NWSDS Consumer Profiles 2023-2025

NORTHWEST SENIOR & DISABILITY SERVICES

2023-2024

CONSUMER PROFILES

Profiles of seniors and people with disabilities who receive services in Clatsop, Marion, Polk, Tillamook, and Yamhill counties.

kim.hunt@nwsds.org

OUR VISION

To be an innovative, nationally recognized leader.

OUR MISSION

Promote dignity, independence, and health; honor choice and empower people.

OUR CORE VALUES

Integrity

Working honestly, ethically, and being accountable.

Professionalism

Representing the Agency and ourselves with pride, expertise, and excellence.

Service

Responding promptly to consumer and community needs.

Compassion

Showing concern and respect for the well-being of others.

ABOUT NWSDS

NWSDS serves seniors and people with disabilities in five counties:

• Clatsop

• Marion

• Polk

• Tillamook

• Yamhill

NWSDS is also known as an Area Agency on Aging and an Aging and Disability Resource Connection (ADRC).

PROGRAMS & SERVICES

Services coordinated and provided by NWSDS include, but are not limited to:

• Information & assistance for seniors and adults with disabilities

• Case management

• Eligibility determination for Medicaid and SNAP (Food Stamp) programs

• Adult protective services

• Licensing of adult foster care homes

• Pre-nursing home admission assessments

• Oregon Project Independence (OPI)

• Home-delivered meals

• Senior Peer Mentoring

• Senior Health Insurance Benefit Assistance (SHIBA)

• Oregon Money Management

• Health Promotions

Visit our website for descriptions of these programs and services for seniors or for adults with disabilities.

GETTING CONNECTED

NWSDS services can be accessed by contacting its Aging and Disability Resource Connection (ADRC) or visiting one of its six service offices:

AGING AND DISABILITY RESOURCE CONNECTION (ADRC):

Email: information.nwsds@nwsds.org

Online: www.nwsds.org

Facebook: www.facebook.com/nwsds.org

Marion, Polk and Yamhill Counties:

Phone: 503-304-3420, toll free: 1-866-206-4799

Clatsop and Tillamook Counties:

Phone: 503-815-2060, toll free: 1-800- 584-9712

Statewide ADRC hotline (for other Oregon counties):

1-855-ORE-ADRC (673-2372)

www.adrcoforegon.org

ADULT PROTECTIVE SERVICES ABUSE REPORTING LINE:

Clatsop, Marion, Polk, Tillamook, and Yamhill Counties:

Toll-free: 1-800-846-9165

Oregon’s Abuse Reporting Hotline (in other Oregon counties):

Toll-free: 1-855-503-7233

Local Police Department (for help at any time)

ADVISORY COUNCILS

The function of the Senior Advisory Council (SAC) and Disability Services Advisory Council (DSAC) is to advise the Board of Directors and the Executive Director on the general welfare of older adults and people with disabilities in the areas served by NWSDS (Clatsop, Marion, Polk, Tillamook, and Yamhill counties) as mandated by the Older Americans Act.

It is to also advise the Board of Directors on the services to older adults (60 years and older) and people with disabilities served by the agency, and on all important matters affecting the operations of the agency, except for matters of personnel administration, staff pay, and benefits.

SENIOR ADVISORY COUNCIL (SAC)

The 20-member Senior Advisory Council is made up of older adults, representatives of older adults, local elected officials, persons with leadership experience, representatives from agencies providing services to older adults and/or the general public.

DISABILITY SERVICES ADVISORY COUNCIL (DSAC)

The 15-member Disability Services Advisory Council (DSAC) is made up of persons that use or have used disability services and individuals interested in issues and services to people with disabilities. This group meets monthly and meetings are open to the public.

Cooperative & Committee work

Both the SAC and DSAC work closely together on a number of projects and committees. There are several long-standing joint committees and various joint ad hoc committees. As of January 2023, the following are active committees:

• Steering Committee

• Legislative & Advocacy Committee

• Monitoring Committee

• Budget Committee

• Nominating Committee

• Ad Hoc Long COVID Committee

• Ad Hoc Polices & Procedures Committee

MARION COUNTY

TILLAMOOK COUNTY

Total population: 26,782

COVID Data

YAMHILL COUNTY

Total

OREGON PROJECT INDEPENDENCE

Since 1975, Oregon Project Independence (OPI) has been providing services to seniors and people with physical disabilities while they are living in their own homes. Services are provided statewide through Area Agencies on Aging, such as NorthWest Senior and Disability Services local offices.

