Home-bound elderly people are still waiting for Covid-19 vaccines, so doctors and nurses go to them

“This is a hidden group that is going to be overlooked if we no longer try to reach it,” said Dr. Steven Landers, president and CEO of the Visiting Nurse Association Health Group, said. people in New Jersey, northeastern Ohio and southeastern Florida. His organization plans to launch a pilot 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 is struggling to breathe due to a serious lung disease. “I can not walk; I am in a wheelchair. There is no way I can get the vaccine if it does not reach me,” she said in a telephone interview.

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

Reaching homemade seniors presents many challenges. Top of the list: Home care agencies and hospice organizations do not have access to gut vaccines for their staff or patients.

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

Vaccine organizations also complain that Medicare does not pay enough to cover their costs – mainly time and effort for staff. (The shots are free because the federal government pays for them.) Taking a vaccination for vaccinations requires an average of about an hour, including travel, time interaction with patients and monitoring after vaccination of people for possible side effects, according to program leaders. .

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

Then there are problems with cold storage and transportation for the Pfizer BioNTech and Moderna vaccines. Both vaccines are fragile after thawing and must be handled with care, according to the new CDC guidelines on vaccination of home-grown adults. Once the vaccination dishes are opened, shots should be delivered within six hours, according to the instructions of Pfizer and Moderna.

These requirements have proved too burdensome for Prospero Health, which serves 9,000 seriously ill patients in their homes in 20 states, including nearly 2,000 home-bound patients. Less than 10% were vaccinated, said dr. Dave Moen, president of Prospero, said.

Things will get easier if Johnson & Johnson and AstraZeneca vaccines, as expected, get approval, he suggested. Both candidates for the vaccine are more stable than the Pfizer and Moderna vaccines and will be more easily administered at home, Moen said.

Palmer Kloster, 84, of Bradley, Illinois, is being cared for by Prospero under a contract with his Medicare Advantage insurer, UnitedHealthcare. He is a largely immobile polio survivor who underwent open heart surgery and received care from paid helpers four hours a day.

“I really need someone to come here and give me a chance,” he told me in a phone call. ‘I do not want that disease [covid-19]. At my age, that would be very detrimental. ‘

In Boston, Mary Gareffa, 84, is grateful that a doctor she knows and trusts, Dr. Won Lee, came to her house in early February to vaccinate her. “I was not home for about eight years, except by ambulance,” Gareffa, who has stomach cancer, weighed 73 kilograms and broke her hip this summer after a bad fall.

It is essential to reach out to patients like Gareffa, said Lee, a geriatrician who works with Boston Medical Center. “It’s worth it to provide quality of life and reduce suffering, and covid-19 causes nothing but suffering,” she said. The Boston program vaccinated 84 people on Feb. 12.

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

Wake Forest’s call program sends a doctor, nurse or assistant doctor along with a pharmacist to deliver vaccinations. About 200 people are served by the program, most of them in their late 70s or early 80s with five or more medical conditions, Drs. Mia Yang, director of the program, said.

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

Robert Pursel, 69, who has severe osteoporosis and fluid retention in his feet and legs, and his wife, Gail, 72, who have severe back problems, both suffered late-January Pfizer vaccinations from Geisinger at their home in Millville, Pennsylvania. receive. Initially, Robert said he was skeptical, but now he’s glad he said yes. If a nurse from Geisinger had not come to them, he would not have been able to get out himself.

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