Categorized | Family Care, Features, Pushback

Next Pandemic We Should Treat Homebound Better

joy, long-term care, homebound

No one is offering giveaways to the people who may need COVID shots the most: the estimated 4 million elderly and disabled homebound.

By Al Norman

Americans hesitant to get a COVID vaccine shot have been lured out of their bunkers with a cornucopia of goodies offered by the White House and states, including: free Uber/Lyft rides to vaccine sites; a $5 million lottery funded with federal COVID relief funds; 4-year tuition scholarships to universities — including room, board and books; free beer, concert tickets, savings bonds, prepaid gift cards, a free pounds of crawfish, and even marijuana joints.

But no one is offering giveaways to the people who may need COVID shots the most: the estimated 4 million elderly and disabled homebound. At the end of April, Kelly Buckland, the head of the National Council on Independent Living, told Kaiser Health News that homebound people were not getting prioritized for COVID vaccines: “As far as I can tell, no one is really doing it. Maybe a few places in the country, but not on the mass scale it needs to be.”

In California, paramedics have administered vaccines in disabled people’s living rooms. Pennsylvania, Texas and New Jersey all have homebound vaccinations. But many states have done little or nothing for the homebound. “The process is slow,” the Associated Press reported, “and requires careful planning, but advocates say getting vaccinated is critical for people who are constantly exposed to visiting aides — and that they should have been a focus sooner.”

patient-centered, Social Security, ageist, nursing, COVID, Trump, vaccineIn my state of Massachusetts, the Commonwealth began an in-home vaccination program on March 29, at a point where the Commonwealth had already administered 3,409,635 doses of vaccine. The homebound were clearly not at the top of the list. The state set up an in-home vaccination central intake phoneline for “homebound people who are not able to leave their home to get to a vaccination site, even with assistance.” The administration of Gov. Charles Baker estimated there were only 25,000 people in the state who needed homebound vaccine support — which is likely an undercount.

The entry rules to qualify for the Massachusetts homebound program were complicated: you had to “have considerable difficulty and/or require significant support to leave the home for medical appointments,” or “require ambulance or 2-person assistances to leave the home,” or “at not able to leave home for medical appointments under normal circumstances.” On May 24, realizing how confusing these rules were, the state simplified the eligibility to be “anyone who could not get to a vaccination site.”

The entryway was also somewhat confusing: you could contact your local board of health, or the statewide vaccine provider — a senior care organization known as the Commonwealth Care Alliance. 162 local boards of health were allowed to manage their own programs. In the rural county where I live, there were at least four different clusters of towns offering vaccines for the homebound.

It was a puzzle for disabled folks who were not skilled with a computer, or didn’t have a smartphone. The largest group of towns reported administering 46 homebound vaccines as of May 27. Another 50 residents in other parts of the county received a shot at home, but no data was available for towns that decided to use the state vendor to reach homebound people. No statewide data was posted on the Massachusetts vaccine dashboard.

“Homebound status is not one of the things we are required to report in the state paperwork,” a local health official told me, “so there will be no easy central way to get this data other than from the individual entities giving them.” I tried repeatedly to get individual city and town data from MassHealth, the agency which managed the homebound program, but no data was available.

The Harvard Medical School told the Associated Press that “inoculation efforts are scattered, and much depends on local officials and medical providers,” the Medical School said. A spokesperson for the National Patient Advocate Foundation told the AP getting vaccine to the homebound was “a problem we knew we were going to have. How are there not plans in place?” From the beginning of the pandemic, the federal government was focused on nursing facilities and their workers, because that’s where COVID deaths were most visible. But behind closed doors, scattered in individual homes and apartments, the elderly and disabled were scared that they would be forgotten.

On June 9, President Biden announced that he would increase the federal payments for vaccines for homebound Medicare recipients. “We’re committed to taking action wherever barriers exist,” the head of Medicare said, “and bringing the fight against the COVID-19 pandemic to the door of older adults.” A week later, Massachusetts unveiled a “VaxMillions” lottery, with five $1 million prizes, and 5 $300,000 scholarships for people age 12 to 17.

Maybe with the next pandemic we will put the homebound at the front of the queue, not at the back. If we can offer millions of dollars, free beer, gift cards and marijuana to younger, mobile people — we can do much better for the elderly and disabled homebound — who don’t need to be bribed to get vaccinated.

Al Norman worked in the elderly home care field in Massachusetts for 38 years. He says he liked working with seniors so much, he decided to become one.

Leave a Reply