Apr. 11—Jane Weber had been "emailing everybody" for weeks desperately seeking COVID-19 vaccinations for herself and her 90-year-old homebound mother, terrified about the consequences should the virus find its way into their Scarborough home.
Her doctor, organizations assisting with her mother's care, state agencies — no one had any information, much less doses to share. And even when Weber managed to secure a shot in early February as a home health caregiver, it would be another month and a half before it was her mother's turn.
Nancy Weber is among the small but slowly growing number of homebound individuals — whose age and medical conditions make them particularly susceptible to the deadly virus — finally being vaccinated in their homes by visiting nurses or other health care providers. In many cases, those shots are arriving three to four months after similarly vulnerable residents of nursing homes were inoculated.
"I feel like they are really stepping up," Jane Weber said, "but it seems like they are finally doing what I wish they were two months ago, with the mobile units and home visits. And then I worry about people who don't have someone like me to advocate for them."
At a time when vaccine supplies are surging and states are opening eligibility to all adults, millions of homebound individuals nationwide are still waiting for their shots.
States and health care organizations, initially hampered by limited supplies and the fragility of the vaccines themselves, delayed campaigns to inoculate homebound patients. That is gradually changing, however, thanks in part to the arrival of the one-shot Johnson & Johnson vaccine that is more shelf-stable and doesn't require a second trip weeks later to administer a final dose.
It is a slow process, given the logistics of essentially door-to-door vaccination in a rural state like Maine. But advocates say it is a long-overdue shift necessary to protect a population still at risk of severe illness or death from COVID-19 from family and caregivers who could inadvertently bring the coronavirus into their homes.
"We are seeing some activity at the local level. What we are not seeing is a lot of coordinated state efforts, let alone federal effort," said William Dombi, president of the National Association of Home Care and Hospice in Washington, D.C. "But there has been some blossoming of effort of late. There seems to be more attention on homebound issues."
More than 82 percent of Maine residents age 70 or older had received at least one shot of vaccine as of Friday and 78 percent had been given all shots necessary for full inoculation against COVID-19. Yet vaccinations of Maine's oldest and most medically vulnerable population have slowed considerably as health care providers struggle with that final, hard-to-reach 15 to 20 percent.
Health experts and care providers say some of those individuals simply aren't interested in getting vaccinated, for a variety of reasons. Others may have had trouble securing appointments or arranging transportation to sometimes-distant vaccination clinics.
But a sizable segment of that unvaccinated population is homebound because of severe heart or breathing conditions, weakened immune systems, late-stage dementia, frailty, mental illness or a host of other disabilities.
"These are people who cannot get out and would need an ambulance to go to a clinic," said Leann Sebrey, a registered nurse and chief clinical officer at Androscoggin Home Healthcare & Hospice, whose organization began vaccinating homebound individuals last month in partnership with the state. "They are the folks who say yes please, because otherwise I am not going to be able to get my COVID shot."
LENGTHY WAITING LISTS
Health and home care organizations across Maine have delivered hundreds of shots to homebound patients in recent weeks. But the waitlists are lengthy, and vaccine providers are working with Area Agencies on Aging, veterans groups, Meals on Wheels providers and other groups to identify and contact others.
Androscoggin Home Healthcare & Hospice is one of six organizations around the state that are now partnering with the Maine Department of Health and Human Services to offer in-home vaccinations of individuals unable to travel to clinics.
DHHS officials said those six organizations cover 14 of Maine's 16 counties and the agency is working to line up providers in the final two, Washington and Sagadahoc. In addition to Agencies on Aging, DHHS is also partnering with organizations such as Elder Independence of Maine, Alpha One Independent Living Center and other community-based groups focused on enabling access to vaccination among ethnic and racial minority groups.
"Maine CDC is closely monitoring the federal allocation of (Johnson & Johnson vaccine) to the state and as supplies increase, will allocate as much as possible to homebound and other hard-to-reach populations," DHHS spokeswoman Jackie Farwell wrote in response to questions. "Maine CDC has also established policy enabling providers to include caregivers and other household members when providing vaccine to a homebound individual. This will facilitate vaccination of others who are often socially isolated themselves due to their caregiving responsibilities.
But it could take months to reach the thousands of others, given the logistics involved.
"We could actually do a lot more if we had the staff to do it," said Robert Abel, chief nursing officer at MaineHealth Care at Home in Saco, which began vaccinating homebound individuals last month. "It's a very labor-intensive process."
Abel called the expansion to home-based vaccinations "a real game changer for our vulnerable community members." Armed with about 100 doses per week from the Maine CDC, Abel's team of six nurses located in three offices had inoculated about 500 homebound individuals and the smaller number of still-unvaccinated caregivers as of last week, with that number growing by about 30 to 35 per day.
