A Qualitative Study of Home Health Aides' Perspectives towards COVID-19 Vaccination.

Home health aides provide care to homebound older adults and those with chronic conditions. Aides were less likely to receive COVID-19 vaccines when they became available. We examined aides' perspectives towards COVID-19 vaccination. Qualitative interviews were conducted with 56 home health aides at a large not-for-profit home care agency in New York City. Results suggested that aides' vaccination decisions were shaped by (1) information sources, beliefs, their health, and experiences providing care during COVID-19; (2) perceived susceptibility and severity of COVID-19; (3) perceived benefits of vaccination including protection from COVID-19, respect from colleagues and patients, and fulfillment of work-related requirements; (4) perceived barriers to vaccination including concerns about safety, efficacy, and side effects; and (5) cues to action including access to vaccination sites/appointments, vaccination mandates, question and answer sessions from trusted sources, and testimonials. Providing tailored information with support to address vaccination barriers could lead to improved vaccine uptake.

A Practical Methodology for Improving the Aging-Friendliness of Communities: Case Studies from Three U.S. Communities.

BACKGROUND AND OBJECTIVES: In this paper, we present a series of three case studies to illustrate an innovative and practical approach to improving the aging-friendliness of communities. These three communities used the AdvantAge Initiative to "listen" to the voices of older adults in their communities and to identify and prioritize aging-related issues. This approach was developed by the Center for Home Care Policy and Research at the Visiting Nurse Service of New York (VNSNY), the largest not-for-profit home health care organization in the United States, and has been implemented in over 60 communities throughout the United States. The methodology involves tools such as conceptual frameworks, survey questionnaires, focus groups, and technical assistance to help stakeholders interpret data and find solutions to identified issues. RESEARCH DESIGN AND METHODS: We interviewed VNSNY program staff and community partners involved in three AdvantAge Initiative projects that commenced at varying time points: Memphis and Shelby County, Tennessee (2012); New York City's Chinatown neighborhood (2006); and the state of Indiana (2008). We also collected and reviewed secondary materials associated with these projects (e.g., meeting notes from community planning meetings, annual reports from grant recipients, press coverage). RESULTS: In this case study, we begin by providing an overview of the AdvantAge Initiative framework and the AdvantAge Initiative key indicators. We then present a more in-depth look at the three communities and how they approached and implemented the AdvantAge Initiative. DISCUSSION AND IMPLICATIONS: These case studies demonstrate that this methodology may be implemented in diverse communities and geographic locations. By looking at the longer-term outcomes and by comparing the strategies employed by each community, we see that communities, regardless of size, can bring stakeholders together to promote health and implement meaningful changes that make the community a better place to live for older adults and their families.

Addressing the Health and Wellness Needs of Vulnerable Rockaway Residents in the Wake of Hurricane Sandy: Findings From a Health Coaching and Community Health Worker Program.

OBJECTIVES: To describe the design and participants of a program that employed health coaches and community health workers to address the social, health, and long-term disaster recovery needs of Rockaway residents roughly 2 years after Hurricane Sandy made landfall. DESIGN: Baseline and exit questionnaires, containing demographic, health, and health care utilization measures, were administered to participants at the start and end of the program. Enrollment and encounter information was captured in program administrative records. Descriptive statistics were used to summarize participant characteristics, personal goals, referrals to local organizations and agencies, and outcomes. Qualitative analyses were used to identify recurring themes in challenges faced by participants and barriers to health and wellness. RESULTS: The program served 732 community residents, of whom 455 (62%) completed baseline and exit questionnaires. Participants were directly and/or indirectly impacted by Hurricane Sandy through property damage, closures of health care facilities, limited employment opportunities, and trouble securing affordable housing. Furthermore, many participants faced considerable adversities and struggled to manage chronic health conditions. Personal goals set by participants included locating health care and other resources (44%), weight management and healthy eating (35%), and self-management of chronic conditions (24%). Health coaches and community health workers engaged participants an average of 4 times-providing counseling and referrals to local organizations and services, including medical and dental services (29%), city-issued identification cards (27%), and health insurance and other entitlements (23%). Comparisons of baseline and exit surveys indicated significant improvements in self-reported health, health care utilization, and confidence managing health issues. No significant improvement was observed in the use of preventive health care services. CONCLUSIONS: The program represents a model for engaging vulnerable populations and addressing social and economic barriers to health and wellness during the long-term disaster recovery phase. Health coaches and community health workers may be instrumental in helping to address the health and wellness needs of vulnerable residents living in disaster-affected areas.

Age-friendly community initiatives: conceptual issues and key questions.

Public policy and programs for older adults traditionally have focused on the delivery of benefits to targeted individuals. Over the past decade, age-friendly community initiatives (AFCIs) have developed as a paradigm shift in contrast to this predominant focus. AFCIs engage stakeholders from multiple sectors within a typically local geographic area to make social and/or physical environments more conducive to older adults' health, well-being, and ability to age in place and in the community. We describe three general categories of AFCIs, including community planning approaches, support-focused approaches, and cross-sector partnership approaches. Following from this conceptual overview, we posit four key policy-relevant questions with implications for the expansion of AFCIs, including what public policy supports are necessary for the implementation of AFCIs across diverse communities, how entities outside of aging can be engaged to collaborate, to what extent advocates for various models can work together, and how the outcomes of these initiatives can be rigorously evaluated. We conclude by discussing how AFCIs are germane to the primary issues highlighted by the 2015 White House Conference on Aging.

Livable communities for adults with disabilities.

In 2004, the National Council on Disability (NCD) commissioned the Center for Home Care Policy and Research to research and prepare a report on the topic of "livable communities" for adults with disabilities. The following is a summary of the major findings in the report and the priority action steps that communities should take to become more livable for people with disabilities. The report was published by the National Council on Disability in December 2004. The National Council on Disability is an independent federal agency making recommendations to the President and Congress to enhance the quality of life for all Americans with disabilities and their families. The full report, entitled Livable Communities for Adults with Disabilities, includes numerous examples of communities that have made improvements in their livability for people with disabilities. It is available on the Council's website, www.ncd.gov.

Developing community indicators to promote the health and well-being of older people.

As the US population ages and the number of older people who are "aging in place" increases, communities will face new opportunities and challenges in responding to this population's desires and needs. Qualitative research was conducted to inform the development of a model of an "elder-friendly community" and a set of indicators to measure and help improve community capacity to promote the health and well-being of older residents. Focus groups were conducted in four US cities with younger and older adults and community leaders who identified attributes that make a community a good place in which to grow old. The group interactions were videotaped, transcribed, and analyzed to identify common themes. Results were remarkably similar across sites. Participants said that a community could be considered elder-friendly if it helped older residents continue active participation in the community, sustain their independence, and reduce the risk of isolation. A model of an elder-friendly community, along with corresponding indicators, was created on the basis of focus group results. These tools are being tested in 10 pilot communities to determine their usefulness for measuring older people's health and well-being, prioritizing aging issues, and stimulating and informing action strategies to improve community "elder-friendliness."