COVID-19 and PACE: Interview with Dr. James Mittelberger

Regulation | March 25, 2021

Dr. James Mittelberger, Chief Medical Officer, Center for Elders’ Independence, joined the LeadingAge Coronavirus Update Call on March 25, 2021. He responded to questions from Ruth Katz and callers.

Dr. James Mittelberger, Chief Medical Officer, Center for Elders’ Independence, joined the LeadingAge Coronavirus Update Call on March 25, 2021. He responded to questions from Ruth Katz and callers.

Q:​Please tell us about the Center for Elders’ Independence

A:​We have eight PACE sites. PACE is a program of all-encompassing services for older adults. Medical and social issues are addressed in an integrated way. We provide care in our centers and in people’s homes and throughout anynursing home and hospital stays they may have.

Q:​What changes did you need to make during COVID?

A:​We have care centers that are indoors and generally engage 70-100 people. So, we instituted changes as recommended by the CDC. We never “closed”, but instead engaged in personalized care planning for each individual,weighing risks and benefits for each person. There were about ten people in each center who could not be managed safely without coming into the center. We kept peopledistanced and followed hygiene and masking guidance. Wedid not have any center-based participants contract COVID.We did testing only when people had symptoms.

Q:​How did the level of community positivity affect PACE sites? We know that was a factor for nursing homes.

A:​Nursing homes have people living there full-time and staff go from person to person. At our PACE sites we had the ability for people to come in and sit down and stay distanced. We were at 10-15% of our usual participants so that made it easier to keep people safe. 

Q:​How did you use technology during this pandemic?

A:​We turned our work inside out and technology was key. We did the vast majority of our medical care by telehealth. We bought participants who needed them devices that they could use. We moved to providing meals by delivering them to people’s homes. We did rehab sessions by video and we set up a robust online activities program. We offered virtual concerts and invited people beyond our participants to attend.

Q:​Are there some elements of technology and virtual connection you will retain post-pandemic?

A:​Yes indeed, some people really liked the video interaction, and we will continue with that. It will allow us to interact with participants more frequently and facilitate their greater engagement. 

Q:​How did the role of families change with participants at home rather than at the centers?

A:​Most of our participants are on Medicaid, and family members often work in stressful or high -risk environments. As part of the care planning process we tried to provide extra services to the families, knowing that they are under stress. Mental health services were especially needed.

Q:​Since so many family members are essential workers, the risk of transmitting COVID to participants seems high. Was that the case?

A:​As I mentioned, none of the participants who came into the center got COVID, but we did have other areas that were hard hit. This was especially true in congregate care facilities.

Q:​How has the vaccination process worked?

A:​We have built strong relationships with our public health departments over the years, and we were able to convince them that our people should be in the 1A group – which makes sense since they are nursing home eligible. And, we went through the process to become vaccinators which allowed us to vaccinate our participants.

Q:​What was involved in becoming a vaccinator?

A:​We worked closely with the public health departments – those relationships and filling out a great deal of paperworkboth to apply, and during the vaccination process were the main elements.

Q:​Did you find that staff were reluctant to receive the vaccine?

A:​Of our home health aides providing care in the home, which is a high- risk environment, only 5 of 35 agreed at first to receive the vaccine. We have a diverse group of NPs, nurses, and doctors and so early on we made a video talking about why the vaccine was important. We did small group discussions and learned that consistent messaging in respectful ways using motivational interviewing made a difference. Now 80%+ of participants and 70+ of staff are vaccinated.

Q:​In listening to you, I hear that you treat staff and residents as individuals.

A:​Yes, I and we believe we should treat people the way wewould want to be treated.

Q:​Did involving non-participants in things like virtual concerts help attract new participants?

A:​We did not use the community zoom events as a marketing tool, but we did continue to see growth in enrollment. We think that was mostly through word of mouth.

Q:​How did residents and families respond to your decision not to close?

A:​Some families were glad to have their family members safely at home. But, for the participants who did come to the center, those families did not have the resources to care for the person at home, so there was appreciation that the center was open for those who really needed it.

Q:​What types of mental health services did you provide?

A:​We offered some general mental health groups, but mostly we held virtual and in-person visits with mental health professionals.