He would love to eventually hit about 200 per week and said the plan is to eventually vaccinate individuals outside of MaineHealth's client base who are referred to them by the state or other organizations. But that will take both more staff, which they are hiring, and larger allocations of vaccine.
For the coming week, none of the home care organizations are slated to receive any vaccine doses from the Maine CDC because of a precipitous — but hopefully temporary — decline in federal distributions of the J&J vaccine.
Officials with the Maine Department of Health and Human Services recently launched a pilot program to vaccinate homebound individuals with Androscoggin Home Healthcare & Hospice and St. Mary's Regional Medical Center. The group was administering 50 to 100 doses a week, primarily in the Lewiston-Auburn area, as of last week, with eventual plans to expand into Oxford and Franklin counties and parts of Kennebec County, according to Sebrey.
'SKEPTICISM AND FEAR'
One of the major hurdles facing vaccine providers is reaching sometimes-isolated individuals, both in terms of getting them on the list and then actually delivering the shot to their home.
At both MaineHealth Care at Home and Northern Light Home Care & Hospice, coordinators aim to group together five home-vaccinations in a particular region to ensure the clinicians have time at each location. Individual vaccine doses are only viable for a certain number of hours once the larger vial has been opened, further complicating efforts to inoculate residents spread out across Maine's rural landscape.
Southern Maine Agency on Aging recently had a waitlist of roughly 150 people who are unable to leave their homes and have requested vaccination. Working with Northern Light Home Care and Hospice, the agency has been helping to schedule appointments for those individuals, including Jane Weber's mother, Nancy, in Scarborough.
Megan Walton, CEO of Southern Maine Agency on Aging, said part of the focus now is outreach into harder-to-access individuals or communities, including among people who are hesitant to receive a shot. Her organization is also working with Catholic Charities Maine and other groups to identify homebound individuals in immigrant communities that still need vaccination.
"There is a lot of skepticism and fear, so we have to put in an extra effort so we reach everyone," Walton said.
Spectrum Generations in Augusta, which serves as the agency on aging for much of central and midcoast Maine, has also been working with Northern Light Home Care & Hospice as well as Redington-Fairview General Hospital in Skowhegan to identify and schedule homebound individuals.
Victoria Abbott, community engagement director at Spectrum Generations, said staff members are reaching out to Meals on Wheels clients as well as fielding calls from individuals. As of midweek, the organization had facilitated 83 home vaccinations.
EFFORTS IN OTHER STATES
In Maine and across the country, the task of identifying and vaccinating homebound individuals has largely fallen on health care organizations, although some states have been more aggressive at tackling the issue than others.
In late February, Texas officials announced plans to mobilize roughly 1,100 members of the Texas National Guard to help with home-based vaccinations in rural or isolated areas of the state. Texas' "Save Our Seniors" campaign planned to work with health care organizations and Meals on Wheels to vaccinate thousands of homebound residents per week.
West Virginia, which has consistently led the nation in vaccination rates since the early days of the national campaign, has left many decisions on deployment of vaccines up to local and county officials. As a result, many West Virginia counties have deployed teams of nurses to travel the state's rural roads to deliver vaccines to homebound individuals.
In Miami Beach, the city's fire department worked with religious and other organizations to administer more than 5,000 shots to homebound individuals and people living in low-income housing by late February, according to news reports. The U.S. Department of Veterans Affairs has also inoculated thousands of homebound individuals across the country.
Dombi, the president of the National Association of Home Care and Hospice, said an estimated 12 million people nationwide receive some form of home services, although not all of those are strictly homebound. There are no national figures for how many of that population have been inoculated, but Dombi said anecdotal reports suggest they are "very small numbers."
The National Association of Home Care and Hospice has been advocating for a "national plan" that would supplement, not supplant, the growing number of efforts occurring at the local and state levels. Dombi said the first phase of that plan would be to enable visiting nurses to pick up vaccine doses from local pharmacies — preferably the single-shot J&J variety — to administer to patients during their regular appointments with homebound clients.
Individuals with family caregivers, or who have private-pay caretakers, will be admittedly harder to reach and might be part of a later phase, he said. But Dombi said that, based on his conversation with top Biden administration officials handling the COVID-19 pandemic, he believes "there is a strong recognition at the White House and at the CDC about the need to do something" about homebound individuals.
"I'm feeling very confident that we now have not only a recognition but a willingness to take action, both on the local level and the federal level," Dombi said. "It is just going to take some time to get there."