Massachusetts Explores The Advantages And Potential Challenges Of The Johnson & Johnson Vaccine, WBUR

Massachusetts received 58,000 doses of the Johnson & Johnson coronavirus vaccine this week, the first shipment of what could be a substantial boost in vaccination efforts here and across the country. But it’s not clear how that boost will play out or when it will start. Gov. Charlie Baker says he’s not expecting any more J&J deliveries until late March or early April.

And Baker hasn’t spelled out how Massachusetts might target the J&J vaccine given its unique advantages: it’s a single dose shot, and it can be moved around a lot — even jostled — without risking stability.

We have some information about how hospitals, health centers and other vaccination programs plan to integrate J&J, but first, let’s look at some numbers that are getting a lot of attention.

Seventy-two percent of Americans who received the J&J vaccine in trials were protected from a mild to moderate case of COVID-19, as compared to more than 90% for the vaccines from Moderna and Pfizer-BioNTech. The three are similar at preventing the worst outcomes: hospitalizations and death. Public health and medical experts are urging people to get any vaccine offered.

“If someone offered me any one of those three vaccines, I absolutely would be comfortable and would be very willing to take any one of those three,” said Dr. Paul Biddinger, who chairs the vaccine advisory board in Massachusetts.

You Get What You Get

In fact, you may not have a choice. Many hospitals and health centers say they’ll give patients the vaccine that’s available at the time of their appointment because managing the timing, logistics and supply of three different vaccines is complicated enough.

Charles River Community Health, which serves 15,000 mostly low to moderate income patients at clinics in Alston-Brighton and Waltham, has been told to expect alternating deliveries of Moderna one week and J&J the next. Other health centers are getting Pfizer as well. And if patients object to the week and the vaccine they’re offered?

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“We’ll attempt to educate them,” says Charles River CEO Elizabeth Browne. “If patients feel really strongly about one vaccine or the other, we’ll say, ‘We hope you can understand that we need to vaccinate as many people as we can as quickly as possible.’ ”

It remains unclear whether all of the state’s large-scale vaccination centers will begin receiving the J&J vaccine once supplies increase, in addition to Moderna and Pfizer. Tufts Medical Center, which began injecting J&J doses this week, is also not offering or entertaining a patient’s choice.

“That’s for a variety of reasons,” says Dr. Helen Boucher, chief of infectious diseases at Tufts. “The first and most important is that there is no reason to pick one over the other” because all three are safe and effective.

In addition, says Boucher, hospitals may only know which vaccine or vaccines they are getting a few days in advance and for safety, it’s simpler to deliver just one at a time.

Lee Nave, a patient at Tufts Medical Center, says he thought he would be getting Pfizer or Moderna Thursday because the registration process had included booking a second shot. But when Nave arrived for his appointment, he was told the syringe would hold the single-dose J&J vaccine.

Nave remembers a mix of feelings. He had read that J&J was not as good at preventing infections overall but good at preventing serious illness.

So, he decided, “If this is one you’re offering me, I’ll take it. And it also seems very convenient to have one shot and get it out of the way,” Nave says.

Lee Naves shows paperwork he received shortly after he was given the Johnson & Johnson vaccine at Tufts medical center. (Courtesy Lee Naves)
Lee Naves shows paperwork he received shortly after he was given the Johnson & Johnson vaccine at Tufts medical center. (Courtesy Lee Naves)

Boucher says most patients she talks to are thrilled to get vaccinated. Still, she’s hearing some questions. Some patients are concerned that the J&J vaccine relied on cells derived from abortions during vaccine development.

The Boston archdiocese said in a statement that Catholics can request a specific vaccine but should not delay getting inoculated if their choice isn’t available.

“We hope that they will ask questions, receive the relevant information about that teaching, and not delay in their acceptance of the vaccination — whichever approved vaccine is offered — when it becomes available to them.”

One and Done

There’s some early evidence of strong interest among Massachusetts residents in the J&J vaccine. In Barnstable County, 1,200 appointments posted online on Friday were gone in 35 minutes.

Some people, like Nave, may prefer the convenience of booking and showing up for a single appointment, and those who dislike shots will appreciate the option of just one jab. There’s also some evidence of fewer side effects from the J&J vaccine, perhaps because it is just one shot. Symptoms like headaches, fever and nausea are more common with Pfizer and Moderna after the second shot.

