Serving Native Elders During the COVID-19 

Pandemic: Findings From an Analysis of 

Title VI Grantee 2020 Program 

Performance Report Data
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI 

Grantee 2020 Program Performance Report Data

Contract Number: HHSP233201500039I / 75P00120F37027

Submitted on: June 1, 2022

Recommended citation: Administration for Community Living. (2022). Serving Native Elders 

During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 2020 Program 

Performance Report Data. U.S. Department of Health and Human Services.
We would like to thank the RTI team, Melissa Hunter, Marque Long, Becky Durocher, Natalie 

Mulmule, and Michael Hayes, for preparing this report. We gratefully acknowledge the many 

contributions of ACL staff, especially our project officer, Kristen Hudgins, PhD. Michelle Myers 

provided excellent editing and document preparation. 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report iii

Contents

Section Page

Executive Summary.........................................................................................................................1 

Background......................................................................................................................................1 

Results..............................................................................................................................................2 

Impact of COVID-19 ................................................................................................................2 

Nutrition Services....................................................................................................................2 

Congregate Meals..........................................................................................................3 

Home-Delivered Meals..................................................................................................3 

Other Nutrition Services................................................................................................4 

Health and Safety....................................................................................................................5 

Personal Protective Equipment.....................................................................................5 

Access to Prescriptions and Health Services..................................................................5 

Durable Medical Equipment..........................................................................................6 

Wellness Checks.............................................................................................................6 

Social Supports........................................................................................................................6 

Group Activities..............................................................................................................6 

Individual Activities........................................................................................................7 

Virtual Programming......................................................................................................8 

Intergenerational Activities ...........................................................................................8 

Caregiver Support..........................................................................................................8 

In-Home Supports...................................................................................................................8 

Household Items............................................................................................................9 

Home Safety...................................................................................................................9 

Access Services........................................................................................................................9 

Information, Referral, and Benefits Enrollment............................................................9 

Transportation and Errand Assistance........................................................................ 10

Technology.................................................................................................................. 10

Communication.................................................................................................................... 10

Newsletters and Flyers................................................................................................ 11

Text Message or Phone Call Check-Ins....................................................................... 11

Card Deliveries............................................................................................................ 11
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report iv

Mass Media................................................................................................................. 11

Other Communication Techniques............................................................................. 12

Conclusion .................................................................................................................................... 13

Appendices

Methods.......................................................................................................................................A-1 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report ES-1 

Title VI grantees are Native organizations and service providers that offer nutrition and 

supportive services to older American Indians, Alaska Natives, Native Americans, and their 

caregivers. They receive funding through the Older Americans Act (OAA) to provide services 

that keep Native Elders safely in their homes and communities. During the 2020 reporting 

period, grantees received additional funding through the Families First Coronavirus Response 

Act; Coronavirus Aid, Relief and Economic Recovery Act; and other sources in response to the 

COVID-19 public health emergency (PHE). Grantees were also given spending flexibility because 

of the Major Disaster Declaration during this time. 

Grantees report annually on how they spend funds provided to them through OAA, and during 

the 2020 reporting period, which ran from April 1, 2020, through March 31, 2021, they were 

also asked to report on how they spent their supplemental funds. They provide quantitative 

data about how many people they serve and how many units of service they provide for each 

service category. They are also given the opportunity to provide written responses to various 

prompts to better illustrate the work they are doing in their communities. 

The 2020 reporting period was during the peak of the COVID-19 PHE. The Administration for 

Community Living sought to learn more about how grantees served their communities during 

this time. This report analyzes the qualitative responses provided by Title VI grantees in their 

2020 Program Performance Reports (PPRs) to better understand what Title VI grantees said 

about their programs during this time. Analysts reviewed grantee responses to each of the 

three qualitative prompts in the PPR, coded the responses based on the content, and identified 

recuring major themes. 

