Steven H. Landers, M.D., president and CEO of Visiting Nurse Association Health Group, prepares to vaccinate a patient during a VNA home visit in Asbury Park.
By Judy O’Gorman Alvarez
In the race to vaccinate there are so many vulnerable populations to protect. But the Visiting Nurse Association Health Group wants to make sure one often forgotten group doesn’t remain unseen.
“We are lobbying for more attention to homebound seniors in this whole (vaccination) process,” said Steven H. Landers, M.D., M.P.H., president and CEO of VNAHG. “That’s something we care about.”
Landers notes the success of vaccinating frontline caregivers and credits the collaboration with community partners, such as Red Bank YMCA and VNACJ Community Health Centers for effective community programs.
“But we’re concerned the homebound is being overlooked,” Landers said.
He points out that the rollout has been successful in vaccinating the elderly vulnerable in live-in and other congregate settings. “And rightly so,” Landers said. “But the older adults who live in the community, the sickest, are at risk of getting to the back of the line.”
That’s what Landers and others are concerned about. If you think all your friends and neighbors have been lamenting how hard it is to get vaccination appointments for themselves or their parents, Landers said the homebound elderly patients currently under the VNA care – or even those who may not be under their care at the moment – are often baffled about how they can be vaccinated.
The message “Check the website later” to make a vaccination appointment means nothing to patients unfamiliar with computers or even lacking online access altogether. And traveling to a vaccine site can be prohibitive. “In many cases it’s almost impossible,” said Landers. “It would involve ambulance transport.”
Fortunately, the VNA already visits many of these vulnerable patients and is embarking on a pilot program to raise awareness and spark ideas about the issue. They are looking for both common sense and out-of-the-box ways to get vaccinations into the arms of the homebound.
Among the suggestions are “family clusters” which would involve a VNA clinician vaccinating a patient in their program, as well as the patient’s family members, caregivers, friends and even neighbors who register and come to the patient’s home during a scheduled VNA home visit. “This model would allow for one vaccinator – likely a nurse – to vaccinate and observe more than one person at a time,” said Landers.
Another idea involves “float nurse” vaccinators who would transport and administer the vaccine to patients, timing their arrival at the home with a regularly scheduled home care visit by another clinician who would observe and follow up with the patient after the floater nurse administered the vaccine and went on to the next stop.
And finally, “vaccine caddies” would require a vehicle equipped with refrigeration and vaccine products and supplies out in the community. “They would respond to requests – via an app or secure message platform – from other home care clinicians in the community who are making scheduled home visits and need a vaccine dose to be brought to homes where they’re doing visits.
“It’s conceivable the caddie could pop around town to enough homes to use up an entire vial of vaccine in the 6-hour window,” Landers said.
Despite the creative ideas that have surfaced, logistics to vaccinating the homebound prove troublesome. Storage and refrigeration require a lot of attention to detail.
According to Landers, the Moderna vaccine can be stored in “normal” freezers that medical offices and home care providers could theoretically maintain and also be kept at room temperature for 12 hours after thawing. However, the Moderna vials contain 10 doses, and the package insert says you must use all of the product within six hours after the vial is punctured.
The other roadblock to vaccinating is cost. “The way that Medicare pays for vaccination, it doesn’t cover the cost to provide a nurse,” said Landers. But he has faith that surmount- ing these roadblocks is not outside Medicare’s realm.
As the term “homebound” suggests, most of VNA’s patients have not been socializing in large crowds and are relatively safe in their households. “But it’s important to remember at any given time, they’re at medical risk,” Landers said. Many have serious heart or neurological diseases. Care providers, family members and others come into their homes and “it’s not uncommon for the homebound to end up in hospital or nursing facility in a congregate setting,” putting them at greater risk.
Isolating patients from their own families can be extreme. “They deserve to have that love and family bonding,” he said.
“I am extremely grateful to VNA for giving my husband the COVID vaccine at home,” said Pam Ferguson of Asbury Park, caregiver to her homebound spouse. “I was stressed thinking about ways I could get him to a vaccine center. When Dr. Steven Landers arrived at our home with the shot it was the biggest blessing.
I am forever grateful to his care team,” she said.
“It’s important to know how active we are being for advocating for better access and improving vaccination rollout to frail elderly and the homebound,” Landers said. He hopes more options for vaccinating homebound individuals will open up once promising vaccines from Johnson & Johnson and AstraZeneca are approved. Those vaccinations only require one dose and do not need to be kept under refrigeration, meaning the logistics for dispensing them would be far less complicated.
For information about vaccinations or to follow Landers’ blog, visit vnahg.org.
This article originally appeared in the Feb. 4, 2021 print edition of The Two River Times.
