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The vulnerable homebound are left behind on vaccination

Jenny Gold, Kaiser Health News, Kaiser Health News on

Published in Health & Fitness

As part of a $15 million no-bid contract with California to administer the state’s vaccination program, Blue Shield of California is obligated to provide vaccine access to homebound people. The company, nonetheless, declined to provide responses to specific questions about such efforts. Spokesperson Erika Conner said the company has “diligently explored opportunities for this work” and recommended that homebound people contact their local public health departments or health care providers.

The logistics of inoculating homebound people with a vaccine that requires cold storage is not simple. Once thawed, a vial of Pfizer-BioNTech vaccine contains six doses that must be delivered within six hours, while a Moderna vaccine vial contains 10 to 15 doses to be used within 12 hours. With each vaccination visit lasting about an hour plus the travel time, there isn’t much room for error, especially in rural areas where residents may live far apart. The one-dose Johnson & Johnson vaccine offers more flexibility, but the pause due to safety concerns resulted in delays.

“Yeah, it’s not easy. If it were easy, we’d already have done it,” said Dr. Mike Wasserman, a geriatrician and member of the California vaccine advisory committee. “But that’s not an excuse. These are the folks who if they get the virus they’re going to die. I don’t accept it.”

Wasserman said he’d give the state a “D” for its efforts to reach the homebound for vaccination. For some, he added, it might already be too late. “If you’re 80 years old and you live in a 1,000-square-foot home with 10 other people, you’re probably dead already.”

In the absence of a coordinated state-driven effort, California counties are attempting a patchwork of approaches.

In Los Angeles County, the public health department has partnered with the sheriff’s department and 15 fire departments to vaccinate homebound residents, with some success. Health officials projected that 50% of the county’s 10,000 homebound residents will have received one dose by the end of April.

In Fresno County, with more than a million residents, health officials said they are compiling a list of homebound people who want help getting a vaccine. So far, fewer than 20 people in that category have been contacted and received the vaccine.

 

In San Mateo County, where Freeman lives, the health department has identified at least 1,000 individuals who are homebound and in need of the vaccine; so far, 100 have been vaccinated.

Before she resorted to renting the $700 mobility van for her father, Beth Freeman contacted county workers. They offered to send a bus to pick up her father and take him to a vaccination site, but she couldn’t imagine how that would work for him, both in terms of the physical logistics and the risk of exposure. She asked the nurses who visited her father twice a week through Sutter Health’s care-at-home program for help — after all, they had given him the flu shot. But no luck. The nurses said they were not allowed to offer the COVID-19 vaccine.

Finally, on April 6, Beth made the difficult decision to transport her father despite his limited mobility. “I did not want to take him out of the house for this. It was risky for his health. But at some point I realized it wasn’t going to happen any other way,” she said. “He wanted to see members of his family and time was ticking.”

She said her father was up all night worrying, and his body was stiff. But with help from a home health aide, she used a special lift to hoist him into a wheelchair and wheeled him down two ramps and into the rented van, where she strapped him to the chair. They drove 20 minutes to the San Mateo County Event Center, her eyes darting from the road to the rearview mirror to check on her father, and then waited 40 minutes in the drive-thru line.

“When I rolled down the window, the nurses were like, What the hell? Why is he only coming to us now?” she said. The experience was so stressful for her father, she added, that he slept on and off for the next two days.

This week, they repeated the ordeal for his second dose — including laying out another $700 for the rental van. “All this, while he sees nurses at home twice a week?” Beth Freeman said. “What a missed opportunity.

(c)2021 Kaiser Health News Distributed by Tribune Content Agency, LLC