Findings fall into several main themes: the overall impact of COVID-19; how grantees continued 

to provide nutrition services, health and safety supports, social supports, in-home supports, and 

access services to Native Elders; and changes in communication techniques used by grantees. 

Each of these is expanded upon in the report, with specific examples from grantees provided. 

EXECUTIVE SUMMARY 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 1 

Title VI grantees are Native organizations and service providers that offer nutrition and 

supportive services to older American Indians, Alaska Natives, Native Americans, and their 

caregivers. They receive funding through the Older Americans Act (OAA) to provide these 

services each year. Grantees received additional funding through the Families First Coronavirus 

Response Act; Coronavirus Aid, Relief and Economic Recovery Act; and other sources, and

spending flexibilities because of the Major Disaster Declaration, in response to the COVID-19 

public health emergency (PHE) during the 2020 reporting period. These additional funds and 

flexibilities were meant to help grantees address the needs of their communities during the 

pandemic. 

Each year, Title VI grantees report on how they spent their funds in a Program Performance 

Report (PPR). All grantees provide quantitative data on the number of people they served and 

total service units they provided for each OAA service. They are also given the opportunity to 

respond to prompts related to what other supportive services they provided through their Part 

A/B funding; what is included in their financial reporting; and how the community benefited 

from their Title VI programs during the PPR reporting period. While the first two prompts are 

related explicitly to Part A/B funding, the storytelling prompt provided grantees an opportunity 

to share about the impact of Part C (caregiver) services as well. 

The 2020 PPR reporting period ran from April 1, 2020, through March 31, 2021, as grantees 

were navigating the COVID-19 PHE. Grantees continued to serve their Native Elders while 

maintaining social distancing and other public health safety requirements. The Administration 

for Community Living (ACL) sought to learn what Title VI grantees said about their programs 

during this unique and challenging time. This report summarizes findings from Title VI grantees’ 

written PPR responses to answer this question. 

BACKGROUND 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 2 

IMPACT OF COVID-19

It is no surprise that the 2020 

reporting period was a difficult 

one for many grantees. Some 

grantees reported completely 

stopping services for Native

Elders for some amount of time 

during the reporting period. 

Others noted that they were 

busier than ever trying to keep 

up with new clients and everchanging public health precautions. Many grantees were working with fewer available staff 

because of furloughs or resignations. When staff positions did become available, it was difficult 

for grantees to fill them. Despite these challenges, they noted that their staff were courageous 

in the face of COVID-19 as they continued trying to serve Native Elders. 

Fifty-five grantees noted that they stopped in-person services during this reporting period–

particularly home visits, congregate meals, and visits to nursing homes or assisted living 

facilities. Several grantees (n = 4) specifically said that this led to increased isolation or 

depression for the people they serve. Others reported that some of their Native Elders and staff 

contracted the virus, and that there was constant fear about the spread of COVID-19. Even so, 

grantees worked to implement new services and help Native Elders in any way they could.

NUTRITION SERVICES

Nutrition services—including congregate and home-delivered meals, nutrition education, and 

nutrition counseling—are integral to helping Native Elders stay safe and supported in their 

communities. Service delivery was drastically altered during the 2020 reporting period because 

of the PHE. The number of people enrolled in nutrition services increased for many grantees, 

with several reporting that they had record numbers of people registered for meals during this 

time. Leech Lake Band of Ojibwe, for example, reported the number of participants in their 

nutrition program increased 150% during the 2020 reporting period. Grantees needed to find 

ways to provide nutrition services to more people under difficult circumstances. 

RESULTS 

“I would like to acknowledge our 

dedicated staff. They have been very 

brave in providing services to our elders 

through the toughest times.”