“We already had people asking for it,” says Dr. Joanna Duby, medical director at Element Care PACE, a program for high risk elders who want to stay in their homes. The program expects to receive some J&J doses for the first time next week.

Element Care runs six PACE clinics across the North Shore and Merrimack Valley. Duby says bringing participants in for one shot rather than two will make logistics much easier. Before COVID, the program’s wheelchair-accessible vans could carry up to 12 people at a time. Now, with safe distancing, it’s one or two people.

“So you can imagine that with a decent size clinic it takes a lot of trips back and forth to bring these people in,” says Duby.

Targeting Homebound and Homeless Patients

Baker has suggested that the J&J vaccine might be especially useful for some hard to reach populations, such as residents who rarely leave their homes and people who don’t have stable housing. The vaccine does not come with the warnings about limiting transportation of the vials to avoid breakdown that accompany the other two available vaccines. But it does have other limitations that will make it hard to use with homebound seniors and other patients.

Here’s the issue: the five doses in a J&J vial must be used within two hours once the vial is punctured — or within six hours if kept refrigerated at 36-46 degrees. That’s easy in a clinic but very difficult for a traveling nurse who must sit and observe a patient, in their home, for 15-30 minutes after the injection.

“If we’re using this for the homebound, it has to be quick,” says Duby, “or we’ll have to have a monitored cooler when transporting it to homes.”

Baker has also mentioned using J&J for mobile vaccination clinics.

Some programs that work with clients who don’t have stable housing are looking forward to receiving the J&J vaccine.

“A one-dose vaccine that is highly effective will be more easily administered to people experiencing homelessness,” said Dr. Jessie Gaeta, chief medical officer at the Boston Health Care for the Homeless Program, in a text. “It’s helpful to avoid the need for second doses when people have to necessarily move around frequently, don’t have stable housing or a reliable address or phone number.”

The state’s vaccine advisory committee is looking at whether there are other populations for whom the J&J shot might work best.

Once supply of the J&J vaccine ramps up, it looks like there won’t be any bonus doses.  Pharmacists say that although they get an extra dose out of Pfizer and many Moderna vials, they don’t get six doses out of the five dose J&J vials.

Beverly Harborlight House Staff, Members Get Vaccinated, Beverly Patch

Element Care helped deliver the second dose to the at-risk and low-income seniors on Thursday.

BEVERLY, MA — Patricia Jackson admits she was nervous about getting a coronavirus vaccine shot when they first became available. It was only after talking to her doctor at Harborlight House that she decided it go for it.

“She went over everything about it and made me feel better,” Jackson said, “so I was like, ‘Cool, let’s do this.'”

On Thursday, Jackson was one of 18 members and 22 staff at Harborlight who received their second shot through a clinic held through a community partnership with Element Care out of Lynn, which supports vulnerable and low-income seniors on the North Shore.

“I was happy with how fast Element Care was able to get the COVID vaccine shots outs to all of us in the program as I know a lot of folks were struggling to find one,” Jackson said.

Element Care registered nurses Jessica Etten and Heidi Connolly helped administer the shots.

“Our seniors rely and count on us so we are making sure to get the vaccine out to them as quickly as possible,” Connolly said. “It’s nice to see the light at the end of the tunnel.”

“After a long and hard pandemic it’s great to finally be able to get the vaccine to our participants and see some hope for a chance at normalcy again,” Etten agreed.

Element Care will next be in conjunction with the Newburyport Health Department at the Newburyport Council on Aging on Sunday.

 

FOCUS ON LYNN SENIORS IN NEW VACCINATION CLINICS, Lynn Daily Item

LYNN — A new round of vaccinations will be going out to Lynn seniors next week, in the Commonwealth’s drive to get elderly people protected against COVID-19.

The new drive will be conducted by Element Care PACE, a Lynn-based elderly care organization that provides care to seniors who live independently, and will be focused on seniors that are in Element’s care.

“Our goal is to get the vaccine out as quickly as possible and as safely as possible, and to not waste any of it,” said Dr. Joanna Duby, the medical director at Element Care PACE.

The organization registered with the Massachusetts Department of Public Health (DPH), and received its first doses from the state this past Tuesday.

Element has already vaccinated its staff and will begin vaccinating hundreds of seniors at two clinics in Lynn next week.

Duby has found a strong interest in vaccinations among the population she works with.

