Cathy Ready's mother rarely leaves her home. The 80-year-old Sacramento resident lives with multiple sclerosis and is restricted to her bed, unless someone helps her get into a wheelchair.
Ready says they tried for about five weeks to find a way to arrange a COVID-19 vaccination at their house. She says neither her mother's doctors nor the staff at her hospice program could arrange for a delivery.
“As far as I can tell, there’s no such service where you can just call up and say I need a registered nurse to come out and do this procedure,” she said, noting that her mom can’t ride in a regular vehicle due to her medical conditions. “So the option is go rent a van for the day.”
Ready did secure appointments for her mom and herself, and they booked a van for $140. But she says families like hers need better options if all Californians are to be fully vaccinated.
“We’re not the only homebound people out there,” she said. “It’s got to be a large population out there that’s waiting on a shot and can’t get it.”
There are an estimated 2 million homebound seniors. Experts say they’ll be among the hardest to reach with vaccine distribution, and health departments and nonprofits are looking for creative solutions.
In most counties, people in need of in-home care have been near the top of the eligibility list since early in the vaccine roll-out. But there are likely still thousands of them trying to figure out how to access the shot.
“There was a big emphasis on congregate settings where people lived together, and they were easily identifiable,” said Eric Dowdy, chief government affairs officer at LeadingAge California, an advocacy group serving older adults and their care providers.
“With people that are homebound, living in the community in apartments scattered across the country, that’s the challenge," he said. "It’s just really difficult to get to that population.”
Dowdy says there are discussions happening on the state level about how to mobilize the home health care workforce to deliver vaccines, but so far nothing formal is in place.
California’s vaccine distribution contract with insurance company Blue Shield includes language about bringing vaccines to the homebound, but the state hasn’t unveiled any formal plans for this group yet.
Representatives from Blue Shield say they’ve “diligently explored opportunities for this work” with home health care agencies and are continuing to make a plan, which they expect to unveil mid-April.
Meanwhile, counties are looking for their own solutions.
In the city of Glendale in Los Angeles County, a hospital has partnered with the fire department to send first responders to deliver shots to the homebound. Teams at the University of Southern California and the University of California, Los Angeles have also assembled to get health providers to peoples’ homes with doses in hand.
In Yolo County, homebound residents can call 211 and let staff know they need an in-home vaccine. County representatives say they’ve vaccinated more than 130 seniors this way since they started offering the service in February.
“It’s going to have to be a doorstep model,” Dowdy said. “They’re going to have to come to the senior to really make sure this happens.”
But many counties without a delivery option are still focused on how to get people with mobility challenges out of their homes and to their nearest doctor's offices or mass vaccination sites.
Sacramento County is using pre-existing paratransit services to offer free rides to people with mobility challenges who can show proof of vaccine appointments. Sacramento Regional Transit is also waiving bus and light rail fares for people on their way to get a shot.
County health staff say there is a small ‘strike team’ that has gone out to residential facilities to vaccinate seniors who didn’t get their doses earlier in the roll-out. Rachel Allen, the county’s immunization coordinator, says that team has also been responding to the occasional request to bring vaccines to homebound residents, and is looking for ways to expand that service.
“We’ve been able to respond to those requests, but they do appear to be increasing,” Allen said at a media briefing Thursday. “We have limited capacity right now but do see it as an increasing need and absolutely do plan to respond to that.”
In Placer County, the health department is working with existing senior service nonprofits to help transport people who can leave their homes. They’re also identifying those who are truly homebound in hopes of setting up home-based vaccinations using the Johnson and Johnson vaccine.
Because this vaccine is given in one dose instead of two, county spokesperson Katie Combs-Prichard says it’s preferable to the two-dose vaccines, which “can be a challenge due drive times between homes; the required observation period post-vaccine; and the expiration window for vials.”
In Orange County, nonprofit groups, health clinics and county staff are working together to get homebound seniors into the community for vaccinations. Meals on Wheels Orange County, originally set up to deliver food to the elerly, is now identifying which of their clients still need to be vaccinated.
Then Meals on Wheels staff are helping people schedule appointments through the county or their doctors, and finding them transportation to the appointment, either from a local senior services nonprofit or through the regional transit authority.
Gio Corzo, vice president of home and care services for Meals on Wheels Orange County, says they’re also providing staff and volunteers to take seniors through the whole vaccination process.
“We serve a very frail population,” he said. “We are able to schedule their transportation, but they still need some level of support and assistance to get through these events ... it’s a very stressful day, having something completely new and being vaccinated.”
Corzo also says many of the seniors they serve have been deteriorating mentally and physically due to isolation during the pandemic. Senior advocates say in addition to getting homebound individuals vaccinated, they’re searching for ways to keep them connected socially.
