NC is making progress, but vaccinating homebound seniors remains a big challenge

The state has a list of agencies and pharmacies who will vaccinate people in their homes for COVID-19, but the list has some holes

It’s become easier and easier for most people to find available COVID-19 vaccine appointments but getting vaccinated poses a particular challenge for homebound seniors.

Getting homebound residents vaccinated involves coordination – connecting organizations that know where they are with vaccine providers, said Charlene Wong, chief health policy officer for COVID-19 at the North Carolina Department of Health and Human Services.

More than 100 vaccine providers are making home visits, Wong said, and people who need them are being identified by area programs on aging, faith groups, and others.

“We’re working hard to try to get more folks to get COVID-19 vaccine in a way that’s safe for them,” she said. They’re also thinking about how to vaccinate caregivers for whom getting out can be a challenge, she said.

Estimates on how many people are homebound vary widely, but there could be as many as 200,000 or more people in North Carolina who cannot leave or rarely leave their homes.

Recently, DHHS compiled a list of places offering COVID-19 vaccines to homebound people. Some counties offer multiple options, including community pharmacies, county health departments, and medical centers. About one-third of the counties, however, have no options listed.

In counties with few or no vaccine providers, DHHS is working with area agencies on aging and groups that serve people with disabilities to explore options, she said.

Not all the counties lacking local options are rural. Durham, for instance, has no local homebound vaccine providers on the DHHS list.

Suspension of the Johnson & Johnson single dose vaccine tore a big hole in Durham County’s plans.

The Centers for Disease Control and Prevention and the U.S. Food and Drug Administration called for a pause in the use of the Johnson & Johnson vaccine last week after reports of six cases of rare and severe blood clots in women ages 18 to 48.

Rodney Jenkins, Durham County health director, told the Partnership for Healthy Durham on Wednesday the suspension of the Johnson & Johnson vaccine “did pause some of our plans.”

The health department is working with Duke Health, the Durham Partnership for Seniors, and the Triangle J Area Agency on Aging to develop vaccination options. “We are evaluating available vaccination options in the event that J&J vaccine administration remains paused when new homebound vaccination plans are confirmed,” department communications director Alecia Smith said in an email.

Duke Health was able to vaccinate 15 Durham residents in their homes over three days before the J&J vaccine was paused, Michelle J. Lyn, chief of the Community Heath Division said in an email.

Duke has also received requests from agencies in Wake and is ready to help vaccinate homebound people there, Lyn wrote.

Vaccinating people at their homes presents logistical challenges that include keeping the vials cold, identifying people in need, and ensuring people who can safely deliver the vaccine are available, Smith wrote.

“DHHS has offered strategies for vaccine providers on transporting vaccines and using them so that no doses are wasted,” Wong said in an interview.

Local volunteers play a vital role

In some counties, including Wake and Cabarrus, Meals on Wheels identified homebound seniors who wanted vaccinations.

“Wake County Public Health reached out and said they had teams who would go to people’s homes,” said Alan Winstead, Wake Meals on Wheels executive director. “They were looking for underserved people – people who couldn’t come to a clinic. Equity was one of their concerns, too. We have a good representation of folks in all kinds of zip codes.”

Volunteers surveyed 1,500 people who get food through the organization.

The names were passed on to Wake Med Health and Hospitals, which coordinated getting the shots in people. Eighty-five people were vaccinated on a Saturday earlier this month, Winstead said. Meals on Wheels volunteers called clients before the vaccine visits to tell them what to expect.

Volunteers have good relationships with people on their food delivery routes, he said, and some in the past have helped clients apply for public benefits such as Supplemental Nutrition Assistance Program, commonly called food stamps.

Homebound people are not visible and “need somebody to advocate for them on the ground level,” Winstead said.

Meals on Wheels in Cabarrus County helped identify people who couldn’t leave their homes, said executive director Kimberly Strong, and the community paramedic program delivered the shots.  Meals on Wheels had been sending information about vaccines to clients all along, she said, and was then approached by the local health department to help people sign up to get people vaccinated at their homes.  About half of the 500 people who get Meals on Wheels deliveries scheduled vaccine appointments, Strong said.

One woman, who is blind, called in tears, thankful that someone would vaccinate her in her home, she said.

Homebound vaccinations in Cabarrus started more than a month ago.

“I think it’s been wonderful,” Strong said.

The Chatham County Public Health Department worked with the local Council on Aging and others to identify homebound people and with the National Guard to deliver the shots.

The National Guard volunteers worked in teams to plan routes to efficiently get to get about 20 doses of vaccine out while avoiding spoilage, said Chatham public health director Mike Zelek.

“Partnerships were so key,” he said.