— Pueblo de Cochiti Elder Program
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 3 

Congregate Meals

Congregate meals are served 

in a group setting and provide 

an opportunity for Native

Elders to not only access 

healthy meals, but also 

socialize with others in their 

community. At the onset of 

the pandemic, many Title VI 

grantees made the difficult 

decision to close their 

congregate meal sites to 

prevent community spread of 

the coronavirus. Of the 53 

grantees who mentioned congregate meals in their qualitative reporting, 55% (n = 29) noted 

that sites were closed or non-operational during this time. However, some made the decision 

to stay open as much as possible because they were the only available place for Elders get a 

meal and they recognized “the need for our people to be together and share a meal.” Many 

grantees (n = 28) reported that they shifted to providing food boxes or curbside pickup of meals 

at congregate meals sites instead of sit-down meals. This gave Elders an opportunity to get out 

of their homes if they wanted to get the meals themselves. Sonoma County Indian Health 

Project said, “drive-through meals [ensured] that our seniors were still able to get daily hot 

meals, some social interaction, and interaction with staff.” It also gave grantees an opportunity 

to provide supplemental food items to Elders outside of premade meals. 

Home-Delivered Meals

Those participating in home-delivered meal programs must be unable to leave home without 

difficulty because of illness, disability, or fragility. During the 2020 reporting period, however, 

eligibility requirements were relaxed because of the closure of congregate meal sites, and 

grantees were able to enroll more people into their home-delivered meal programs. 

A total of 148 grantees reported on their home-delivered meals programs. Their delivery 

programs were staffed by volunteers and program staff, and deliveries ranged between 2 and 7 

days a week. Most deliveries were hot meals with fresh meats, fruits, and vegetables, but some 

grantees also noted including frozen foods and snacks in the deliveries. Several grantees 

provided coolers and ice boxes to keep food fresh if it needed to be dropped off on porches. 

“...our title VI program has provided the 

only place for Elders to gather and have a 

meal together. This congregate meal site 

has only been operating for a little over a 

year now and during the COVID-19 

pandemic it was the only steady, reliable 

meal that Elders received during this time.” 

— Aleutian Pribilof Islands Association, Inc
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 4 

Home deliveries also afforded staff the opportunity to conduct welfare checks on Native Elders 

to confirm that they were staying healthy and had enough to eat. Grantees reported that even 

though staff were masked 

and distanced, Elders were 

still happy to see someone 

briefly during meal drop 

offs. Some grantees seized 

on the meal deliveries as an 

opportunity to include 

additional services and 

supplies to Elders who were 

unable or unwilling to leave 

their homes during the PHE. 

Examples of these add-on 

services included providing 

art activities, masks, and wellness resource information. Grantees included flyers and memos 

with home-delivered meals as a way to ensure that Elders were receiving accurate information. 

White Earth Reservation Tribal Council even reported providing the COVID-19 vaccine as a part 

of their home-delivered meals program.

Other Nutrition Services

For some grantees, funds were used for activities beyond the traditional congregate and meal 

delivery programs. Six grantees reported spending funds on vehicles to help with meal delivery 

or other food distribution purposes, and five noted that they used funds to pay for fuel used 

during deliveries. Grantees (n = 5) also spent funds on freezers or other kitchen equipment to 

help expand their nutrition services. 

Craig Tribal Association distributed 109 vegetable plants to their Elders. Funds in Port Gamble 

S'Klallam Tribe went toward maintaining a community garden that Elders could visit to gather 

fresh produce. One tribe (Confederated Tribes of Siletz Indians) purchased a cow, and another 

worked to get buffalo and beef donations (Fort Peck Assiniboine & Sioux Tribes). Yakama 

Nation distributed 100 boxes of seafood donated from the Nisqually Tribe. Two grantees noted 

that they provided water and other hydration delivery in addition to food.

Several grantees (n = 5) noted that the price of food increased during this reporting period and 

that the COVID-19 supplemental funding helped them deal with those price increases. Nine 

grantees provided Elders with grocery store gift cards or vouchers to help them manage these 

price increases.