“The seniors are the ones who want it more than a lot of younger people, because they’re the ones who have seen the devastating effects of the virus on them and their friends,” said Duby, who reported that approximately 180 of the 1,000 patients Element Care PACE works with had contracted the virus, and more than 50 patients had died.

“It’s been devastating. In addition to the risk of getting the virus, the social isolation has been awful,” she said. “They can’t eat with their friends, they can’t see their families, and it’s taken a huge toll on their mental health and their physical health.”

Duby said the process of getting the vaccinations set up was difficult, and that she wished seniors could have had access to the vaccines sooner.

“It’s been a challenge,” said Duby. “It’s hard to know when you’re getting a vaccine, how much you’re going to get, when you’re going to get it. We hoped that the rollout for seniors would be sooner, especially for places that have been hit hard like Lynn.”

As of February 1, residents 75 and older became eligible for the COVID-19 vaccine as the state opened the second phase of its vaccine distribution plan. However, that rollout has been blasted by state representatives and elderly organizations for being overly complex.

People 75 or older are asked to apply for a vaccination appointment through the state website, www.mass.gov. Duby reported that her organization was uniquely equipped to assist its seniors with navigating this process since its staff have close relationships with the individuals they care for and can provide them with vaccination information directly.

For other Lynn seniors, the process of getting registered has been more difficult.

Rosemie Leyre, 78, a Lynn resident, encountered several issues with the website when she tried to apply for a vaccination this week.

She found out about the vaccination process opening to seniors 75 and older from a neighbor, and went to the state website to apply. She entered her location and her zip code, as was requested by the site, she said.“It said this zip code does not exist,” she said. “Then I got a message that said ‘try again in 24 to 36 hours.’ And I had a few friends who had had the same experience.”

Eventually, she was able to apply through the “Patient Gateway” portal from Massachusetts General Hospital and scheduled an appointment for Wednesday evening at a Lynn site.

Leyre said her friends were very interested in getting the vaccine as soon as possible.

“The people I know are all very positive towards the vaccine,” she said.

Of the group of people she knows, she said only one of them was skeptical of the vaccination.

A Belgium native, Leyre hopes that once the virus subsides she will be able to visit her daughter, who still resides in her home country.

“I can’t believe how long it has been since I traveled,” she said.

Guthrie Scrimgeour can be reached at gscrimgeour@itemlive.com

Thousands of Massachusetts hospital staff expected to begin getting long-awaited COVID-19 vaccinations next week

Staff and residents at senior care facilities may be only days behind

By Deanna Pan and Robert Weisman Globe Staff,Updated December 11, 2020, 7:03 p.m.

The Food and Drug Administration Friday night approved the first COVID-19 vaccine in the United States for emergency use, clearing the way for the first Massachusetts residents to receive inoculations as soon as Tuesday, as hospitals and senior care facilities say they can begin immunizing staff and residents within hours of receiving their shipments of the precious cargo.

Shipments of the two-dose regimen from drug makers Pfizer and BioNtech, packed in dry ice, should be en route to hospitals on Monday or Tuesday, officials said.

Within 24 hours of receiving their first shipment, officials at the state’s largest hospital system, Mass General Brigham, will be able to vaccinate a limited number of employees, said Dr. Paul Biddinger, the system’s medical director for emergency preparedness. He said the system, which includes Mass General and Brigham and Women’s hospitals, expects to ramp up vaccination capacity before the end of the week.

“We want to start with a minimum across the enterprise of 1,000 employees a day, but we want to actually be able to accelerate beyond that relatively quickly,” Biddinger said. “We’re hoping it’s only a matter of a couple of months to get us through the majority of our workforce.”

Mass. hospitals hope to administer COVID-19 vaccine to some workers as soon as next week

Dr. Saul Weingart, chief medical officer at Tufts Medical Center, said he anticipates the hospital will receive its first 975 doses on Monday, and begin offering the vaccine to employees in “patient-facing” areas shortly after that.

“So we would potentially have about 1,500 to 2,000 staff members who would be eligible to receive the vaccine, and our expectation is we would get it into them all in a six-week period,” he said.

Boston Medical Center, meanwhile, is preparing to roll out its staff vaccination program on Dec. 16, the day after the hospital expects to receive its shipment of two trays containing 975 vaccines each. BMC has already hired temporary nurses on contract to begin administering shots.

The hospital is still finalizing which employees will be offered vaccinations first, explained David Twitchell, BMC’s chief pharmacy officer, with staff who are at risk of exposure to COVID-19 receiving priority. Employees will be notified of the opportunity to schedule their vaccination appointments in randomized batches of 300.

