I. Introduction
About the Cuyahoga County Division of Senior and Adult Services
The Cuyahoga County Division of Senior and Adult Services (DSAS) is one of the largest county agencies serving seniors in the State of Ohio. With an annual budget of approximately $25 million, DSAS is a cornerstone of the overall support system of health and human services provided to older adults in Cuyahoga County. DSAS has a number of different departments to aid older adults in the aging process: including the OPTIONS for Independent Living program, which helps seniors who wish to age in place at home, and the Adult Protective Services (APS) department, which protects seniors from physical, financial, and emotional abuse. In addition to supporting community outreach services, DSAS also funds a number of institutions throughout the county that provide a local touchpoint to seniors. Known as the Cuyahoga County Division of Senior and Adult Services Senior Center Network, these organizations come in a variety of forms, from independent nonprofits to government-supported agencies. What they have in common is that they provide another form of outreach and support services to older adults in their neighborhood or throughout the county, regardless of where the older adult finds themselves in the long-term care continuum.
With an annual budget of approximately $25 million, DSAS is a cornerstone of the overall support system of health and human services provided to older adults in Cuyahoga County.
About the DSAS Senior Services Center Network
The Cuyahoga County Division of Senior and Adult Services Senior Center Network was originally formed as the Municipal Offices on Aging Association (MOAA) and was composed of municipal government offices that served seniors.[1] Over the years, the network evolved to include centers designed to help seniors, and organizations that included seniors in their programming. The network has representation from all eleven-county council districts and frequently shares internal information, such as ideas and best practices, and provides external communication to elected officials about the network’s ability to meet the needs of the local senior population.
Setting the stage
The Center for Community Solutions was initially prepared to survey members of the senior center network to provide insight for current and future needs. The organizations within the network were already dealing with an aging county population for which resources would be needed from all sectors of the community to meet and sustain a high quality of life for Cuyahoga County seniors. According to research, approximately 30 percent of Cuyahoga County residents will be 60 years of age or older by 2030.[2]
Approximately 30 percent of Cuyahoga County residents will be 60 years of age or older by 2030.
But at the start of the COVID-19 pandemic, these organizations had to pivot quickly and adapt to a very different environment. New research indicates that COVID-19 is now being transmitted the highest among younger adults,[3] but preliminary research showed that the pandemic disproportionately affected seniors, in both cases and deaths. Therefore, self-isolation, either at home or in a senior living environment such as a nursing home or assisted living center, became a means of personal survival and necessity for seniors.[4] At the same time, in addition to restricting visitors to nursing homes and assisted living environments, government regulations limited the size of physical gatherings, reducing the service opportunities at the senior centers and in some community-based institutions. The operators of these organizations had to move quickly in order to adapt to these new guidelines.
Instead of surveying the senior center network about conditions more generally, the Cuyahoga County Division of Senior and Adult Services decided to ask these same organizations about the impact of the pandemic and get a more detailed idea of the current and near-future needs of the institutions. Understanding the impact of the pandemic on the health and safety of the workers and the general public became imperative.
The impact of the COVID-19 pandemic
As of this writing, the novel coronavirus has killed 270,000 people in the United States, according to the Centers for Disease Control and Prevention.[5] A study by the Commonwealth Fund shows that nearly half of Black Americans surveyed reported experiencing an economic challenge because of the pandemic, whereas 21 percent of white respondents reported such an impact. Both Black and Latino survey participants reported pandemic-related mental health concerns at a rate approximately 10 points higher than white respondents. Additionally, Black Americans had 2.6 times higher the number of cases, 4.7 times higher the number of hospitalizations, and 2.1 times higher than number of deaths than white Americans.[6]
II. The survey and the results
The Cuyahoga County Senior Center Network Survey was distributed from September 8 to 24, 2020, and received a 60 percent response rate from the senior center network agencies.
Examining the problem
In general, the organizations shared that most focused on senior needs such as transportation, congregate meals, socialization activity, and other supportive services. The organizations were asked to share the impact of the pandemic on their activities. Approximately 75 percent of respondents said the pandemic caused “significant disruption.” However, the answers were evenly split as to whether they predict recovery will bounce back quickly or be drawn out.
When asked about how services had changed, respondents outlined some of the specifics, including the following:
- Cancellation of congregate meals and socialization activities
- No home visits from social workers—only virtual check-ins via phone or internet
- Group field trips canceled indefinitelyAdditionally, respondents indicated that once restrictions were put into place, such as mandated social distancing and elimination of face-to-face contact, staff not only had to adjust the programming activities but also had to overcome objections from seniors, many of whom did not like virtual interactions. Low participation led to reductions in services, such as transportation, and increases in costs, such as sanitizing and disinfecting of facilities. The cost increases coupled with the decrease in utilization meant reductions in income and cashflow, which led to furloughs and staffing cuts. Yet the needs of seniors were just as high. In fact, 60 percent of respondents noted they had seen an increase in “Demand for Service,” such as more home-delivered meals (because of no congregate meals) and other outreach designed to reduce loneliness and social isolation, even as 37 percent said they had seen a decrease in staffing levels.
