering “all persons within the of Hawaii to stay at home or in their place of residence except as necessary”.

The number of consumer visits to the ADRC visits in March far surpass the average 32 visits a day with a total of 489 visits with 427 unique visitors in February (2/15 to 2/29).

EOA / KUPUNA CAUCUS – FOOD & RESOURCES GUIDE FOR HAWAII’S KUPUNA

In the wake of the COVID-19 Epidemic in the State of Hawaii, the Kupuna Caucus of the Hawaii State Legislature and the Executive Office on Aging has collaboratively developed a list of statewide resources that are available for Hawaii’s Kupuna.  This resource list will be posted on the Hawaii ADRC website (www.HawaiiADRC.org).

AREA AGENCIES ON AGING STATUS UPDATES TO COVID -19

Hawaii County Office of Aging

Hawaii County Office of Aging (HCOA) is continually refining the process of congregate meal distributions by assisting the provider in maintaining their lists of recipients and routes and ensuring the vendor can get what they need to continue their operations under COVID-19 conditions.  HCOA worked on a unit rate increase for meals.

The Mayor continues to promote his prevention and mitigation strategy with a distribution of approximately 1,600 flyers by mail or personally to date. HCOA ensured that all their providers hand out these flyers to their employees and clients. HCOA is also their Caregiver newsletter and Silver Bulletin mail outs as additional vehicles of dissemination.

LASH informed HCOA that it is business as usual. HCOA continues to process and make referrals to LASH.

Administration is asking to begin follow up phone calls on consumers to limit the people falling through the cracks. HCOA started this at the end of last week starting with our current referral list, especially those whose services have not started yet because of capacity issues.

Honolulu Elderly Affairs Division (EAD)

Kupuna Food Security Coalition – projects

• Malama Meals still providing meals to the community; 29 sites, 2563 meals per day; 17,941 total meals provided to date. https://malamameals.org/
• Share Aloha Challenge – home delivered meals for non EAD clients starting Monday, March 30^th to April 8^th. Opportunity to serve longer depending on community donations.

• Have an underlying health condition that puts them at risk for further medical complications;
• Have limited resources such as limited family support to prepare meals or no reliable transportation; and
• Not receiving services from other government-subsidized meal programs, including home delivered meals.
• Seniors who would like to sign up for the meal delivery service may call Francis Healthcare System at (808) 547-6501.
• https://www.showalohachallenge.com/
• Emergency Kits deployed to 575 vulnerable seniors
• Kupuna Food Security Coalition meeting today at 1:00 pm
• Salvation Army Kroc Center built out in 1-week time the capacity and is now distributing 2437 meals per week and 350 Kroc Cares Kits (food bags) per week – serving kupuna, keiki and families in need from Kapolei, Makakilo, Nanakuli out to the Waianae Coast
• Help is on the Way – Free Delivery Service is building capacity quickly and has provided assistance for all inquiries that have come in. More information at https://hihelpisontheway.org/
• Finalizing coordination with HMOW and Mom’s Meal for 116 clients being provided 14 meals every two weeks.
• Coordinating congregate participants to home delivered meals.
• Service Provider invoices are still being processed.

Maui County Office on Aging

• MCOA remains open for business. However, only contact with community is being done by phone. Half of the staff is working remotely.
• MCOA is working with UH Maui College to look at novel ways to provide food to participants in the community. Giving food vouchers was an idea.
• MCOA is looking at food trucks that are willing to be at the Kahalui Sunday Market to help fill a void.
• 130 older adults who were receiving congregate dining are now getting home delivered meals.
• More LTSS requests are being received for new participants with needs due to COVID-19.
• Issues have surfaced because of COVID-19. Lanai and Molokai are unable to get certain supplies and food because they can’t take it on the ferry. MCOA will keep a pulse on this issue.
• EOA discussed with MCOA on how to address the needs of the well elders who are sheltering at home and unable to go to EnhanceFitness classes. Caroline discussed if they could film the EF classes and make it available on something like Olelo (in Maui it is Kaku). EOA and MCOA will work on this together to make it statewide to help with social isolation.

Kauai Agency on Elderly Affairs (KAEA)

• Of the 17 staff, 13 are teleworking.
• County Executive is providing daily reports to the Mayor.
• KAEA is working with the County Economic Development program on the Farmers Market. Award was made to the Kauai Foodbank. Farm Fresh boxes are provided. KAEA oversees intake for the 1,056 older adults who would benefit the program.
• Kauai has seen a reduction in service delivery for homemaker, chore, and personal care.
• Kauai’s emergency meals are being delivered this week. 10 pallets will arrive on Kauai. 15 meals per box. These meals will be provided to those who receive home delivered meals, congregate and Adult Day Care services. Park and Recreation staff will assist in the distribution of the MREs.
• Challenges – equipment to telework from home was old. KAEA had to scramble to get equipment in place for staff.

COVID-19 has challenged our network to think out of the box. The stay at home order magnified those needing long-term services and supports. News and updates are changing daily. We are in a constant state of flux and the information listed above may not be a comprehensive summation of all the work being done to date.

If you have any questions, please contact Lisa Nakao at Lisa.Nakao@doh.hawaii.gov and myself at Caroline.Cadirao@doh.hawaii.gov. Mahalo.

AGING NETWORK’S RESPONSE TO COVID-19 – STATUS UPDATE- s and p (1)