Home Health & Hospice Week

Allowing agencies to vaccinate patients at home should be a priority too, reps urge.

Home health and hospice agencies are working hard to combat vaccine hesitancy, but in many areas they haven’t even gotten there yet because access to COVID-19 vaccinations continues to be limited.

In two states with some of the largest numbers of home health and hospice workers and patients in the nation, providers are still struggling to secure vaccinations for their staff, industry representatives report.

In Texas, the state designated home care workers as 1A for vaccine priority, which was “very positive,” notes Rachel Hammon with the Texas Association for Home Care & Hospice. Then the state distributed vaccine doses to hospitals and “vaccination hubs,” but workers had little to no luck accessing vaccinations at either of those locations.

Agencies have asked to partner with hospitals to furnish vaccinations to agency staff, and the hospitals have said no, Hammon tells AAPC. As for the hubs, the slots get snapped up as soon as they come online. If you’re an agency with 300 employees to schedule for inoculations, you are effectively left out of the process, she relates.

“It’s exceptionally frustrating,” Hammon stresses. “Freestanding agencies are left to their own devices.”

That’s been the experience of Jonathan Willman, Director of Operations for Consolidated Home Health, which serves pediatric patients in the Houston area. For weeks and weeks, health systems have told Willman that their vaccine supply is already allocated with no available doses for the agency’s home health nurses, Willman tells AAPC.

Willman was especially incensed when he heard about remote-working hospital employees such as insurance and billing-related staff receiving $500 bonuses to get COVID vaccinations while his direct care staff had to wait in a seemingly interminable line. “Are you kidding me?” Willman exclaims. “If there is any Tier 1A person that calls you [seeking vaccination], you shouldn’t be able to do that,” he fumes.

He couldn’t get his roster of 125 nurses in for vaccinations, even on an individual basis, as he made calls to various pharmacies, health systems, and health departments located hours away. Finally, he found a sympathetic ear at a health department that would accept small batches of nurses for vaccinations, he relates. About 25 Consolidated Home Health nurses are still waiting for their turns.

In addition to more transparency in how health systems handle their vaccine supply, Willman also calls for Tier 1A direct care health workers to get bumped to the head of the line, since they were unable to get vaccinations before the state moved on to Tier 1B. “These nurses have been on the front line since day 1,” Willman stresses. Unlike physician offices and other settings, home health typically can’t substitute telemedicine visits for in-person ones, he adds.

Willman worries this issue will “continue to fly under the radar,” he says. “This is not just mom and pops having this problem,” but bigger companies too, he maintains.

Dr. Anna Loengard with Accentcare, one of the nation’s largest home health chains (see story, p. 55), confirms this reality. Accentcare workers “have not really had a systematic way to be vaccinated,” Loengard told CBS News station 11/21 in Dallas-Fort Worth. So far only 15 percent of her staff have received their first dose, according to the news station.

Failing to remove vaccination access isn’t just bad for home health and hospice workers, it’s also life threatening for their patients, Hammon stresses. Licensed Home and Community Support Services Agencies “provide medically necessary home care services to over 300,000 of Texas’ most vulnerable aged and disabled individuals who are most susceptible to severe COVID-19 infection,” Hammon said in a Feb. 5 letter to Texas Gov. Greg Abbott (R). They also “represent a workforce of front line workers of over 300,000 nurses, therapists and personal care aides combined,” the letter said.

Florida providers are in a similar boat, says Bobby Lolley with the Home Care Association of Florida. HCAF estimates that less than 25 percent of its members’ staff have received COVID-19 vaccinations, Lolley tells AAPC.

Agencies are still back at square one in some cases, fighting to get their workers recognized as part of the 1A priority group. A December Executive Order from Gov. Ron DeSantis (R) included “health care personnel with direct patient contact” in the priority group. But “home health agencies continue to report that workers are being turned away at vaccine locations across the state due to varying interpretations of the order,” Lolley said in a Feb. 9 letter to the governor.

“A nurse, therapist, or personal care worker caring for patients in the home setting is no different from their counterpart providing care in a facility setting, yet home health workers continue to be a ‘blind spot’ in the immuni­zation program,” Lolley charged. “Home health workers serve approximately 350,000 patients each year who have complex service needs and are at high risk for COVID-19 but might not be able to go to a vaccination site,” the letter said. “Workers’ inability to access the vaccine has led to growing numbers of these patients declining home health services because clinicians and caregivers have not been vaccinated,” he warned.

Florida providers and their representatives are requesting “explicit designation of home health clinicians and caregivers as front-line health care workers,” according to the letter.

And providers in both states urge their governors to allow HHAs to furnish the vaccine, both to their own staff and to their homebound patients. “We can be part of the solution” to speed the administration of the vaccine to the most vulnerable citizens, their caregivers, and their health care providers, Hammon maintains. “They’re saying they need to get shots in arms,” she observes. Home care providers are the perfect way to do so — especially once the more stable Johnson & Johnson vaccine gets approved.

Agencies in other states are already inoculating patients, including the visiting nurse associations that comprise the VNAs of Vermont in that state. On Feb. 5, the VNAs began home vaccinations for Vermonters 75 and older who are homebound and unable to go in person to one of the state’s vaccination clinics, reports the Mountain Times newspaper.

“Our home health and hospice teams have displayed incredible courage and resolve going into people’s homes to deliver high-quality and compassionate care throughout this pandemic,” said Jill Mazza Olson, executive director of VNAs of Vermont, according to the newspaper. “They’ve kept countless individuals in their homes and out of hospitals and long-term care facilities, preserving hospital space for those who need it most.”

In Texas, allowing agencies to furnish vaccinations would mean the governor must issue an executive order allowing agencies specific permission to furnish the COVID-19 vaccine. Currently state law allows them to provide other specifically listed vaccines including influenza and pneumo­coccal, but doesn’t specify COVID-19 “because it was written 18 years ago,” Hammon tells AAPC. Pending state legislation is expected to eventually clear up the problem, but it is likely to take months to work through the system.

However, the political climate is not ideal for Abbott to issue an executive order, so it’s “sensitive,” Hammon acknowledges.

Lack of home health and hospice patient access to vaccination is a serious concern. In a survey of its members conducted last month, the Home Care Association of New York State found that 45 percent of home care and hospice agencies reported that over half of their patient population would not be able to receive the COVID-19 vaccine outside of their homes, says HCA-NYS spokesperson Roger Noyes. That “rais[es] concerns about the process for vaccination of homebound New Yorkers who have advanced illness or chronic conditions and cannot travel to a vaccination site or are put at risk in doing so,” Noyes tells AAPC.

Widespread Access Problems Persist

While Texas and Florida providers are experiencing access problems on a large scale, the same is occurring in smaller pockets in many other states.

“It depends on the locality,” shares Marcia Tetterton with the Virginia Association for Home Care and Hospice. “Some are having great success while others are struggling.”

In Ohio, “there is variation throughout the state on a county-by-county basis, which is impacted by supply of course,” says Joe Russell with the Ohio Council for Home Care & Hospice.

“We are still short on vaccines in some counties,” reports Barry Cargill with the Michigan Home Care & Hospice Association. “State and the counties seem to be doing a good job vaccinating home health and hospice. Just need to get more vaccine into our state,” Cargill tells AAPC.

In the HCA-NYS survey, as of Jan. 13, 85 percent of home care and hospice agencies reported that only 1 to 10 percent of their staff had received at least one dose of the COVID-19 vaccine. “Our sense is that the supply shortages mean that these figures probably haven’t changed much from when we did the poll,” Noyes offers.