Home care providers have a long history of public health expertise, including vaccinations. The COVID-19 response is no different.
While the COVID-19 vaccination effort is enormously complex, home care providers throughout New York are working to overcome these challenges on behalf of patients and staff.
HCA is profiling these efforts in a new feature called Home Care #VaccinateNY.
Sullivan County Public Health Service: 'Homebound? We’ll Bring the Vaccine to You'
The nurses of Sullivan County Public Health Services are ready and willing to travel to any location in the county to ensure local homebound residents are vaccinated against COVID-19. In fact, they’ve already administered vaccines to nearly 30 such residents, the agency reported on May 21.
“While the exposure risk is low if you live alone and only have occasional visitors or caregivers, the coronavirus is very contagious, and for anyone with underlying health conditions, the long-term health impacts are still largely unknown but can be devastating — and potentially fatal,” Public Health Director Nancy McGraw cautions.
Since March 2020, at least 74 deaths have occurred among Sullivan County residents from COVID-19, with more than 6,517 confirmed cases, she added.
Older adults and people with underlying health conditions or compromised immune systems are at higher risk of developing severe illness, hospitalization or death from this virus, which is why programs like Sullivan County's are so important.
“The good news is that vaccines are much more widely available to everyone, and our nurses are available to administer the COVID-19 vaccine shot in the comfort of your own home if you are unable to get to a vaccine clinic, pharmacy or healthcare provider on your own,” McGraw adds. “We have plenty of supply and are eager to continue vaccinating as many people as we can in the weeks ahead."
The county is using a ‘hub and spoke’ model, focusing on communities with lower vaccination rates, and then sending a nurse and EMT out from the clinic to homebound persons in that zip code. Sullivan County is working closely with its local Office for Aging and Emergency Community Assistance Center to coordinate these efforts.
Homebound visits can be scheduled through the County’s Emergency Community Assistance Center at 845-807-0925 (English and Espanol). The actual visit lasts approximately 20 minutes, and caregivers/relatives in the home can receive a dose at the same time.
Photo courtesy of Sullivan County Public Health Service: Helen Klinger, left, chats with RN Sue Flynn before receiving her COVID-19 vaccine at her Woodbourne home.
Royal Care CEO Josh Klein – a Licensed Paramedic – Takes Hands-On Lead Vaccinating Home Health Aide Staff
New York City-based Royal Care is administering the COVID-19 vaccine directly to all of its caregivers — an effort that is being led, hands-on, straight from the top.
In addition to being Royal Care’s lead executive, CEO Josh Klein is also a New York State-certified paramedic who began administering doses to Royal Care home health aides in March as part of Royal Care’s pioneering effort to vaccinate its own staff.
The agency invites staff to request a vaccine through a simple-to-use online form in English as well as Spanish and Chinese translations. It is accompanied by helpful resources explaining the various vaccines, differences between them, how they work, and how they've been tested for safety.
Klein has been profiled in the New York Post for his response work throughout the COVID-19 pandemic, not only providing for the in-home needs of Royal Care’s patients but also as a volunteer EMT for Hatzolah, the largest volunteer ambulance service in the U.S. In that capacity, he’s responded to hundreds of emergency calls related to COVID-19.
“During the COVID-19 pandemic, home health aides played an essential role in safeguarding patients at home,” Royal Care says. “Prioritizing and safeguarding caregivers first will indirectly actively shield such high-risk individuals.”
Photo courtesy of Royal Care: CEO Josh Klein administers vaccinations as part of Royal Care's staff vaccination program.
St. Peter’s Administers Over 1,000 Vaccine Doses to Patients Across PACE, Home Care & In-Home Primary Care Programs
The various senior services and in-home programs under the umbrella of St. Peter’s Health Partners have collectively delivered well over 1,000 vaccine doses to patients as of late March. This includes older adults and homebound individuals served by the Eddy Visiting Nurse & Rehab Association, Eddy SeniorCare’s Program of All-Inclusive Care for the Elderly (PACE), and the Practitioner Home Based Primary Care Program.
This multi-pronged approach has allowed St. Peter’s Health Partners to broaden its reach across programs, equipped with all three of the currently approved vaccines in recent months: Moderna, Pfizer, and Johnson & Johnson.
Because of strict refrigeration requirements, the SeniorCare and community-based care divisions at St. Peter’s have designated the Pfizer and Moderna doses for PACE enrollees and individuals in The Eddy’s Home Based Primary Care Program, a special chronic disease management program whose Nurse Practitioners are delivering the doses at home to patients.
Meanwhile, the Eddy’s home care program, the Eddy Visiting Nurse and Rehab Association, has enlisted its nurses to identify and help build a roster of patients eligible and homebound hoping to receive the vaccine at home, “a significant tracking effort,” says the program’s Executive Director Lisa Lemery. Each nurse administers approximately five doses per day — the full amount of a vial. These have to be disseminated within a six-hour window (if refrigerated), and must account for travel time, the observation period at each home visit, and the required documentation necessary to complete.
“It’s such a joy to hear from patients when you call and make arrangements for in-home vaccination — how thankful they are because they’ve wanted to get vaccinated and now they can have someone provide it in their own home,” Lemery added.
Photo at vaccination site courtesy of Eddy Visiting Nurse & Rehab Association.
‘Strong Coordination’ Key to Success of Essex County’s In-Home Vaccination Effort
Essex County’s Certified Home Health Agency (CHHA) serves a geographically sprawling region where nurses might drive as far as 100 miles to reach home care patients. With two nurses administering about 15 doses a day, the county’s vaccination program has so far been able to provide about 100 doses to patients at home over the course of one week in March.