Services include personal care, homemaker/home care services, chore services, assisted transportation, adult day care, respite, case management, registered nursing services and home-delivered meals. The goals of Oregon Project Independence are to:

• Promote quality of life and independent living among seniors and people with physical disabilities;

• Provide preventive and long-term services and supports to eligible individuals to promote self-determination and reduce the risk for institutionalization;

• Provide services to frail and vulnerable adults who either lack or have limited access to other long-term services and supports; and

• Optimize eligible individuals’ personal and community support resources.

Eligibility for the Oregon Project Independence program is based on level of need determined by each administering Area Agency on Aging using a common assessment tool; there are no financial eligibility requirements. Priority is given to frail and vulnerable older adults who are lacking sufficient access to other long-term services and supports or who are at the greatest risk for needing out-of-home placement.

OPI has traditionally served those who are 60 years of age or older or who have been diagnosed with Alzheimer’s disease or a related disorder and meet the requirement of Oregon’s long-term care services priority rule. However, in 2014, OPI expanded to include all adults 19 years of age or older with a physical disability.

MEDICAID - OPI COST COMPARISON

OPI is funded by the legislature with state General Funds. OPI services are modest; providing approximately 20 hours of in-home services per month. OPI consumers do not receive Oregon Health Plan (OHP) or Medicaid Long-Term Care benefits with the exception of SNAP (food stamps) and Supplemental Low Income Medicare Beneficiary Program benefits. More than 96% of all OPI consumers are at income levels that would qualify them for Medicaid services, which is at or below 200% of the Federal Poverty Level.

If an OPI consumer were to move into Medicaid, the costs to the state would immediately increase at a significant rate compared to protecting funding for the OPI program.

Only seniors with incomes of less than $1,823 per month are exempt from co-pays. People pay progressively higher co-pays as their income increases, until at $4,861 per month people pay the full amount.

A recent study conducted by an independent consulting agency titled “The Business Case for Oregon Project Independence” concluded that the benefits of OPI far outweigh the costs. In the report they examine the Social Return on Investment (SROI) for OPI, measuring “how much ‘good’ comes from a given effort.” The benefits totaled $49.4 million at a cost of only $13 million - a ratio of 3.8 to 1 SROI.

ADL: Activities of Daily Living

IADL: Instrumental Activities of Daily Living

SROI: Social Retunr on Investment

For more information on the graph to the left, this report, and the methodology used, please visit this site or find it under “Program Reports” on the State’s OPI page here.

*Expansion and changes for this program may be coming in 2023. At that time, criteria, services offered, and eligibility for the program will change.

1

Priority of Paid Services

1 = Greatest Need | 18 = Least Need Requires full assistance in mobility, eating, elimination, and cognition

2 Requires full assistance in mobility, eating, and cognition

3

Requires full assistance in mobility, cognition, or eating

4

5 Requires full assistance in elimination

411-

015-0010

6 Requires substantial assistance with mobility and assistance with elimination

10

Requires substantial assistance with mobility, assistance with elemination and assistance with eating Requires substantial assistance with mobility and assistance with eating

Priority of Paid Services (Effective 10/01/2022)

7 Requires minimal assistance with mobility and assistance with eating and elimination

To determine the service priority level, an individual must be found eligible, using the Department’s standardized assessment tool, as meeting at least the requirements for Assist or Full Assist in activities of daily living as defined in OAR 411-015-0006, in the following order and as designated in OAR 411015-0015.

8 Requires assistance with eating and elimination

9 Requires substantial assistance with mobility

11

12 Requires minimal assistance with mobility and assistance with elimination

13

Requires assistance with elimination

14

15 Requires assistance with eating

16

Requires full assistance in bathing or dressing

17

18 Requires assistance with bathing and dressing

Requires minimal assistance with mobility and assistance with eating

Requires minimal assistance with mobility

Independent in the above levels but requires structured living for supervision for complex medication regimen

SERVICES LOST

Combating Heat

Improving Health & Quality of Life for Vulnerable Older Adults

During the July 2022 heat wave, NWSDS agency staff pulled together to identify high risk consumers needing air conditioning (AC) units to mitigate negative health impact on them and ensure their safety.