“The Program takes the time to visit with 

the elders when delivering food... we ask if 

there is anything we can help them with; 

we listen to THEIR stories and latest news 

and events, providing some socialization 

and meaningful contact with our staff and 

our elders.”

— Yurok Tribe 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 5 

HEALTH AND SAFETY

Personal Protective Equipment 

Title VI grantees reported 

using their funds to ensure 

the health and safety of 

their Elders in various ways. 

The pandemic was the focus 

of much of these efforts, 

and many grantees (n = 47) 

reported that they provided 

their communities with 

personal protective 

equipment (PPE) such as 

masks, gloves, and face 

shields. Several grantees (n = 22) also provided items like cleaning supplies and hand sanitizer. 

These items were either purchased by the grantees themselves using OAA or other 

supplemental funds or obtained through community partnerships with local hospitals or other 

community health organizations. 

United Indian Health Services Inc. for Tolowa Dee-ni' Nation purchased sewing machines and 

supplies so that Elder volunteers could make masks. These masks were then handed out in 

monthly to-go packs that included water bottles, hand sanitizer, and health information, and 

distributed during meal deliveries or available for curbside pickup at community centers. It was 

important to grantees that these materials were easily accessible to their Elders to prevent the 

spread of COVID-19. 

Access to Prescriptions and Health Services

Once COVID-19 vaccinations became available, several grantees reported efforts to ensure that 

Elders could safely receive the vaccine. Many (n = 19) reported including information about 

where vaccines were available in newsletters and flyers. They also helped Elders schedule their 

appointments and provided transportation to those appointments. Some (n = 5) held 

vaccination clinics at their community centers. For Elders who were homebound or did not have 

transportation, a few grantees (n = 2) were able to provide the vaccine in the Elder’s home, 

including during meal deliveries.

It was important that Elders continued to receive normal health care services throughout the 

year as well. Grantees (n = 8) made sure that Elders continued to have access to their 

prescriptions by doing prescription pickup and delivery or helping Elders set up online 

prescription delivery. Others (n = 12) reported providing transportation to routine medical 

appointments. 

“The senior center staff is committed [to] 

keeping our Elder community healthy and 

safe by providing protective masks, PPE, 

disinfecting supplies, hygiene items and 

distributing COVID-19 updates via flyers.”

— Pascua Yaqui Tribe 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 6 

Durable Medical Equipment

The transition to sheltering in place during the PHE was a significant change, and grantees 

wanted to make sure that their Elders were remaining safe in their homes. Some grantees 

(n = 6) purchased durable medical equipment like grab bars, wheelchairs, canes, walkers, and 

shower chairs. These could either be delivered upon request or were available for pickup at the 

senior centers’ lending closets. One grantee (Wilton Rancheria) reported installing safety grab 

bars in 17 Elders’ homes and another purchased a hospital bed to have on hand for Elders 

returning from hospital stays (Makah Tribe). Two grantees purchased emergency monitoring 

devices like bracelets and necklaces that could connect Elders to emergency services in case of 

a fall. 

Wellness Checks

Grantees tried to be 

proactive about anticipating 

the needs of their 

community members. 

Several grantees (n = 16) 

emphasized the importance 

of doing wellness checks, 

especially to help monitor 

Elders living alone at home. 

Many completed wellness 

checks over the phone, but 

some also used their meal 

or supply delivery services 

as an informal wellness check and were able to chat with Elders while social distancing. 

Grantees were able to determine whether an Elder needed personal care services or additional 

durable medical equipment, or was running low on PPE through these wellness checks. 

SOCIAL SUPPORTS

Social connectedness has beneficial physical and mental health impacts, but the PHE limited 

people’s ability to gather in person, and many grantees stopped their usual visits to people in 

their homes, including nursing homes and assisted living communities (n = 6). Despite this, Title 

VI grantees worked to combat social isolation and ensure that their Elders remained connected 

by providing activities to promote companionship and a sense of security. 

