Home Health & Hospice Week

COVID-19 vaccinations are starting to roll out amid confusion and disarray.

Whether home health and hospice agencies are having trouble securing vaccinations for their staff depends in large part on where they are located, providers and their representatives report.

Mainstream press stories confirm that COVID-19 vaccinations are getting into home health and hospice employees’ arms.

For example: On Dec. 28, the Waco- McLennan County Public Health District administered the first round of its allotment of the vaccine to 41 workers from three home health agencies, and planned to continue, reported the Waco Tribune Herald. Brett Rhodes, owner of Home Instead Senior Care in Hewitt, told the newspaper the health district called the company offering the vaccines, and he jumped at the chance. “We are working with the elderly 24 hours a day, seven days a week, and the elderly are the most vulnerable population out there, and also my employees are on the frontlines too,” Rhodes said.

Dec. 28 is when Illinois began offering vaccinations to non-hospital workers as well, notes Sara Ratcliffe, head of the Illinois Home Care and Hospice Council.

In many areas, vaccinations of non-hospital workers picked up steam after the holidays.

For example: The Eau Claire City-County Health Department in Wisconsin opened up vaccinations to home health, personal care, and hospice workers Jan. 6, reported WEAU 13 News. In Idaho, the Panhandle Health District was already vaccinating home health personnel and began hosting COVID-19 vaccination clinics starting Jan. 6 for more, reported KREM 2 News. In Kansas, Shawnee County Health Department and GraceMed administered vaccines to home health workers on Jan. 5 in Topeka “because they otherwise would not receive it during this phase,” they told KSNT News.

In Oregon, Oregon Health & Sciences University is partnering with the Service Employees International Union to vaccinate home care workers, reported Oregon Public Broadcasting. The program will be particularly tricky because there is no central employer to distribute the vaccinations, and workers speak a number of languages, OPB noted.

That decentralization is what is making the vaccinations such a challenge for home health and hospice agencies, especially smaller providers and those not affiliated with a hospital or other facility, experts say.

“While vaccinations are rolling out to home care and hospice staff, it has been a range of wonderful to haphazard,” National Association for Home Care & Hospice President William Dombi tells AAPC.

After intense lobbying and education efforts, most states have categorized home health and hospice workers into their Phase 1A priority group for vaccination. But even within that group, there are differences.

For example: In Virginia, home health workers are in Phase 1A, category iv. “Currently most local health departments are in Phase 1A category iii,” Marcia Tetterton, head of the Virginia Association for Home Care and Hospice, reported at press time.

In Virginia, “the state Department of Health has given the local health departments broad vaccine distribution authority,” Tetterton relates. “Some skilled home care have already vaccinated,” she said, but it’s up to each local health department. Virginia had administered 26 percent of its vaccine doses, according to Centers for Disease Control and Prevention data available at press time. That ranked 31st out of 50 states at that time.

In New York, the state has created 10 regions, each with a “hub” responsible for determining who exactly gets vaccinated based on state priority guidance, explains Roger Noyes with the Home Care Association of New York State. “Frankly, it’s an uneven process,” Noyes tells AAPC. For instance, some regions have websites to verify and schedule vaccination appointments, some don’t. New York had administered 32 percent of its vaccine doses, ranking 22nd in the nation.

That erratic pattern is the same in Illinois, Ratcliffe acknowledges. “As the plan for distribution varies by county so do our reports of how it is going,” Ratcliffe says. “Chicago and the collar counties have websites for agencies to register their staff for distribution, but more rural areas do not.”

The good news is “it seems to be fairly orderly overall,” Ratcliffe says. Illinois had administered 33 percent of its vaccine doses at press time, ranking 21st.

The BAYADA Home Health Care chain has seen differences “state by state” in all 23 states it serves, Chief Government Affairs Office David Totaro tells AAPC. While most states have home care workers in that 1A designation, “it’s never communicated clearly how to get it,” he says of the vaccination. Many providers don’t know whether to contact their hospital, the health department, or who.

The decentralized vaccination process plus the decen­tralized nature of home health and hospice agencies is a double challenge, Noyes notes. Home health and hospice staff “are not all in one place at one time” to receive shots, he points out.

Some areas require individuals to make their own appointments, and they can face technical difficulties like downed websites or phone lines, or even just extremely long hold times.

In New York, some providers are trying to coordinate with major hospital vaccine suppliers to set up clinics for their employees, while others must rely on the individual route. “It runs the gamut on how agencies are approaching it,” Noyes says. But it boils down to disseminating information and navigating logistics.

In New Jersey, where BAYADA is headquartered, two home health agencies administered vaccinations to home health workers the week of Dec. 28, Totaro relates. But confusion still abounded and many staff went unvaccinated.

“With the local control approach in use, the operation and administration of the vaccines requires a very localized engagement by the providers,” Dombi notes. “They must take the initiative to be successful in getting access.”

Providers shouldn’t be shocked by the less-than-smooth vaccination process. “This is the largest public health crisis in 100 years,” Noyes points out. It’s no surprise that “the solution will be just as momentous and huge.”

Note: The CDC COVID Data Tracker for vaccinations is at https://covid.cdc.gov/covid-data-tracker/#vaccinations .