These AC units were a part of the Air Conditioner Deployment Program created following the passage of Senate Bill 1536 during the 2022 legislative session. The bill allocated $5 million to purchase air conditioners for high-risk Oregonians.

The week NWSDS delivered the AC units, temperatures reached 102 degrees. Multiple staff from across the agency assisted with identifying, making calls, gathering data, delivering units, and setting up units. From volunteers to case managers to our highest levels of management, NWSDS came together to ensure AC units made it to those in need as quickly as possible. The gratitude and relief felt by those who received these units was felt by everyone.

Within days, NWSDS delivered 65 AC units out to our communities. Of these 65 AC unit, 54 were delivered to Marion County consumers and 11 to Yamhill county apartment complex where consumers were facing eviction due to .

Donna (pictured) is one of the NWSDS consumers who received an AC unit. Like many NWSDS consumers, she had never had an air conditioning unit before. At 71 years old with diabetes, neuropathy in her feet, and arthritis, the severe heat causes her feet and ankles to swell and retain fluid making movement extremely difficult and painful.

In the past, she has relied on cold baths for her feet and cold towls for her head and neck, constantly changing them out. This exacerbated the pain and swelling. Living on a very tight, fixed income, there is no way Donna would have ever been able to afford an air conditioning unit on her own. Her NWSDS case manager reached out to her and was able to deliver and install the unit within 48 hours of the Salem NWSDS office receiving it.

The air conditioning unit completely changed her quality of life during heat waves. She no longer has to worry about mobility issues and pain from swelling due to extreme heat. She can live comfortably in her home, and she considers this a huge blessing for her health in her older age.

OregONEligibility

the issues

In 2020, Oregon shifted eligibility determination procedures into a “one stop shop” system known as the ONE System. This was supposed to make things more efficient and easier for Oregonians, but for many the opposite has been true. Consumers were not consulted about the change and have continually been left out of conversations and plans and updates to the ONE System. Their voice has not just been silenced, it has been completely ignored as if their thoughts on the system - built supposedly for them - doesn’t matter. This is not person-centered care.

Consumers have continually reported frustration, anxiety, and confusion working with the ONE System. Examples of issues staff have witnessed repeatedly include:

• Incorrect data is entered into ONE by Virtual Eligibility Center (VEC) staff that do not understand or do not have enough training on the system or technical intricacies of eligibility. Consumers have their services cut off or are approved for benefits they do not qualify, requiring local AAA/APD staff to call and tell them information was incorrectly entered and they don’t actually qualify for benefits.

• Consumers wait on hold for hours to speak to someone in a VEC office about mistakes made in the system affecting their benefits.

• There is no consistency with who serves the consumer out of a VEC office, so consumers have to continually repeat themselves and are made to feel like a number not a person.

NWSDS and other AAAs in the state have continually run into barriers seeking to address these issues for their consumers. Reports go unanswered. Promised fixes to the system do not happen. NWSDS has had to create workarounds to address the issues, which are expected to only get worse with the proposed changes to the ONE System. It is costing both time and money to workaround the system and fix system errors.

Our Ask : Delay the eligibility transition to Oregon Eligibility Partnership and develop a plan to shift workflows so that AAAs and APD offices are the only offices that work long-term care (LTC) cases for older adults and adults with physical disabilities.

• All LTC calls to VEC’s as well as tasks and applications via the ONE portal be routed to the consumer’s local APD/AAA office.

• Add contact information for local APD/AAA offices to any notices sent to LTC consumers.

• Ability for AAA/APD offices to prioritize LTC eligibility above all other eligibility work for other populations processed in ONE.

• Data made available to APD and AAA offices to illustrate current volume of LTC cases and tasks within our service areas.

• System fixes to allow the above to occur. These fixes must include the ability for LTC cases to be held and associated tasks “frozen” and only worked by designated AAA/APD branch serving the LTC consumer.

• System flaws lead to consumers being asked erroneous questions, adding up to 45 minutes to eligibility appointments. The system needs to be fixed so staff are not asking unnecessary questions, wasting the time and energy of both staff and consumers.

OregONEligibility the consumer impact

Consumers are experiencing unecessary burden and stress from incorrect denials and approvals within the ONE System caused through virtual eligibility centers.