Group Activities 

Twenty-five grantees reported on ways they continued to gather safely during this time. One of 

the most common activities grantees hosted was bingo. Eleven grantees noted that they held 

“car bingo” events, in which Native Elders gathered in a parking lot and played bingo from their 

cars. Grand Portage Band of Lake Superior Chippewa said this gave people an opportunity to 

“The Title VI program also was able to 

monitor elders at [their] homes and help to 

meet their medical needs such as being 

able to make telephone or online medical

appointments, and to assist with getting 

their groceries in a safe manner.”

— Toiyabe Indian Health Project, Inc. – 

Southern 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 7 

“enjoy the afternoon outside of their homes.” Similarly, Ottawa Tribe of Oklahoma noted that it 

helped “to keep the spirits of our Elders up and reduce social isolation.” 

Grantees also turned to outdoor cultural activities as a way to help Elders remain connected to 

their communities. Big Valley Band of Pomo Indians, for example, arranged some traditional 

tribal activities, including gathering seaweed and picking medicinal plants. These cultural 

activities varied based on the tribe, but five grantees noted that they were able to continue or 

revive these activities during this time.

Despite the unusual circumstances, grantees attempted to cultivate some normalcy for their 

Native Elders. Three noted that they continued to hold celebrations for holidays or special 

events, and three others reported that they still had social events, but they were physically

distanced. One grantee (Kiowa Tribe of Oklahoma) reported holding a themed parade of cars so 

that tribal Elders could see each other. 

Individual Activities 

Another way grantees 

attempted to stave off 

boredom among their 

Native Elders was by 

providing them activities 

they could complete on 

their own. Thirty-nine 

grantees reported that they 

provided individual activities 

to their Native Elders. Most 

of these grantees (n = 32) 

said that they created 

activity packs that were 

then delivered to Native Elders, often with deliveries of food or other essentials. These activity 

packs included arts and crafts materials, puzzles, word games, adult coloring books, and more. 

The arts and crafts kits were sometimes accompanied by a how-to video Elders could watch to 

complete the craft. While these sorts of activities were to be completed alone, they helped 

Native Elders feel connected to their communities at large. 

Nine grantees created challenges or competitions that Elders could complete alone and turn in 

the results of to receive a prize. These included completed puzzles for an entry into a weekly 

raffle, participation contests such as door decorating, and scavenger hunts held outside. One 

grantee (Ottawa Tribe of Oklahoma) created Elder Bingo events where Elders would get bingo 

cards with various activities like reaching out to a friend, eating an apple, or taking a walk. 

These cards helped Native Elders remain connected and encouraged healthy behaviors. 

“When meals were delivered, there would 

on certain occasions be activities included 

for making crafts or supplies for giving out 

Halloween candy safely. There were also 

videos made by staff on how to make crafts 

and also Tai Chi exercise videos made by 

staff.”

— Squaxin Island Tribe 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 8 

Virtual Programming

Sixteen grantees reported

pivoting from in-person 

activities to virtual 

programming during the 2020 

reporting period. Virtual 

activities included talking circles 

and informal chats held via 

Zoom, cooking demonstrations, 

and cultural singing and 

drumming. They also included 

informational opportunities, 

such as Elders Council Meetings, 

question and answer sessions, 

and health presentations. Staff were often at these meetings and events to provide technical 

support to Native Elders. The switch to virtual programming allowed for continued connection 

among Native Elders, and one grantee said they will likely continue offering hybrid options for 

participation moving forward as a way to be more inclusive of all Native Elders. 

Intergenerational Activities 

Grantees continued to create opportunities to bring generations together. Ten grantees 

specifically noted holding intergenerational activities during this reporting period. Central 

Council Tlingit & Haida Indian Tribes of Alaska said that they used a “two generation approach” 

to connect Native Elders and youth to each other as mentors, where each person is learning 

from the other. They also reported holding a monthly community service project in which youth 

from a local high school partner with Native Elders to complete art projects. One youth 

participant said of the program, “Together we helped each other see our worth.” 

