Elderly people living at home are still waiting for Covid-19 vaccines, so doctors and nurses are coming to them

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

Jane Gerechoff, 91, of Ocean Township, New Jersey, is waiting for the group to vaccinate her. She had a stroke more than a year ago and has difficulty breathing due to severe lung disease. “I can’t walk; I’m in a wheelchair. There is no way in the world to get the vaccine if they don’t come to me,” she said in a telephone interview.

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

Reaching elderly people living at home presents many challenges. Top of the list: Home care agencies and hospice organizations do not have access to envious vaccines for their employees or patients.

“There is no distribution of vaccines to our members and there is no planning to meet the needs of the people we serve,” said William Dombi, president of the National Association for Home Care & Hospice.

Organizations that administer vaccines also complain that Medicare is not being paid enough by Medicare to cover its costs – mainly staff time and effort. (Vaccines are free because the federal government is paying for them.) Making a call to the vaccine home requires an average of about an hour, including travel, interaction time with patients and post-vaccination monitoring of people for possible effects. collateral, according to program leaders.

Medicare reimbursement for the first injection is $ 16.94; for a second chance, it costs $ 28.39, according to Shawna Ramey, a consultant who presented the data in a recent American Academy of Home Care Medicine webinar. “The real cost of these visits is about $ 150 or $ 160,” said Dombi.

Then there are problems with the refrigeration and transport of the Pfizer-BioNTech and Moderna vaccines. Both vaccines are fragile after being thawed and need to be handled carefully, according to the CDC’s new guidance on vaccinating adults at home. Once the vials of the vaccine are opened, the vaccines must be administered within six hours, according to the instructions from Pfizer and Moderna.

These requirements proved to be very heavy for Prospero Health, which serves 9,000 seriously ill patients at home in 20 states, including about 2,000 patients who stayed at home. Less than 10% have been vaccinated, said Dr. Dave Moen, chairman of Prospero’s medical group.

Things will be easier if the Johnson & Johnson and AstraZeneca vaccines receive approval, as expected, he suggested. Both vaccine candidates are more stable than the Pfizer and Moderna vaccines and would be easier to administer at home, said Moen.

Palmer Kloster, 84, of Bradley, Illinois, receives care from Prospero under a contract with his Medicare Advantage insurer, UnitedHealthcare. He is an almost immobile polio survivor who has undergone open-heart surgery and receives care from paid helpers 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 that disease [covid-19]. At my age, it would be very harmful. “

In Boston, Mary Gareffa, 84, thanks that a doctor she knows and trusts, Dr. Won Lee, came to her home in early February to vaccinate her. “I haven’t left the house in about eight years, except by ambulance,” said Gareffa, who has stomach cancer, weighs 73 pounds and broke her hip this summer after a bad fall.

It is essential to reach patients like Gareffa, said Lee, a geriatrician who works with the Boston Medical Center’s home program. “It is worthwhile to provide quality of life and reduce suffering, and covid-19 only causes suffering,” she said. The Boston program vaccinated 84 people as of February 12.

The vaccines come from the stock of the medical center. Before leaving, team members call patients and address any concerns they may have about taking the injections. Most are African American and many families want to know if the vaccine will make their frail parents or grandparents sick. “They need to hear that it is safe to get an injection from someone who knows their medical problems,” said Lee.

Wake Forest’s home care program is sending a doctor, nurse or medical assistant paired with a pharmacy resident to deliver vaccines. About 200 people are served by the program, most of them in their late 70s or early 80s with five or more medical conditions, said Dr. Mia Yang, the program’s director.

Wake Forest’s goal is to provide home vaccines for up to 40 patients a week and include family caregivers if there is an adequate supply, said Yang.

Robert Pursel, 69, who has severe osteoporosis and fluid retention in his feet and legs, and his wife Gail, 72, who has serious back problems, received Pfizer vaccines from Geisinger in late January at his home in Millville, Pennsylvania. At first, Robert said he was skeptical, but now he is happy to have said yes. If a Geisinger nurse had not come to them, he would not have been able to go out alone.

Because of his swelling, “I can’t put my shoes on,” said Robert, and “I would have to walk barefoot through the snow and ice outside.”