“We’re trying to be transparent [about the process],” he said. “It’s not about one person being more important than the other; it’s about trying to have a rational way of rolling this out.”

Governor Charlie Baker this week announced a plan to offer the first vaccinations primarily to health care workers and seniors in long-term care facilities. He expects the state to receive 300,000 doses of the vaccine by the end of December, although this is contingent on the FDA giving approval to vaccines developed by Pfizer and Cambridge-based Moderna.

Mass. lays out COVID-19 vaccine timeline, but most will have to wait till spring

The FDA advisory committee is scheduled to debate whether to allow emergency use of Moderna’s vaccine next Thursday.

Both vaccines require people to get two shots a few weeks apart to be maximally effective; the shots also must be kept at extremely cold temperatures to prevent the vaccines from spoiling. As a result, the first shipment of Pfizer’s vaccine is being delivered only to Massachusetts hospitals equipped with ultra-cold freezers.

Senior care sites are hustling to set up their own vaccination spaces, ready consent forms and protective gear, and reassure skeptical health workers and seniors that the vaccines are safe and effective.

“This is an entirely new experience,” said Matt Salmon, chief executive of Salmon Health and Retirement, which hopes to vaccinate 700 residents and 1,500 staffers at a half dozen skilled nursing facilities across central Massachusetts over the coming weeks. “In the history of nursing homes, we’ve never had to do mass vaccinations in such a short period of time.”

Some senior care facility administrators have been told vaccinations at their sites will start on the week of Dec. 21 or the following week. But they are clamoring for more information from federal health authorities and from their contractors, CVS and Walgreen, which will administer the vaccination clinics, on how it’s all going to work.

“Operators are living in fear that they’ll just get a knock on their door,” and the vaccinations will begin without adequate preparation, said Tara Gregorio, president of the Massachusetts Senior Care Association.

While the pharmacy companies have promised to bring the equipment needed to handle the injections and have hosted webinars providing basic information, senior care operators say they’re still in the dark on key points, such as clinic hours and expectations of their staffs.

The companies, following federal guidelines, have committed to making only three visits to each nursing home, rest home, and assisted living center to administer the two-dose regimen — a schedule operators say is far too compressed to vaccinate hundreds of staffers working in three shifts. Some fear that side effects of the vaccine could cause temporary staff shortages if everyone is vaccinated at once.

“We have a lot of ground to cover between now and when the vaccinations start,” Salmon said. “If we don’t coordinate on this, it’s not going to be as effective as it could be.”

Assisted living administrators, meanwhile, are waiting to find out how many initial doses they will receive from the state. They’re also cautioning against letting down their guard at a time when virus infections are rising in senior facilities.

“We want to lean into best practices in infection control in assisted living now as we see the light at the end of the tunnel,” said Brian Doherty, president of the Massachusetts Assisted Living Association.

Some organizations employing home health care workers have registered to receive vaccine supplies from the state Department of Public Health. Front-line workers who help home-bound seniors are in the high-risk group set to be vaccinated first, but details of how and when they’ll get their shots remain to be worked out.

“As soon as we can do it, we’re ready to go,” said Dr. Joanna Duby, medical director at Element Care in Lynn, a nonprofit that sends more than 100 nurses, personal care assistants, physical and occupational therapists, and other workers into the homes of elderly low-income residents. “In terms of when we’re going to get the vaccine and how we’re going to get it, we’ll wait to hear.”

Staff at senior care facilities have gotten used to adjusting to fast-changing conditions since the COVID-19 pandemic began last spring, but Salmon of Salmon Health and Retirement, said preparing for vaccinations on short notice without adequate information may pose the biggest challenge yet.

“This is a whole new level of flying by the seat of our pants,” he said.

At Mass General Brigham, by contrast, administrators are well along planning a rapid mass vaccination. They’ve divided the work force into four waves, starting with staffers involved directly in COVID-19 evaluation, testing, and care. The hospital system also is launching a feature on one of its smartphone apps that will allow staff to schedule their vaccination appointments.

“We want to try and make it through each of the wave as quickly as we can,” Biddinger said.

Mass. elders living at home helped by free programs

COVID-19 has dramatically impacted older adults, through illness or the isolation often needed to keep them healthy. In Massachusetts, a free program is supporting those able to stay in their homes by partnering with families as the pandemic continues to take its toll.