Caregiver Support

Several grantees (n = 7) noted that the pandemic limited the support they were able to provide 

caregivers. Grantees provided telephonic support and written materials to caregivers, and 

some provided activities for grandparents caring for grandchildren. Two grantees reported that 

they still actively provided respite to caregivers during this time.

IN-HOME SUPPORTS

Grantees reported on ways they kept Native Elders safe and comfortable in their homes during 

the health pandemic. They did this by providing everyday household items (n = 24) and

improving home safety (n = 25).

“We have provided many opportunities for 

our Elders to gather virtually...These Elders 

are feeling more included than they have in 

the past when events were not offered 

virtually. In the future, when we are able to 

gather in person, we will maintain the 

opportunity for virtual participation in our 

meetings.”

— Confederated Tribes of Siletz Indians 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 9 

Household Items

Grantees purchased items to help Native Elders maintain their day-to-day household activities. 

Items included personal hygiene or toiletries (n = 12), cleaning supplies (n = 6), bedding (n = 6), 

and more. Common examples of personal hygiene items included soap, toothpaste, and toilet 

paper. Grantees who reported the total units they provided often noted the high volume of 

materials they purchased. For example, Fort Belknap Indian Community reported purchasing 

and distributing 16,867 packages of toilet paper during the reporting period.

Home Safety

Grantees also spent funds 

on enhancing Elders’ 

homes to provide them 

with independence. Some 

common categories of 

spending included chores 

or home maintenance 

(n = 12), home 

modifications or 

purchases made to 

increase at-home 

mobility (n = 9), and 

heating services (n = 7). 

Common chore and home maintenance activities included everything from lawncare to 

plumbing to salting icy sidewalks and driveways. Home modifications included installing ramps 

and grab bars. Grantees also helped provide heating services, which ranged from paying for 

utility bills to providing wood to heat Elders’ homes. 

ACCESS SERVICES

Access services help individuals get the information, referrals, and support they need to remain 

safely in their communities. Native Elders turned to local organizations as sources of reliable 

health information and for assistance with accessing services during the pandemic. Grantees 

reported providing information and referrals, benefits enrollment, transportation, legal 

support, case management, translation services, direct financial assistance, and more.

Information, Referral, and Benefits Enrollment

Many grantee organizations remained open during the PHE. Even if they were not seeing 

people face to face, they continued answering phone calls, responding to questions, and 

checking in on their Native Elders. Eight grantees mentioned maintaining or increasing their 

information and referral services during the pandemic. The cases they reported on in their PPRs 

“...with the help of our Title VI employee, 

our Tribal Housing Department, and our 

Tribal Medical Team, we were able to make 

her house accessible for her to move 

around and be comfortable in her own 

home. Having departments work together 

to provide services to this one elder 

changed her housing situation. She was 

able to return home and be with her 

family...”

— Nooksack Indian Tribe 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 10

were often complex, as clients had more than one emergent need. Grantees worked with other 

organizations to meet these needs and provide wraparound services. 

Four grantees reported that they helped clients enroll in various benefits programs during this 

time. These included Medicare and Medicaid enrollment, COVID assistance, Department of 

Veterans Affairs benefits, Supplemental Nutrition Assistance Program enrollment, disability 

applications, and Social Security. These critical sources of financial support helped Native Elders 

during a particularly challenging time, as costs for everyday items increased. One grantee 

(Wichita and Affiliated Tribes) also reported that they helped with voter registration during this 

time. Four grantees assisted Elders with temporary housing or provided research or legal 

services to help secure housing.