For Example:

• 75 y/o Yamhill Co. consumer needing services contacted a virtual eligibility center to start benefits. Eligibility was denied incorrectly at the virtual eligibility center due to worker error, no referral was made to the local branch for a Case Manager to assist with services. NWSDS office was only made aware of need for services due to daughter calling our office directly. NWSDS Eligibility Specialist and Case Manager are now coordinating to determine eligibility for services in an assisted living facility.

• 97 y/o Marion Co. consumer living in a long term care facility was incorrectly approved for Medicaid by a virtual eligibility center due to worker error. Consumer was both over resources and over income at time of application. NWSDS was involved due to service need and Eligibility Specialist at NWSDS noticed error after consumer had incorrectly been on Medicaid for two months. This situation will need close monitoring and coordination with family due to complex financial situation. Family needs guidance on Medicaid rules and processes to ensure consumer is correctly approved for Medicaid when income and resources are within guidelines. Case Manager is also involved and coordinating with the facility. Situations like this cannot be managed by a self-service portal. There is a high probability of either incorrect approvals, or incorrect denials without the needed coordination at the local level between staff, consumers/families and the facility.

• Overcrowded hospitals have been a real problem since the pandemic began. NWSDS efforts to respond to eligibility requests for consumers needing both long term care and an eligibility determination ASAP can be hindered due to ONE system and workflow issues. This can result in consumers being in the hospital longer than they need to be. For example, our dedicated hospital Eligibility Specialists can be actively working with a consumer/family and workers from other parts of the state, not familiar with the specific consumer situation, will also enter information into ONE. Often incorrectly, leading to incorrect denials and erroneous mailings to consumers and families. It is not uncommon for staff to spend hours fixing these errors.

The State has a responsibility not only to the consumer, but to the Federal government and tax payers.

Staff must serve the consumer to the best of their ability and guide them through complicated processes patiently and accurately. For the Legislature, ODHS has a responsibility to implement systems that are efficient, effective, meet Federal Medicaid requirements and serve the consumer. Currently, the ONE system is not serving consumers and is not effectively using state budget dollars.

Long COVID

Range of new, returning, or ongoing health problems people can experience four or more weeks following initial COVID-19 infection

Since the beginning of the COVID-19 pandemic, there have been reports of people who contracted the virus experiencing debilitating symptoms after seeming to initially recover. Over the past two years, what is known as “post-COVID condition” by the Centers for Disease Control and Prevention (CDC) and Long COVID by the general public, has garnered more research and acknowledgment as a serious condition with life-altering effects.

We know that Long COVID can affect anyone, including children, and it can develop in people who had asymptomatic, mild, or severe COVID-19. However, we don’t know why Long COVID affects some people and not others. More expedient research needs to be done, and the medical community must be better trained on how to best serve and treat those experiencing the condition.

There are many symptoms of Long COVID and they often differ from person to person. Common symptoms include fatigue, difficulty breathing, headaches, heart palpitations, digestive issues and brain fog. These can last weeks, months, or even years and may cause lifelong disabilities. According to the CDC, about 80% of people with long COVID reported activity limitations due to this condition.

According to the CDC an estimated...

13.5% of Oregon adults have experienced Long COVID

7.5% of Oregon adults are currently experiencing Long COVID

For the most recent data on cases, vaccinations, and interactive maps, please visit Map & Case Count on the NYT Website here. Statistics and definitions taken from cdc.gov on Dec. 15, 2022.

OTAGO Exercise Program (OEP)

OTAGO is a unique program for fall prevention. Falls are common—1 in 4 Americans aged 65+ fall each year.

Every 11 seconds an older adult is treated in the emergency room for a fall.

OTAGO is a home-based exercise program that targets those who are at moderate-to high-risk for falls (usually someone who has already fallen).

There is strong evidence that the program builds strength and balance AND restores self-confidence, which removes fear of falling and in turn, reduces ISOL ATION.

There is also less cost to the system because there are fewer falls and therefore fewer chances of serious injury resulting in hospitalization & long-term care institutionalization.

People stay independent longer and in the community longer.

SUCCESS IN OTAGO

“One of my graduates is an 86-year-old, Korean War veteran, who lives in a small community with his wife of 60+ years. He was falling at home and found out about our program through NWSDS.