When asked about areas of highest concern, over 85 percent of service providers said they were very concerned about the mental and physical health of their clients. In addition, 77 percent said they were “very concerned” about the economy in general. When asked about the concern of the economy in general, 91 percent of respondents said they were “very” or “slightly” concerned.
When asked about the well-being of staff, 85 percent said they were “very” or “slightly” concerned with the mental health of their staff. On the other hand, 60 percent of survey participants said they were “not very concerned” with the productivity of their staff. In addition to ensuring a high quality of care for senior center clients, most organizations appear to have also been focused on supporting staff as workers wrestled with the impact of the pandemic on their own lives.
Even with the large disruption in services and the impact to staff, 50 percent of survey respondents said their agencies have adapted very well. Another 44 percent said they have adjusted somewhat well. Only one person said “neither poor nor well” and one said “somewhat poorly.” No one responded “poorly.”
94 percent say their agency has adapted very well or somewhat well
Many respondents credit the local aging network’s efforts as helpful to their agency’s ability to pivot and provide changing services. Mentions included support from the Cuyahoga County Division of Senior and Adult Services; local governments; such as mayors and city councils; federal government dollars; and philanthropic organizations. Almost all respondents also credited their staff members for their agency’s success in adapting to the new environment. While some lamented about staff being laid off, they also reported that staff members who were able to stay on learned new skill sets, adapted to protocols, and were willing to help “in any way they could.” This is especially notable because institution leaders had responded about their concern for the mental health of staff, yet they’ve also heralded their staff for weathering the crisis. Supporting staff is critical so that they are not worn down.
Looking forward, more than half of survey respondents said they expect seniors to return to senior programming within three to nine months. Even so, survey respondents expressed concern about the long-term impact of the pandemic on the older adults they serve. When asked about the top impact concerns of COVID-19 five years from now, respondents overwhelmingly mentioned mental health issues, such as mental decline, isolation, anxiety, loss of socialization, and increased loneliness. In addition, survey respondents expressed alarm over the decline in seniors’ physical health, which they attribute to a lack of social interaction. Some respondents also noted long-term concern about finances and the long-term economic stability of the seniors, including losses of income. When asked to rank the top concern of COVID-19 on older adults and adults with disabilities, 94 percent cited “social Isolation” as their number one concern. That worry even trailed the concern of contracting the SARS-CoV-2 virus (61 percent). Food insecurity ranked as number three, with 50 percent highlighting its importance.
Survey responses noted how local churches had stepped in to assist with outreach and to drop off “activity baskets” filled with puzzles and Personal Protective Equipment.
Survey respondents were particularly thankful for the community support. Survey responses noted how local churches had stepped in to assist with outreach and to drop off “activity baskets” filled with puzzles and Personal Protective Equipment (PPE). Others noted how nonprofits have stepped in to assist with closing the digital divide, including increasing digital literacy and promoting access to virtual senior center programming. One response spoke glowingly of Senior Transportation Connection and how helpful the organization has been to the senior center members.
When it comes to getting information, senior centers overwhelmingly look to the government for the latest information. The vast majority mentioned the Ohio Department of Aging as well as the Cuyahoga County Board of Health and the Cuyahoga County Division of Senior and Adult Services.
When it comes to organizational needs, 79 percent of those who responded, said they have been able to acquire PPE. Eighty percent have been able to acquire cloth masks to distribute, and 86 percent said they have been able to offer flexible hours to their staff, a strategy intended to prevent burnout.
As the organizations look ahead, 68 percent of respondents say that they are experiencing financial distress right now or will be within the next twelve months. When asked what they would do with additional funding, many say they would devote the funding to upping staffing levels to meet the current needs of citizens. Another consistent answer was that additional funds would be used to increase access to technology. Finally, respondents said they would use additional funds to increase transportation and/or home delivery of meals.
When asked about needs other than money, respondents provided limited answers. However, some mentioned a need for more volunteers, online classes and technical support training for seniors, and flexibility in reporting.
Eighty-five percent of the senior center respondents say they felt valued by the community.
The good news is that 85 percent of the senior center respondents say they felt valued by the community. Additionally, 97 percent say they feel the Cuyahoga County Division of Senior and Adult Services is “extremely responsive” or “very responsive.” Only one person said “somewhat responsive.” No one indicated a response level lower than that.