Below is a link to a piece that aired on November 17th, 2020 on Boston’s WCVB 5 News on how PACE helping Massachusetts elders live safely at home.

https://www.wcvb.com/article/free-program-supports-massachusetts-seniors-living-at-home/34701206

PACE program assists with Care, transportation

For Norm and Mary Jo Zarella of Lowell, Massacusetts, MASSPACE is a lifeline. “We would be lost without it,” Norm said. Mary Jo, who has been diagnosed with dementia, receives comprehensive care from doctor visits to day care while Norm con­tinues to work, and even has caregiver support at home. Monday through Friday an aide arrives at 6:30 a.m. to help Mary Jo with daily tasks as Norm readies for work. At 8:30 a.m. she gets a ride to Fallon Health’s Summit ElderCare pro­gram in Lowell where she spends her day socializing, eating meals and doing recreational activities until early afternoon, when she gets transportation home. Another aide meets her there to accompany her until Norm returns from work.

Click here to continue reading….

Home Care Magazine

5 Questions With: Candace Keubel, Executive Director of MassPACE

 

MassPACE, the Massachusetts chapter of Programs of All-inclusive Care for the Elderly, has taken an innovative approach to serving its clients, mostly patients who are dual eligible for Medicare and Medicaid, during the pandemic. While traditionally center-based, MassPACE shifted to an at-home model, sending caregivers out with tablets for telehealth and also setting up social activities, counseling and more. Some centers were even transformed into temporary infirmaries for COVID-19 patients to reduce hospitalization. HomeCare talked with MassPACE Executive Director Candace Kuebel about some of the lessons and about partnering with homecare organizations.

HomeCare: It sounds like MassPACE has done a great job pivoting in these crazy times. Tell me a little bit about what that looked like.

Candace Kuebel: Yes, we were able to pivot literally overnight and I’ll tell you why. It might have been our finest hour, because the PACE model of care was designed 30 years ago to be extremely person-centered. Many of our patients participate in the development and the practice of their daily care plan, along with an 11-member interdisciplinary team ranging from a geriatrician through transportation coordinator; it’s a pretty mind-blowing model. And it’s center-based. A PACE center can be thought of as an adult day health center, but co-located with a soup-to-nuts medical clinic and rehabilitative therapy gym. It’s like social cafe in the front of the house and it’s the Mayo clinic in the back.

Many of our participants traditionally visited the pace center on a regular basis for their social and medical rehab and nutritional needs. Now, some of our participants live in assisted living and they get their socialization at the assisted living, or they are very active in their supportive housing unit for various reasons. Does that mean that they don’t get the care that is delivered by all of these 11 disciplines? Absolutely not. They get in their homes, right? So that model existed already. While challenging, it was something that was already happening. And those challenges were met with opportunities to rapidly redeploy site-based staff to home-based care, as well as to introduce and deploy to more participants important technology—some of which was already happening, but went on steroids during the pandemic.

HomeCare: What was your biggest challenge?

Kuebel: The biggest challenge, and you’ve heard this many times before, was scrounging up the personal protective equipment (PPE). I know I’m singing to the choir here because the home health industry was at the bottom of the food chain in being able to secure PPE. And it is just mind-blowing to us; how do we deliver care into the home? Without it, we cannot ensure the safety of our workers and of our vulnerable patients… We had to be very creative and get it however we could. And then the testing, you know—it was just an unbelievable phenomenon that in America, we would have this situation. But you know what? This healthcare model employs innovative people and resourceful people, and especially the homecare industry; they are the unsung heroes. These are the angels in the healthcare system, the frontline workers who put themselves out there.

HomeCare: What worked better than you expected?

Kuebel: We were so surprised to find that our participants and our employees were willing to do whatever it took to make this work. You think about health care and you think about the fact that these are people who have multiple chronic conditions. These are nursing facility, clinically eligible individuals starting at age 55, up to 65% of them have a comorbidity with some sort of behavioral health diagnosis. This is the kind of population we’re talking about. And they were in lock step with us…

It’s not just about the medical care though, right? It’s about our activity staff that developed activity kits or coloring kits and paints and they delivered them along with their meals. “Here’s your lunch and here’s something for you to do this afternoon,” they said. “And we’re going to call you in the evening while you’re getting ready to take your medication and make sure that everything is okay.” It was very high touch, and they had the ability to do that and the caregivers really appreciated that and were really willing to work with us… That didn’t require any kind of technology or any big shift or anything like that. It was just thinking through, okay, what will make this person’s day better?