The agency used coolers and a temperature tracking device to ensure that its allotments of the Johnson and Johnson vaccine got to patients within the required six-hour window after each five-dose vial is punctured. This is no small feat, especially when you consider travel time, a minimum 15-minute patient observation period at each home visit, and the prospect that a patient — for a variety of reasons — may be unable to receive the vaccine at the appointed time, requiring backup plans.
“The logistics of getting the vaccine out to people requires a strong coordination effort,” says Jennifer Newberry, BSRN, Director of Patient Services for Essex County Health Department’s Home Health Unit who says the agency makes about two or three confirmation calls to patients ahead of time before heading out to administer vaccines.
She adds: “We always have a backup person eligible to receive the vaccine” — such as a family caregiver — if a nurse arrives at a patient’s home and the patient is not home, refuses the vaccine, or is unable to receive it. Thankfully those circumstances have been rare.
Because the county runs a point-of-dispensing (POD) site, it has a wait list to draw from if needed. As a public health agency, Essex County’s CHHA is also well connected with other community organizations, whether it’s senior housing agencies, area offices for aging, adult protective services, or other home care agencies that cover the county — all of which are important partners in the effort to identify eligible individuals for in-home vaccinations, in addition to the many inquiries that the county receives directly from the community.
This role “allows us to more readily identify homebound residents and their eligible caregivers/household members and utilize our existing nursing staff to administer vaccine to this more vulnerable population," said Program Coordinator Andrea Whitmarsh in recent remarks to the Press Republican newspaper.
Photo above courtesy Essex County Department of Health: Kelly Bush, RN vaccinates John McGinnes of Moriah, NY as part of the ECHD vaccination program for homebound individuals.
Montefiore’s In-Home Vaccination Program
Bronx-based Montefiore Home Care (MHC) began its in-home vaccination program with initial doses of the Johnson and Johnson vaccine on March 12.
MHC is the nation’s first hospital-based home care agency, established in 1947, and is part of the Montefiore Hospital health system. Though Montefiore’s home care agency is separately registered as a vaccination site, it’s been able to use one of the hospital system pharmacies to accept delivery and storage of the vaccine until the doses are ready to be administered to patients at home.
As of March 22, the agency had received 200 doses and was able to vaccinate 105 patients in its first week. The orders come in 100-dose increments — an allocation that is separate from doses ordered for the rest of Montefiore’s health system.
“The Johnson and Johnson vaccine requires only one injection, which is a big plus,” says Mary H. Gadomski, BSN, RN, Executive Director at Montefiore Home Care. Once a vial is opened, the vaccine must be used within six hours, “so we are keeping our vaccine visits separate from our regular home care visits.”
Many patients want the vaccine, says Gadomski, but the process requires extensive coordination when scheduling home visits to ensure that patients are ready for a dose. Some patients may be recovering from COVID-19 and “physicians might recommend that the patients wait, due to numerous factors. In other cases, the patient simply wants to discuss vaccination decisions with family members.” Also, all patients need to be screened for allergies and past history of anaphylaxis.
“Since the first day that the vaccines were made available, our clinical staff have worried about their homebound patients, and how they would get access to the vaccine," Gadomski added. "Knowing that our patients could not go to Yankee Stadium or other vaccine sites, it’s been wonderful to be able to offer the vaccine to our patient population. I am proud of our nurses who rallied to the call to be vaccinators without hesitation. Our patients and families are so appreciative!”
Photo above courtesy Montefiore Home Care: Home Health Nurse Misael Campos administers the vaccine to MHC Patient Michael Quinones.
Nascentia Health Vaccinates 300 Clients and Caregivers in Their Homes
HCA member Nascentia Health has led upstate New York's first in-home vaccination program, administering 300 doses of the Johnson & Johnson single-dose vaccine to the organization’s homebound clients between March 10 and 16.
Onondaga County Health Department allotted the vaccines to Nascentia as part of a program to bring more vaccine accessibility to the most vulnerable citizens in the area.
Nascentia currently has nearly 1,200 patients who receive skilled nursing home care throughout a 6-county region, many of whom face barriers to reaching vaccine sites.
With only a couple days’ notice from the county, Nascentia’s team of nurses and care managers quickly reviewed existing patient records to identify those who had not received a vaccine but met eligibility requirements, and contacted them to offer the home vaccination option. Caregivers, such as a spouse or aide, were also able to receive the vaccine in the home if they met current state eligibility requirements.
In addition to identifying eligible patients, Nascentia had to manage the logistics of actually administering the doses effectively. Each vial contains five individual vaccines. Once a dose is drawn from a vial, all of the doses must be drawn and administered within several hours. This required vaccinations to be arranged within a narrow geographic area to ensure that all five doses could be given within the time frame required. Thankfully, the Johnson & Johnson vaccine only requires standard refrigeration, which makes it an excellent fit for a mobile vaccination program.
Onondaga County will be expanding their home vaccination program moving forward and Nascentia is looking forward to partnering with them on this initiative.
“This batch of vaccines is a wonderful start toward vaccinating our elderly and disabled patients who are not able to visit mass vaccination sites or local clinics,” said Nascentia’s Chief Clinical Officer Andrea Lazarek-LaQuay. “We are hopeful that additional vaccines will be allocated to us so we can continue to reach out to those underserved by other vaccine options.”
WATCH: Home-Bound COVID-19 Vaccinations Begin Across Central New York, Spectrum News, March 11, 2021
Photo courtesy of Nascentia Health.