He practiced his OTAGO like it was his job. He walked daily and completed his exercises three times a week. He progressed each time I tested him until he was able to do the stand-and-sit test faster than anyone I had seen. He passed all four, balance tests, and increased speed on his TUG (timed up-and-go) test every time.

He would always tell me that it really helped him to have me come to his house rather than having to travel to a nearby town for therapy.

He was so positive and grateful, it really made me feel good about what our program means to people who need in home services. Preventive health is the future, and this program really works for those who practice it.”

Senior Mealsite & Home Delivered Meals Program

In uncertain times, through heightened health concerns and supply chain issues, NWSDS has continued to serve older adults and people with disabilities throughout the five counties we serve.

A study published by Feeding America in 2019, found that roughly 5.2 million older Americans face food insecurity. This number is expected to have risen as the COVID-19 pandemic has impacted not only the ability to safely access food in places like grocery stores but also the cost and availability of healthy and nutritious foods.

The home-delivered meals have meant more than just nutritious food for those in need, though. “For a lot of people we serve, these meals mean someone is coming to visit with them,” according to the Sheridan Nutrition Site Coordinator, Carrie Brooks. “Often they do not see other individuals, no visitors. You know, they’re home alone. A lot of them engage in conversation because that’s their social contact; they do not get out. Some of them do not have vehicles to even get out and do their own shopping. It’s a lifesaver for a lot of them.”

NWSDS nutrition programs are heavily dependent upon volunteers, and each site builds a little community. The in-person mealsites began opening up near the end of 2022, and the need for volunteers to serve our older adults at mealsites is great.

From March 2020 through August 2022, NWSDS delivered over 153,000 meals to older adults in Yamhill County

YAMHILL COUNTY

NWSDS Consumer Profiles

Age 65

Living Situation

Lives alone in own home

Monthly Income

$5,481

Type of Assistance

POLK COUNTY

146 hours per week of in-home Medicaid

Monthly Service Cost

$9,735.28

“Without this program I would hate to think what my life would be like. I would have no other way to stay out of a nursing home and in the community without these services.”

“I love to be an advocate for people with disabilities and help people live more independent and productive lives.

I served as the executive director of the State Independent Living Council (SILC) for eight years and as acting director of Oregon Vocational Rehabilitation.

I started receiving Medicaid in-home services around 2008, through the Employed People with Disabilities program. However, in 2016, I had to retire after I had septic shock. After this, I needed almost full-time care from in-home services, especially after my husband passed away. The ability to live with this program enables me to have enough energy and be independent in everything I still do.”

‘I am always getting people to understand that the in-home program services are the difference between life and death.’

Although Tina’s care needs are extremely challenging, the program keeps extremely disabled people like Tina in their homes and out of nursing homes. It provides a better quality of life while avoiding the nursing home care, which is the most expensive of all care options.

Konstantine Medicaid - SPL 03

Age 32

Living Situation

Lives with family

Monthly Income

1,083.00 SSD

Type of Assistance

MARION COUNTY

Approx. 158 hours per week of in-home Medicaid

Monthly Service Cost

$5,633.09

At the age of 19, Konstantine was in a life-altering car accident when the car he was in hit a patch of black ice while visiting family in Canada. After months of care in Canada, Oregon, and Colorado, he was able to move into his family home that had been adapted for his care as a quadriplegic.

Now, Konstantine requires 24/7 care to ensure his needs are met. The current home care worker crisis is putting undue stress and pressure on his family to provide care. There aren’t enough workers available to cover all of his care needs.

A few years ago, his hours/week of in-home care was cut back, and he spent the year in and out of the hospital and doctor with a myriad of issues that could have been prevented with adequate care. His case manager saw the impact and worked with his family to increase his hours back to what they were. With

the increase of hours, the hospital and doctor visits decreased, and his quality of life improved dramatically.

This further shows the importance of our home care workers in providing quality of life for our consumers not only need but deserve.

Despite the challenges thrown his way, Konstantine maintains an impressive positive outlook and continues his passion for hunting, computers, and living life to the fullest thanks to his family and caregivers.