HomeCare: What about on the clinical side? And infection control? You were able to keep infection rates really low.

Kuebel: Let me just talk about that for a minute. It took different plans, developing models where, you know, you don’t want to expose 11 members of the care team to one person who may be infected. They came up with these very complicated algorithms, really, such as having one caregiver be assigned to all of the individuals in one housing unit. And that person would go in with an iPad, something as simple as that and would have eyes on the patient and the interdisciplinary team with Zoom or something like that. … That is how we kept people well in the community and how the team pivoted. … You know, I mean, you know, given the highly contagious nature of the virus, its long incubation period and airborne transmission, that is why you’ve had the fatality rates in congregate settings. And that is why we needed to keep people out of there.

HomeCare: What should home health and HME providers know about working with PACE? Or are there things about the PACE model that they might be able to apply to their business model?

Kuebel: Let me just make a very, very important point, and that is that 11-member disciplinary interdisciplinary team is employed by the pace organization. I think of concentric circles; the participant is in the middle of the circle and then that first outer band is the interdisciplinary team. And then the second band is our contracted providers. We contract with thousands of home health agencies; they are our secret sauce and we can’t do this by ourselves. (In terms of working with HME providers,) the beauty of the capitated model is we aren’t limited; we don’t have to get permission. If our team decides that somebody needs a rollator and they subscribed it, it’s not, this person needs to get authorization so she can maybe have it tomorrow. She is at risk. And so let’s get that over to her this afternoon.

 

 

 

 

Demand for In-Home Senior Care on the Rise

An increasing number of seniors are opting for in-home care over nursing home facilities as a safer option amid the coronavirus pandemic.

Below is a link to a piece that aired on October 21st, 2020 on Boston’s NBC News at 11pm on how PACE is a great alternative to nursing home care.

https://www.nbcboston.com/news/local/demand-for-in-home-senior-care-on-the-rise/2215480/

Coronavirus Disrupts Routine for Dementia Patients” includes quotes from Element Care’s physician Dr. Eric Reines. [Lynn Daily Item]

She used to see her daughter and grandson every Sunday, go to church, and even help cook dinner that night if it was a recipe she is familiar with. But there are no more visits, no more church, and no more trips to places like the grocery store due to the pandemic of COVID-19.

Lynn resident Sam is his wife’s caretaker. She suffers from Alzheimer’s disease and the resulting dementia, but, under usual circumstances, the couple maintains a sense of normalcy by having a routine. Sam did not wish to identify himself or his wife by name.

“It’s not so much that routine helps her memory, it’s more that it gives her joy, a sense that there are people that come see her and care,” Sam said.

Sam said his wife has barely left the house since the coronavirus outbreak, and he has minimized his trips out of the home because he’s worried about getting them both sick in their old age. He has made lots of phone calls to friends and family, and always gets his wife on the phone, but it’s not the same as the frequent in-person visits.

“She asks (where her daughter is), and she asks when she’s coming,” Sam said. “It’s sad to hear, and there’s no sense in saying, ‘I’m sorry, we don’t know when she’s coming back.’”

A lack of regular communication has been the most difficult of the COVID-19 pandemic for his wife, Sam said, and the rest of their days haven’t been that different than normal. They wake up around the same time each day, and do things in a very specific order. They get dressed, then eat breakfast sitting in the same seats they do every day, with the television always on in the background.

“It can get tough trying to figure out what the rest of the day is like. We are watching a lot on TV,” he said.

Dr. Eric Reines is a physician with the nonprofit healthcare organization Element Care, which serves the elderly throughout Essex County and northeastern Middlesex County, with four offices in Lynn, and other locations in Beverly, Gloucester, Lowell, and Methuen. Reines has provided geriatric care to dementia patients at their homes, at Element Care offices, and at nursing homes during his past 12 years with the organization, and said having a normal routine is critically important.

“Right now, it’s rough. It’s a heartbreaking situation,” said Reines.

Element Care’s day care services are closed right now, and visitors are not allowed at its nursing homes, except in extreme situations such as end-of-life visits. And, for the many seniors with dementia who are confined to their homes right now, they can’t have visitors like children and grandchildren to brighten their days.