When asked what DSAS could do to be more responsive, many expressed gratitude for the work that DSAS has done in providing information about support systems available from the county, as well as providing resources to face any challenges. One emerging suggestion was that DSAS could be more helpful in providing advocacy for additional resources and support, specifically at the state level. Several respondents expressed frustration with some of the state guidelines, and several said DSAS could do more to advocate on behalf of local institutions.
Our clients are so grateful for the meals and phone calls, etc.
Finally, survey participants were asked whether they had additional information they would like to share about older adults or the management of a senior center. Answers included the following:
- “It is time-consuming but very rewarding.”
- “We are doing the best we can.”
- “Our clients are so grateful for the meals and phone calls, etc.”
- “It is a hard task some days, but it is most rewarding to see them thrive.”
- “The clients we serve are like extended family. They care about the staff and we feel the same. This is a very difficult time for everyone, but seniors are very resilient.”
III. Next steps and recommendations
Organizational Recommendations
The responses from the survey participants point to several major themes, and several solutions can be proposed to meet needs. Listed below, in no particular order, are several recommendations.
Encourage volunteer efforts to fill short-term need. The institutions highlighted that revenue shortfalls forced staffing reductions via furloughs and layoffs, yet agencies still had to maintain levels of service. These changes can place increased stressors on remaining staff, which in turn, can increase the risk of burnout—not just because of service delivery but also because staff members are navigating the effects of the pandemic crisis on their personal lives. Volunteers may be able to fill short-term staffing gaps. Government, nonprofit, and private-sector organizations should take a proactive stance in connecting existing volunteer programs, making sure those programs are aware of the crisis facing senior centers, and informing them of what they can do to help.
Increased advocacy at the state level. The responses in the survey point to the enormous amount of power and control on guidelines at the state level. As one of the largest county agencies serving seniors in the state, DSAS is in a unique position to flex its political and policy muscle, using analytical data and anecdotal evidence to ensure that stories and data are shared not just locally, but at the state level as well. DSAS and county leadership need to ensure that policymakers from both sides of the political aisle are familiar with the plight of senior centers during the pandemic and what policy changes can be made to ensure solid deliverables and that spending on older adults is viewed as an investment with the same importance as funding for other agencies that serve different demographics. If such advocacy is already taking place, marketing efforts must be improved, because a lack of awareness of current efforts is apparent.
Senior needs were increasing before the pandemic, and those needs have come into an even sharper focus in the past nine months.
Increase funding to offset staffing losses. Revenue losses have resulted in drastic changes to staffing levels. But staffing reductions create a giant hole in a center’s ability to meet the needs of seniors. Senior needs were increasing before the pandemic, and those needs have come into an even sharper focus in the past nine months amidst the COVID-19 crisis. Governments and philanthropic organizations need to know what current staff levels serve seniors, what those levels were prior to the pandemic, and what levels are needed to ensure a high quality of life for senior populations. Then resources need to be identified to meet those staffing needs.
Increase mental health funding and support systems for clients of senior centers, as well as for staff members. Mental health was cited as a top—and in many cases the highest—concern of institutional leaders. The pandemic has taken an unprecedented toll on the mental health of staff, senior center attendees, leaders, and families. This survey has underscored the need for mental health support systems. Additionally, mental health organizations and leaders should distribute information to educate supervisors and fellow staff members to identify signs of mental distress and to direct struggling individuals to support.
The pandemic has taken an unprecedented toll on the mental health of staff, senior center attendees, leaders, and families.
Increase technology accessibility, through internet access, hardware, and technology training. The transition to virtual engagement of seniors has highlighted a lack of tech accessibility. Virtual engagement requires hardware, such as laptops and tablets, and a reliable internet connection. Plus, individuals need a certain level of digital literacy to use products, technology, and services. An analysis should be completed to assess the resources required to address these issues, including how to overcome infrastructure hurdles in historically dis-invested communities that have experienced “digital redlining.”
Invest in ways to ensure the physical and mental health and safety of clients. Cuyahoga County Division of Senior and Adult Services has one of the largest Adult Protective Services divisions in the entire State of Ohio. Because of this, the county has a number of investigators who can examine instances of physical, emotional, and financial abuse. However, the pandemic has resulted in a decrease in the number of in-person interactions with mandated reporters (bankers, physicians, etc.). DSAS data shows that the numbers of reports of APS instances has dropped slightly. Similar decreases have been reported in the number of referrals statewide to Child Protective Services.[7] However, that does not mean the number of individuals who are victims has gone down. Indeed, with the distribution of stimulus checks and other financial relief, higher instances of financial abuses of seniors are possible. Cuyahoga County Senior and Adult Services should have an organized marketing campaign with messaging highlighting the availability of APS services to the general public. As the number of reported cases goes up, the division must ensure that the infrastructure is available to meet those needs. This will ensure that clients who are served by the senior centers have the support they need and will alleviate concerns about their physical and mental well-being.
