The plan was for a local pharmacy to set up COVID-19 vaccination clinics inside senior housing buildings in Elizabeth. Convenient locations? Yes. Simple undertaking? No.
The first few months of New Jersey’s vaccination campaign have reinforced what those who work with diverse populations of older adults have long understood: Simple plans only work for some.
Experienced service providers know that older residents with chronic illnesses or mobility challenges might need assistance getting to a vaccination clinic — even if it’s in the lobby downstairs or the building next door. And after months of warnings about the danger of gathering in public places, many might also fear waiting in long lines for a vaccine they might already be leery of.
So, as an agency that serves more than 2,000 residents, the management team at the Housing Authority of the City of Elizabeth (HACE) knew that even with clinic sites located inside their buildings, they would need a detailed strategy to enable all interested older residents to be vaccinated safely.
As a state with an aging population, a fragmented public health system, a mostly car-dependent transportation infrastructure and a vast, unmet need for affordable housing, New Jersey could take many larger lessons from the plan HACE administrators devised — lessons that could and should be applied not just in times of crisis and not just within the narrow framework of aging-services programs, but across all levels of government policymaking and community services planning.
Assembling the team
First, HACE assembled a large and diverse crew of its own staff to assist, including top administrators, property managers, maintenance staff and office workers, ensuring enough familiar faces to put residents at ease and enough bilingual interpreters to translate vaccination instructions. It also turned for help to the city’s community police and emergency medical services divisions, guaranteeing sufficient medically trained staff for anyone who had an adverse reaction.
Ahead of the planned clinics, HACE staff went door to door to collect registration information and assist residents in completing the necessary forms. On clinic days, the vaccination crews also administered doses in tenants’ apartments and had staff stationed throughout the floors to monitor reactions. Additional staff made sure clinic sites did not become too crowded.
Across five days in January and February, nearly 1,400 vaccine doses were administered to staff and residents, including many who were initially hesitant but assuaged by the personalized outreach.
The HACE effort is one of the too few success stories in a statewide vaccination campaign plagued by cumbersome registration procedures, unwieldy websites, inadequately trained telephone hotline staff and poor vaccination distribution decisions.
Vaccine supplies remain limited in New Jersey, but that is far from the only reason that many older, disabled or isolated New Jerseyans have been disenfranchised, especially those from historically marginalized racial/ethnic groups. The barriers to vaccination many have faced are endemic to New Jersey’s older adult services and planning systems, which too often lack contingencies for those without technology, transportation or a support network of family and friends to help them.
Age-friendly alliance across counties
But experiences such as those in Elizabeth show that progress is possible. We are fortunate to belong to an alliance of age-friendly communities that spans Bergen, Essex, Morris, Passaic and Union counties. With support, in part from private philanthropy since 2016, age-friendly leaders of communities in this alliance have been working to cultivate collaboration across sectors to make their municipalities better places to grow up and grow old.
We have seen age-friendly improvements within our communities through the coordinated efforts of local government, community organizations, local businesses, grassroots community groups, and more. Successes are reflected in revamped zoning rules, new infrastructure priorities, communication platforms designed for residents in middle and later life, and more inclusive community events.
We’ve learned, though, that community-level action alone isn’t enough.
For progress to become both widespread and sustainable, New Jersey needs a state government-led “Age-Friendly New Jersey” initiative. Gov. Phil Murphy’s proposed 2022 budget includes a small amount of funding toward this aim, making now an opportune time to examine how state government can support age-friendly progress at all levels of government and by fostering stronger public- and private-sector partnerships.
First, as part of this initiative, the state should require and equip all government agencies to incorporate age-friendly principles within their work — not just at Human Services and its Division of Aging Services, but also Public Health, Transportation, Community Affairs, Labor and Workforce Development, and beyond.
Second, this initiative should include incentives for public- and private-sector leaders to engage in multisectoral age-friendly planning and action at the local level and share best practices. Our philanthropically supported alliance provides a model that can be scaled up through investments by the state.
State must take the lead
Third, to promote and assess age-friendly progress, the state also needs to take the lead on developing a formalized system of reciprocal communications and data-sharing across all government levels and the private sector. This could be modeled, in part, on New Jersey’s Regional Health Hub program, which facilitates coordination between local community leaders and key state agency leaders to support innovations in the state’s Medicaid program.
In our vision of an “Age-Friendly New Jersey,” the numbers of older adults who become “invisible” in their own communities would shrink as we take coordinated state- and local-level action toward emergent issues (such as COVID-19 vaccinations) as well as longer-standing ones, such as social isolation, economic insecurity, and limited housing and transportation options.
Such chronic ills are too often blamed on the act of aging rather than on the failure of societal systems to act.
In Elizabeth, where an age-friendly community initiative was launched five years ago, local leaders had the boots-on-the-ground insight and leadership to identify the challenges of vaccinating older adults in the city’s public housing buildings. Then they relied on the public- and private-sector partnerships they had formed to help marshal the resources needed to overcome them.
Such collaborative, innovative approaches to promoting older residents’ health and well-being should be the norm, rather than the exception across our diverse state. Adopting “Age-Friendly New Jersey” as a philosophy of serving, a goal of planning and an ingrained system of governing would make that so.