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COVID-19 Vaccination:

Learn Lessons From VNSNY’s COVID Vaccination Practice

Published on Fri Mar 12, 2021

Learn Lessons From VNSNY’s COVID Vaccination Practice

About 50 percent of the agency’s aides have undergone vaccination; encouragement — including $100 bonuses — probably helped.

Home health and hospice agencies’ challenges come on multiple fronts for COVID-19 vaccination, including securing access for workers who want the vaccine and encouraging those who are reluctant to get jabbed. The Visiting Nurse Service of New York’s experience as a provider of vaccinations may offer instruction for agencies tackling both scenarios.

Background: VNSNY, which says it’s the largest not-for-profit home- and community-based health care organization in the U.S., began furnishing vaccinations to staff at its midtown Manhattan office in early January, recounts VNSNY exec Andria Castellanos. That came after a complicated process of working with federal, state, and New York City officials and systems to become a vaccine center, Castellanos tells AAPC.

With around 13,000 employees total, organizing and administering inoculations was — and continues to be — an enormous task requiring “tremendous logistics,” Castellanos acknowledges.

Important difference: Instead of creating a system where staff register themselves for vaccination appointments, VNSNY set up a scheduling team for each of its business lines — state-licensed home health, Medicare-certified home health, hospice, community mental health, and care management, Castellanos relates. The scheduling teams then reached out to all employees in their division who were eligible for vaccination.

The scheduling teams has had to roll with the punches to keep up with ever-evolving state guidance on whom VNSNY is permitted to vaccinate, starting with direct care workers, Castellanos says. For example, on March 9 the state lowered the eligibility age to those 60 and older, which makes a new wave of workers available for vaccination.

One perk of using a scheduling team is that they can set staffers’ appointments around their job hours, making sure they don’t conflict, Castellanos offers.

At press time, VNSNY had administered about 10,500 doses and “we’re still going,” Castellanos reports. That figure includes first and second doses. To make sure all doses get used, the agency sometimes offers vaccinations to workers from separate, similar organizations on a limited basis, she adds.

Vaccine hesitancy is widespread, and the home care worker population is no exception. A recent Pew Research poll says 30 percent of Americans say they “probably” or “definitely” plan to not get vaccinated. Many home care agencies have reported having vaccination rates in the low double-digits.

Aides are often cited as the group least likely to want vaccination. But Castellanos reports that all types of employees of child-bearing age — women and men — who are contemplating planning families have also expressed significant hesitation in receiving the vaccine. “We’re hopeful the science comes out on that soon,” she tells AAPC.

VNSNY is “really proud” that it has achieved about a 50 percent vaccination rate for its home health aides, and a 50-to-60 percent rate for its staff overall. “It’s a work in progress,” Castellanos acknowledges, but it’s a good start.

Caveat: It’s a challenge to get accurate information about staffers who have been vaccinated at other locations, so the agency’s rate is an estimate, Castellanos points out.

Castellanos credits a number of aspects of VNSNY’s program with maximizing vaccination rates, from scheduling technique to education efforts (see box, p. 75).

New York, Texas Target Homebound Seniors For Vaccination

Meanwhile, while home health and hospice agencies continue to strive to get their staff vaccinated, inoculations for patients at home are finally getting much-needed attention.

In New York, telehealth company Ro is working with the state’s Department of Health and Yonkers officials to administer COVID-19 vaccinations to eligible residents in their homes in the Yonkers area. “The program aims to help vulnerable populations, including the elderly, disabled and homebound, that face logistical challenges accessing vaccination sites,” the New York-based company says in a release.

How it works: Those interested can sign up solely via the company’s www.covidvaccinedrive.com website, a company spokesperson confirms to AAPC. “To ensure the program reaches those with limited digital access or literacy challenges, Ro and the Department of Health are working with the Yonkers Mayor’s Office and Office for the Aging, to engage family members, caregivers, and guardians who can sign up eligible vaccine recipients and help coordinate in-home vaccination on their behalf,” she says. The vaccinations are free and administered by a registered nurse or pharmacist, the spokesperson adds.

Who can use it: “Eligible individuals currently include anyone 65+ in select zip codes of Yonkers as well as other vulnerable patient populations, including the disabled and homebound,” the spokesperson explains. “Eligibility for this pilot program was determined by New York State.”

In a recently completed pilot of the program, 90 percent of patients were non-white and nearly 60 percent had incomes lower than $15,000 a year, reports Reuters. The average age was 79.

In Texas, Gov. Greg Abbott (R) announced a statewide Save Our Seniors initiative to vaccinate homebound seniors. The program expanded from 28 to 36 counties in its second week.

How it works: The Texas Division of Emergency (TDEM) and the Texas Military Department (TMD) “will work alongside local jurisdictions to set up a central drive-through vaccine clinic in the community or administer directly to homebound seniors,” says a release. “These decisions will be driven by local officials as they identify vulnerable residents in their communities to participate in this program.” The program targets those who are homebound or 75 and older.

The governor announced the SOS program on Feb. 25 in Corpus Christi, where he lauded “the work being done by the Corpus Christi Fire Department, Meals On Wheels, and city leadership to identify and vaccinate homebound seniors in their community.” The SOS initiative implements “a similar model throughout the state … with the support of the Texas National Guard,” he said, according to a release.

In Wichita Falls, “the one thing we have not been able to do is to serve those individuals who are at home and unable to leave their home,” Wichita Falls-Wichita County Public Health District Director of Health Lou Kreidler said, reports station KFDX. Now the SOS program is providing 10,000 doses to homebound and other eligible seniors in 34 counties in its second week, Abbott’s office says in a release.

Home health and hospice agencies would still like to pitch in on this effort. “We could really help a lot with our educating and vaccinating our senior population that we serve,” Wichita Home Health Services administrator and Texas Association for Home Care & Hospice representative Chrystal Everett told the news station.

Still waiting: TAHC has been pushing for passage of legislation that will allow home health and hospice providers to furnish vaccinations, TAHC’s Rachel Hammon told AAPC last month.

If Texas House Bill 797 were to pass, Everett says her staff would move forward with immediate education, KFDX reports.

And in Minnesota, White Earth Home Health has been vaccinating residents of four counties at walk-in vaccination drives within the Chippewa White Earth Reservation.

How it works: Residents of Becker, Mahnomen, Norman, and Clearwater counties over age 45, as well as White Earth Tribal members age 18 and up are eligible, reports the Duluth News Tribune. Those who work, live, or own property on the Reservation and family members who share households with Tribal members are also eligible.

The state is allocating vaccine to White Earth after a Centers for Disease Control and Prevention study found Native Americans are more vulnerable to the potentially deadly effects of COVID-19 than other ethnic populations, the Tribune says.

Note: See the Texas bill at https://legiscan.com/TX/text/HB797/2021.

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