Prepare more emergency response plans. Many organizations reported they were pleased with their agency’s pandemic response. However, this satisfaction should not preclude the need to understand what things went well in the service transition and what things did not. To that end, an analysis is needed to find out if organizations had an emergency response plan in place. If so, was that plan followed? If not, what support from the county would be helpful in the development of such a plan? Much institutional knowledge is being accrued through this crisis. That knowledge should be documented for use in the event that the aging network finds itself once again in a cataclysmic disruption of service delivery.
Eighty-six percent of survey respondents said they feel that the community “values and appreciates the senior center.”
Promote the necessity of senior centers, and seniors in general, to the community. Eighty-six percent of survey respondents said they feel that the community “values and appreciates the senior center.” This is an extraordinarily high number and a reflection of the high value placed on the services provided. Exploring the measurable and immeasurable value that services for seniors bring to the community is critical. Of utmost importance is ensuring that seniors have access to what they need to ensure a high quality of life as they age—including transportation, affordable housing, food, and mental health services. An enormous amount of goodwill can be tapped into to elevate the case for reaching out to seniors and connecting them to the senior services network, whether it is during or after the pandemic crisis passes.
Recognize the work that senior centers are doing in a challenging environment and increase awareness. Many of the respondents acknowledged the enormous responsibility of looking out for some of the most vulnerable populations in the county. One of the survey respondents said, “It’s challenging, but rewarding.” In talking about the yeoman’s job they are doing in responding to the pandemic, organizational leaders are quick to highlight the resiliency of their constituents and staff and to take the focus off of themselves. Several respondents said, “We are doing the best that we can.” That being said, the Cuyahoga County Division of Senior and Adult Services (DSAS) can and should continue to recognize the hard work of the staff and volunteers at these organizations. Recognition would lift morale among staff and elevate the message of what senior centers are doing as the pandemic crisis continues. Put bluntly: the world needs good news.
the State of Ohio will be undergoing a State Transportation budget process and the 2022-2023 Biennial General Operating budget process.
Support will need to come quickly. Institutions indicated that many are facing a fiscal shortfall in the next months. Many organizations indicated they will be experiencing a funding crunch in the next nine months as a result of revenue losses. To address the needs outlined earlier in this paper, funding will have to come quickly. In the next twelve months, Cuyahoga County will be going through an HHS Levy Increase funding process, the State of Ohio will be undergoing a State Transportation budget process and the 2022-2023 Biennial General Operating budget process, and the county will be undergoing its own 2022-2023 budget process. The senior center and aging network, public sector organizations included, should not be shy in outlining their needs and underscoring the importance of supporting aging services. This is especially true as the pandemic rages and shows no sign of slowing.
Understand that recovery will take time. But preparation must begin immediately. While the aging network must underscore the fierce urgency of relief that is needed, it must also recognize that recovery will take time. The long-term physical and mental health effects of the pandemic are not yet known. Preparation of necessary infrastructure needs to happen now as the impacts to mental and physical health become more fully realized. Cuyahoga County Division of Senior and Adult Services earned high praise for its communication and support of the senior centers throughout the pandemic. For that, the agency should be commended. However, the division faces the unenviable task of simultaneously trying to prepare for a post-pandemic future without knowledge of what that future will look like or when it will occur, especially as case counts and death tolls continue to rise. That being said, if DSAS has not yet begun planning for the post-pandemic future, they must do so immediately. They must outline what funding and staff support to the senior center network is currently in place at the county level as well as what the staffing needs are of the senior center network, and how to build up that support system if and when things return back to “normal.”
The need to act on diversity, equity and inclusion are also adding stressors during this time.
Understand that the pandemic is not being experienced similarly. One of the respondents mentioned “the need to act on diversity, equity and inclusion are also adding stressors during this time.” Indeed, as has been covered by the Center for Community Solutions in the past, minority older adults may be wrestling with not just the pressures of the pandemic but also with racial unrest that may trigger racial traumas rooted in historical injustices.
IV. Conclusion
Closing/gratitude
The Center for Community Solutions expresses its thanks to all who participated in the survey. Additionally, we thank the stakeholders who provided historical information for this report. The author wishes to thank Emily Muttillo, Research Fellow for The Center for Community Solutions, for her assistance in the survey gathering and data presentation of this report.
[1] Courtesy: DSAS Staff
[2] https://comsolutionst.wpengine.com/wp-content/uploads/2019/06/7.11.2016Age-FriendlyClevelandAssessment.pdf
[3] https://www.cdc.gov/mmwr/volumes/69/wr/mm6939e1.htm
[4] https://www.kff.org/coronavirus-covid-19/issue-brief/what-share-of-people-who-have-died-of-covid-19-are-65-and-older-and-how-does-it-vary-by-state/
%20(1).png)