Transportation and Errand Assistance

Transportation is another 

critical access service for 

Native Elders. Two grantees 

specifically noted that they 

stopped transportation 

services during this time, 

while eight others reported 

that they continued to 

provide transportation as 

safely as possible so that 

Native Elders could get to 

appointments, grocery 

stores, post offices, and 

more. Eight grantees also 

mentioned that they started 

providing or increased shopping or errand assistance for Native Elders as a replacement for 

transportation services, as many Elders felt nervous to leave their homes during the pandemic. 

Technology

Seven grantees discussed how they helped ensure that Native Elders remained connected and 

able to access each other and information during this time. Six reported that they bought and 

handed out electronic devices like laptops, tablets, and phones to help with this. These devices 

allowed Native Elders to participate in community events and social activities and stay in touch 

with loved ones. 

COMMUNICATION 

Grantees changed their communication techniques during the 2020 reporting period to match 

social distancing requirements and the reduction of in-person services. Thirty-nine grantees 

reported communicating with Elders through newsletters and flyers; telephone calls and texts; 

“Our solution was COVID Shopping 

Assistance. We collected orders by 

phone...and delivered them to their homes 

on a pre-determined day. We worked with 

a local convenience store to fill the orders. 

We paid for the groceries using COVID 

funding, removing the need for staff to 

handle cash and allowed the Elders to 

keep what cash [they] did have until they 

could get to bank.”

— Saint Regis Mohawk Tribe 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 11

cards and letters; and mass media such as TV, radio, and social media. Many grantees provided 

information about the pandemic, how to remain healthy, and what was going on in the 

community. Grantees also communicated with Elders to learn how to meet their needs and 

socialized with them to counteract some of their feelings of isolation and loneliness. Depending 

on the type of communication, grantees communicated with Native Elders on a daily, weekly, 

or monthly basis. Some grantees had multiple communication strategies. 

Newsletters and Flyers

Nineteen grantees disseminated newsletters and flyers to Elders through the mail, in 

newspapers, and with home-delivered meals or drive-by meal pickups. Newsletters and flyers 

had information about COVID-19, reminders to stay safe during the pandemic, and non-COVID 

health-related updates such as exercise and nutrition tips. Leech Lake Band of Ojibwe sent out 

flyers and memos with meals for all health updates, procedure changes, and upcoming events. 

Jicarilla Apache Nation began a newsletter to keep Elders engaged and informed with medical 

advice and updates on COVID-19 in the community, health education, dietary advice, recipes, 

exercises, and meditation recommendations. 

Text Message or Phone Call Check-Ins

Sixteen grantees called or texted Elders to check up on them and to provide them with vital 

information about resources, such as the availability of vaccination appointments and 

symptoms to watch out for if exposed to COVID-19. Southcentral Foundation reported 

increasing their monthly phone calls from once a month to once a week to help isolated Elders 

feel connected. Yerington Paiute Tribe reported having daily or weekly phone calls with Elders 

to learn about their needs so a staff member could respond to it and run errands for them.

Card Deliveries

Four grantees distributed cards and letters to Elders to socialize with them and provide them 

with emotional support throughout the pandemic. Little River Band of Ottawa Indians wrote 

notes on to-go containers and provided Elders with the materials to write a letter back. For 

Elders who had little to no family contact, sharing notes with them helped to cheer them up. 

One Elder wrote the grantee back to express how much she looked forward to the notes and 

how much she liked writing back. She told staff that it was the only thing she looked forward to. 

In Jicarilla Apache Nation, a pen pal project was started with another senior center between 

Native Elders who were living alone.

Mass Media

Seven grantees conveyed key information through TV, radio, social media, and other types of 

mass media. Mass media may have helped grantees promote information on a larger scale than 

other forms of communication. Inter-Tribal Council of Nevada, Inc. (Battle Mountain) created a 

TV commercial that had community members speaking in their own language to encourage 

people to follow CDC Guidelines and remind Elders they were not alone in the pandemic. Oglala 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 12

Sioux Tribe relayed information on the tribal website, weekly webinars, and on a radio program 

to keep Elders informed about the pandemic. 