“The biggest thing is family and loved ones can’t visit. We try to set up ways to Facetime or Zoom or Skype between people with dementia and their families,” Reines said. “Sometimes families will visit just to knock and wave through a window, but, on a case-by-case basis, sometimes that can be more upsetting than no visit at all.”

Reines said people with dementia may not understand why they haven’t been visited. It’s also difficult that caregivers are getting sick, and strangers will have to fill in, confusing dementia patients. For those with very poor memory, doctors may even suggest that caregivers tell a white lie.

“If the memory is bad enough, you can tell them, ‘They were just here yesterday, they can visit tomorrow,’” Reines said. “I don’t like to tell white lies, but sometimes that’s the better part of the battle.”

People with dementia staying inside are being given activities like watching TV, doing puzzles, and playing word games. Objects that are familiar to them, or pictures, can be helpful in keeping a small sense of familiarity in their lives, Reines said.

“Some (people) are getting listless, just lying in bed, depressed,” Reines said. “Some insist on getting more upset if they are being held back.”

Reines said “it’s not worth the fight” if a person with dementia gets extremely upset and needs to go out for a walk. He added they should be wearing masks, and even gloves and goggles — that can be confusing as well — and staying 6 feet from others.

“Really, routine is important. If whatever part of routine is something you can still maintain, do that,” he said.

There are so many “unknowns” when it comes to COVID-19, Reines said, and that also applies to dementia patients. It’s unknown how long the pandemic will last before their routines may resume, and it’s unknown if they will be affected long-term by the current lack of normalcy.

Making sure that people with dementia are as comfortable as possible, while also minimizing the possibility of them getting sick, is about all that can be done.

The Changing Face of Aging Well [Merrimack Valley Magazine]

The Changing Face of Aging Well

Today’s baby boomers think differently than earlier generations about what it means to age well. They want to remain independent, stay mentally and physically fit and maintain a wide array of interests. At the same time, achieving optimal health is no easy task for many of them, especially for those on fixed incomes who are challenged by the high cost of health care. 

Many boomers and other older adults ponder, “How do I continue being me and doing the things that I love when my income drops, my network gets smaller and many health care options are beyond my means?” says Bruce Jankowitz, director of marketing at Element Care, a nonprofit organization that provides health care to low-income adults 55 and older in the Merrimack Valley through its Program of All-Inclusive Care for the Elderly (PACE). “Today’s older adults want the best of both worlds,” continues Jankowitz, “[They want] health care that helps them to stay independent and live in their homes and communities for as long as possible and cool activities so they can continue to do the things they love.”   

Over the last few years, Element Care has used the PACE model to address the changing needs and expectations of its clients. Participants joining the program have access to services that help them stay active. For example, participants can receive avatar home companions — electronic pets such as virtual cats or dogs that operate on a 4G network. These electronic pets play games with their owners, provide reminders to exercise and take medications and allow 24/7 monitoring for signs of distress.

“About 25% [of participants] are using the new technology,” Jankowitz says. “From keeping them happy and active to reminding them to take their medication, Element Care is adapting to a new generation of boomers.”

Element Care’s other programs include cooking classes; the PACE Olympics; Latino music, dancing, dominoes and food in Lowell and Methuen; and special events for the Cambodian New Year including past performances by the Angkor Dance Troupe. 

“The paradigm for aging well is changing and Element Care continues to innovate to engage older adults of all ages and cultures,” says Jankowitz. This commitment to innovation is on display at the PACE Element Care wellness center on Central Street in Lowell and at Ingalls Court in Methuen. There, an entire team of clinical and social service professionals proactively manage the health care of their participants. Element Care provides everything they need to age well, including primary, specialty, hospital and dental care; physical and occupational therapy; transportation to all medical appointments; and hosting activities that address the changing needs of older adults. There are no monthly premiums, copays or out-of-pocket expenses for those who qualify for Medicare and MassHealth. Medicare only and private pay options are also available.

There are other challenges that face boomers at any income level. Their generation faces an epidemic of obesity and diabetes. Alzheimer’s and dementia rates are skyrocketing. Increased traffic congestion in our area can make it feel as though the roads are less safe (although this isn’t necessarily clear from the data). And who knows what changes to our health care system will create unforeseen consequences as more and more boomers head into retirement?

Still, what matters most is that boomers seem unwilling to accept the old stereotypes about what it means to live and thrive in life’s later decades. How they, and we as a society work together to facilitate this process is a challenge we avoid facing at our own peril