Age

87 Years Old Living Situation

Lives with spouse

Monthly Income

$849 via Social Security

Type of Assistance

4.5 hours/week of with home care worker

Monthly Service Cost

$407.35 of which she pays 5%

Johna lives with her husband Jerry. Both of them have been active members of Tillamook County for over 22 years. Johna suffers from arthritis, muscle atrophy and has limited range of motion and chronic pain. She relies on her home care workers to remain independent so that she can continue to live in her house.

Jerry says “Johna and I have had the privilege of using the services of the Oregon Project Independence for the past eight years. Johna has a deteriorating muscle problem caused from taking the Statin drugs for Cholesterol. She has lost use of her muscle and hurts all the time in her arms and legs. She can no longer do most household chores. The OPI program has been a Godsend for us. We would be lost without this program and with my worsening arthritis would be forced to sell our home. We know that monies are short but would beg you to please support this program. Thank you for all you do. Jerry and Johna.”

In October of 2020, Johna experienced a fall affecting her balance and taking away more of her range of motion. Johna stated “it would be awful if I were to lose my home care worker if the OPI program was to go away.”

Here are some acronyms and terms that may either be mentioned in this document or pertain to the work that we do.

Aging and Resource Development Center (ADRC): A statewide resource for those looking for information about services to address aging or disability needs. ADRC provides information about local public and privately paid options and has trained professional staff who can help consumers with immediate needs or future plans.

Area Agency on Aging (AAA): An Area Agency on Aging is a public or non-profit agency, designated by the state, to address the needs and concerns of adults, age 60 and older, at the local level. Area Agency on Aging is a generic term. Specific names of local Area Agencies on Aging may vary. NorthWest Senior & Disability Services is the name of the Area Agency on Aging serving Clatsop, Marion, Polk, Tillamook and Yamhill counties.

Type A: Provides services under the Older Americans Act and Oregon Project Independence. Type A AAAs serve only older adults, and look a lot like most AAAs throughout the United States.

Type B: Provides the same services as the Type A, but also conduct eligibility determination for Medicaid and SNAP (Food Stamps) benefits, and serve both seniors and adults with physical disabilities.

B1: Administer the Older Americans Act, Oregon Project Independence, Medicaid and Food Stamps. Type B1 AAAs serve only older adults, but there are currently no B1 AAAs in Oregon.

B2: Administer the Older Americans Act, Oregon Project Independence, Medicaid and Food Stamps to both older adults and adults with physical disabilities.

Community-Based Care (CBC): Community-based care is the foundation of Oregon’s longterm care system. The state has developed a system so that individuals can remain independent in their own homes for as long as possible or move into lower cost alternatives to nursing homes. Oregon’s system helps older adults and adults with physical disabilities locate and receive the services they need in the least restrictive setting.

Food Insecurity: The limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways.

Home Care Worker (HCW): Helps with light cleaning, shopping, laundry and making meals for older adults and adults with physical disabilities who need this help so they can remain safely in their own homes.

Personal Support Worker (PSW): Supports children and adults experiencing intellectual or developmental disabilities, or adults experiencing a mental illness, in their own homes and communities.

SOURCES

We have done our best to use reliable and verifiable sources for all of our data. Please see below for the full list.

Please note the dates information was collected and the dates information was published. We know the COVID-19 pandemic and subsequent inflation has affected many things that may not be reflected in the information we were able to obtain. We will update information as we are able in an effort to reflect as current and accurate statistics as possible.

Consumer profile stories are collected directly from and approved by our consumers featured. We want to extend our utmost gratitude to each individual who shared with us and thank them for trusting us with their stories. We hope each person provides insight to the challenges and also the resiliency of those we serve.

Long COVID - Household Pulse Survey - COVID-19. 15 December 2022. https://www.cdc. gov/nchs/covid19/pulse/long-covid.htm

Oregon by the Numbers. The Ford Family Foundation. 2022 Edition.

The Business Case for Oregon Project Independence. The Compelling Reason. 2020. https://www.oregon.gov/dhs/SENIORS-DISABILITIES/SUA/Documents/opi-businesscase-2020.pdf

The State of Senior Hunger in America in 2019. Feeding America. 15 August 2022. https:// www.feedingamerica.org/sites/default/files/2021-08/2021%20-%20State%20of%20 Senior%20Hunger%20in%202019.pdf

Oregon Coronavirus Map and Case Count. The New York Times. 15 December 2022. https://www.nytimes.com/interactive/2021/us/oregon-covid-cases.html