Other Communication Techniques

Six grantees reported other communication strategies to communicate with Elders in their PPR. 

Pleasant Point Passamaquoddy reported that one of their programs made color coded 8” x 11” 

sheets of paper for Elders to place on their doors: green paper with the words “I am okay”; 

yellow paper with “I need cleaning supplies, masks, gloves”; orange paper with “I need 

someone to talk to”; and red paper to indicate “I need medical attention.” Staff checked the 

signs several times a day, 7 days a week, and responded accordingly to the signs.
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report 13

The pandemic created many new, unexpected challenges for Title VI grantees and the 

communities they serve. However, it is clear that the Title VI grantee programs provided 

important support to their communities and many grantees (n = 33) expressed how grateful 

they were to be able to continue providing these services during the PHE. Grantees went above 

and beyond ensure that their community members were safe and healthy in their homes by 

providing food and PPE deliveries, transportation to medical appointments, arranging for home 

health or personal care services, and providing up-to-date information on COVID-19 testing and 

vaccinations. The grantees were especially proud to have been able to provide a sense of 

normalcy and connection to their Elders during a challenging time.

CONCLUSION 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report A-1 

The majority of the Title VI grantees responded to at least one of the qualitative prompts in the 

PPR, as shown in Exhibit 1. Of the 282 Title VI grantees, only 40 did not respond to any of the 

three prompts.

Exhibit 1. Grantees with Qualitative Data

PPR Prompt N % 

Other Supportive Services 145 51

Financial 175 62

Storytelling 185 66

Source: ACL-provided download of Title VI 2020 PPR data

The team conducted a thematic analysis of all grantees’ responses to the three prompts from 

the 2020 reporting period. Each prompt was analyzed separately to ensure that all data were 

reviewed and themes were captured. An Excel workbook was created for each of the three 

qualitative prompts, into which coded responses were entered. RTI used a combination of 

deductive and inductive coding for this process, starting with a set of predetermined codes for 

the prompts related to other supportive services and financial qualitative reports and 

generating all codes for the storytelling prompt. The initial codes for other supportive services 

and financial qualitative matched the areas for which grantees were required to provide 

quantitative data. For other supportive services, initial codes were Social Events; Health 

Promotion and Wellness Activities; and Nursing Facilities/Home or Residential Care 

Communities Visits. The initial codes financial qualitative were Part A/B: Staffing; Part A/B: 

Nutrition Services; Part A/B: Access Services; Part A/B: In-Home Services; and Part A/B: Other 

Supportive Services. A purely deductive approach was taken to coding the storytelling 

responses, so there were no initial codes provided to analysts.

Analysts reviewed grantee responses to each of the three prompts and assigned all or some of 

the text to codes based on the themes they saw in the response. A grantee’s response may 

have been assigned to more than one code depending on how extensive the response was. If 

an analyst reviewed a grantee response and found that a relevant code did not yet exist, they 

used descriptive coding to summarize the content of the text into a word or phrase that 

captured what the grantee reported. The new code was added to the workbook for that 

prompt, and the relevant text or excerpt was copied into that column in the grantee’s row. This 

process was repeated for all grantee data in each of the three workbooks. Each time an analyst 

read a grantee response, they first reviewed the available codes to see if it fit somewhere 

before creating a new code.

APPENDIX A: METHODS 
Serving Native Elders During the COVID-19 Pandemic: Findings From an Analysis of Title VI Grantee 

2020 Program Performance Report Data Final Report A-2 

The team next combined the qualitative data from the three prompts into one workbook so 

that all grantee data for each of the three prompts were included in one place. Codes were 

reviewed and merged into similar concepts. This process led to the development of a set of 

overall themes that told the story of how grantees served their communities during the 2020 

reporting period. These themes included the general impact of COVID-19, nutrition services, 

health and safety, social supports, in-home supports, access services, and communication 

techniques.