Homebound seniors still waiting for Covid-19 vaccines, so doctors and nurses are consulting them

“This is a hidden group that will be overlooked if we do not step up our efforts to reach them,” said Dr. Steven Landers, President and CEO of Visiting Nurse Association Health Group, which provides care home health and palliative care to more than 10,000 people. people from New Jersey, northeastern Ohio, and southeastern Florida. His organization plans to launch a pilot home vaccination program for frail patients next week.

Jane Gerechoff, 91, of Ocean Township, New Jersey, waits for the group to get her vaccinated. She had a stroke more than a year ago and is having difficulty breathing due to severe lung disease. “I can’t walk; I’m in a wheelchair. There’s no way in the world that I can get the vaccine if they haven’t spoken to me,” she said in a phone interview. .

Although Gerechoff does not go out, she lives with an adult son who interacts with people outside the home and receives help from physiotherapists and occupational therapists at home. Any of them could introduce the virus.

Reaching homebound seniors presents many challenges. Top of the list: Home care agencies and palliative care organizations do not have access to covid vaccines for either their staff or their patients.

“There is no vaccine distribution to our members, and there has been no planning to meet the needs of the people we serve,” said William Dombi, president of the National Healthcare Association. at home and hospices.

Organizations that administer vaccines also complain that they are not being paid enough by Medicare to cover their costs – primarily staff time and effort. (Vaccines are free because the federal government pays for them.) Making a home visit for a vaccine takes about an hour on average, including travel, patient interaction time, and post-vaccination follow-up for people. for potential side effects, according to program officials. .

Medicare reimbursement for the first injection is $ 16.94; for a second shot, it’s $ 28.39, according to Shawna Ramey, a consultant who presented the data during a recent American Academy of Home Care Medicine webinar. “The actual cost of these tours is closer to $ 150 or $ 160,” Dombi said.

Then there are cold storage and transport issues for the Pfizer-BioNTech and Moderna vaccines. Both vaccines are fragile after being thawed and should be handled with care, according to the CDC’s new guidelines on immunizing adults confined to the home. Once the vaccine vials are opened, the injections should be given within six hours, as instructed by Pfizer and Moderna.

The demands have proven too onerous for Prospero Health, which serves 9,000 critically ill patients at home in 20 states, including nearly 2,000 homebound patients. Less than 10% have been vaccinated, said Dr Dave Moen, president of the Prospero medical group.

Things will get easier if the vaccines from Johnson & Johnson and AstraZeneca receive approval, as planned, he suggested. These two candidate vaccines are more stable than the Pfizer and Moderna vaccines and are said to be easier to administer at home, Moen said.

Palmer Kloster, 84, of Bradley, Illinois, receives care from Prospero under contract with his Medicare Advantage insurer, UnitedHealthcare. He is a largely immobile polio survivor who has undergone open heart surgery and receives paid aide care for four hours a day.

“I really need someone to come here and give me a chance,” he told me in a phone conversation. “I don’t want this disease [covid-19]. At my age, that would be very damaging. “

In Boston, 84-year-old Mary Gareffa is grateful that a doctor she knows and trusts, Dr Won Lee, came to her home in early February to vaccinate her. “I haven’t been out of the house for about eight years except in an ambulance,” said Gareffa, who has stomach cancer, weighs 73 pounds and broke his hip this summer after a bad fall.

Reaching patients like Gareffa is critical, said Lee, a geriatrician who works with the Boston Medical Center home program. “It is worth providing quality of life and reducing suffering, and covid-19 causes nothing but suffering,” she said. The Boston program had vaccinated 84 people as of February 12.

The vaccines come from the supply of the medical center. Before going out, staff call patients and share concerns about vaccines. Most are African Americans, and many families want to know if the vaccine will make their frail parents or grandparents sick. “They need to hear that it’s safe to get the vaccine from someone who knows their medical issues,” Lee said.

Wake Forest’s home visiting program sends a doctor, nurse or medical assistant paired with a pharmacy resident to administer the vaccines. About 200 people are served by the program, most of them in the late 1970s or early 1980s with five or more health issues, said Dr Mia Yang, program director.

Wake Forest’s goal is to provide vaccine home visits to up to 40 patients per week and to include caregivers if there is a sufficient supply, Yang said.

Robert Pursel, 69, who suffers from severe osteoporosis and fluid retention in his feet and legs, and his wife Gail, 72, who has severe back problems, both received Pfizer vaccines in late January de Geisinger at their home in Millville, Pa. At first Robert said he was skeptical, but now he’s glad he said yes. If a Nurse Geisinger hadn’t come to them, he couldn’t have come out on his own.

Because of his swelling, “I can’t put my shoes on,” said Robert, and “I should walk barefoot in the snow and ice over there.”