Shut-ins get shot at vaccine
Amid widespread inoculation eligibility, the homebound still need to be reached
Albany
Getting out of the house has been no easy task for Mary Nardiello.
The 94-year-old Albany resident began using a wheelchair last year to get around after nerve damage from her diabetes precipitated a series of falls that put her in the hospital unable to walk. Now, she only leaves home to go to the doctor.
When the COVID-19 vaccine became available to seniors in January, her daughter, Pat
Mangini, briefly entertained trying to get Nardiello out of the house and to a vaccine site.
“It would have been difficult,” Mangini said. “We would have had to arrange transportation that can accommodate her chair, get her down the ramp and with the snow and the ice, we just thought we better wait for the weather to get better and go from there.”
Later that month, Mangini heard on the news that the Albany County Sheriff ’s Office was vaccinating people who can’t leave their home, so she
called and got her mom on a list. It would be at least another month, though, before someone came to give the shot.
On April 2, a masked EMT and paramedic with the sheriff ’s office delivered Nardiello’s final inoculation while her daughter watched, smiling with relief. After a year of social isolation and a close brush with COVID -19, it was a joyful moment.
“You feel better knowing you have it because we have aides who come in and out, and two of them actually caught COVID at one point,” Mangini said. “So it just feels good knowing she has that extra layer of security.”
Falling through the cracks
With the latest batch of New Yorkers, those 16 and older, now eligible for the vaccine, providers are ramping up their efforts to reach people like Nardiello who have been eligible for months but are unable to get vaccinated because of difficulties leaving their house. This population of the homebound includes older people, sick and disabled, who are at particularly high risk for poor outcomes from COVID -19.
But with no official state-led campaign informing this group of their options to get vaccinated, the task has fallen to local health departments, vaccine providers and offices for the aging. In addition to advertising
the service on their social media channels and through local news campaigns, they have been consulting lists from local agencies of people who receive in-home services and conducting outreach that way. Still, they worry some are falling through the cracks.
“There’s no systemic, holistic plan for reaching this group,” said Beth Finkel, state director of AARP New York. “The governor has done a great job of rolling out the vaccine to so many populations and we are very thankful for that, but the group that really still needs attention is the homebound.”
Approximately 300,000 New Yorkers receive services in the home, she said, but the number of people who are unable to leave home is likely much higher.
Finkel wrote a letter to Gov. Andrew M. Cuomo last month calling for the implementation of a statewide, coordinated plan to vaccinate the homebound, as well as their caregivers.
Other states, including Texas, Massachusetts and Florida, have developed statewide approaches for vaccinating the homebound, she said. One simple option is to have a dedicated hotline that people can call to get their name on a list that could then be distributed to local vaccine providers. Right now, many local communities have such hotlines, but they are spread across multiple providers and many remain unaware of the service.
New York could build an option into its existing vaccination hotline and website for people to signal they require an in-home vaccination, Finkel said.
“Other states are acting to address this issue now,” she said. “Why is New York lagging behind?”
Jeffrey Hammond, a spokesman for the state Health Department, did not directly respond when asked whether the state was working to develop a coordinated, statewide campaign such as the kind Finkel described.
“NYS is working with multiple local agencies and organizations including local health departments, hospitals, regional vaccination hubs and their network partners, home health care and visiting nurses’ associations, state and local offices for the aging, inhome pharmacy providers, and community paramedicine programs and to implement creative local plans to vaccinate the homebound population,” he said in an email.
Due to the time-consuming nature of in-home vaccinations, providers have been asking the state to send them more singledose Johnson & Johnson vaccine specifically for use with homebound people. Many are using the twodose Pfizer or Moderna shots, doubling the number of trips they have to make to each home.
EMS agencies say they could speed up the vaccinations if their EMTS were authorized to vaccinate people without the supervision of a physician, nurse practitioner or physician assistant — as recent executive orders require. Ambulance companies are sending paramedics to administer the vaccine, with EMTS there to assist.
‘We know these people’
While some believe a statewide approach to vaccinating the homebound is needed, local vaccine providers are adamant that familiarity with their local needs is sufficient for getting the job done.
“We know these communities. We know these people,” Albany County Sheriff Craig Apple said. “I can’t tell you the dozens and dozens of people who have reached out to me on social media to tell me they have a loved one in Knox or Albany who could use this service and so we add them to our list.”
Apple said his office saw a need for the service from the very beginning, due to its history of providing services in the county’s remote Hilltowns and outlying areas of Bethlehem, Coeymans and Guilderland, where many high-risk and older people live. In some rural areas, he said, the issue isn’t that people can’t leave their homes — it’s that they won’t.
“A lot of folks in these outlying areas just don’t go to the city,” Apple said. “They don’t like to go to the city and that’s why a lot of folks out here don’t get the services that they truly need — not for anyone’s fault but honestly their own because they just don’t like to go down to Albany.”
The sheriff ’s office has a large emergency medical services division whose employees are authorized to administer vaccine so it began to host drivethrough clinics in some of the rural areas. They have done more than 150 inhome vaccinations as well, Apple said.
“It is very time-consuming because we have to wait with them for 15 minutes afterwards,” he said. “And then you move on to the next house, which could be 10 miles away or 2 miles away. So the numbers aren’t huge. We try to do 10 a day or sometimes 15, but if we can only do one a day we’re happy to do it.”
John Mcdonald, a local state Assemblyman who runs an independent pharmacy in Cohoes, said he knows exactly which of his patients can leave their homes and which can’t after years of providing home delivery of prescriptions.
He’s been bringing the vaccine directly to them and anyone else who calls to say they can’t leave home, though Mcdonald tries to make sure the person is truly homebound, he said.
“I don’t want people who are lazy and just don’t want to get out because there are people who think it’s like a pizza delivery,” Mcdonald said. “But most people are honest.”
His familiarity about town is also helpful to the effort, he said. Last week, Mcdonald ran into a firefighter at a local Stewart’s who knew a homebound person in need and added them to his list.
“It’s happening organically because of longstanding relationships,” he said.
‘Best day of their lives’
In large and geographically diverse Saratoga County, 11 ambulance companies have vaccinated more than 1,600 people in their homes, according to Mike Mcevoy, the county’s EMS coordinator.
Many of the people have been formally identified through the county’s vaccine interest list, an online form that launched in February for people to fill out to be contacted about inoculation opportunities. The county has been working its way through the list, calling individuals when supply becomes available and asking whether they are able to leave the home. Those who aren’t are put on a list for homebound vaccinations, Mcevoy said.
Others are identified more informally, he said.
“These are community paramedics,” Mcevoy said. “So they are out there seeing people, taking blood pressures at senior centers, and going out and picking someone up who falls down at home. They know the underserved individuals in their communities and the ones without internet or phone.”
The vaccination effort has been a huge morale boost for EMS providers, Mcevoy said.
Residents who are stuck at home are often grateful not to be forgotten, and happy to mark an end to a grueling year of social isolation. Some have burst into tears at the thought of seeing their loved ones and grandchildren again, he said.
“It’s a career-changing experience for a lot of our paramedics who feel like, oh, someone’s actually happy to see me,” Mcevoy said. “Because otherwise, every call they get is for a person having the worst day of their lives. For some, getting this vaccine has become the best day of their lives.”
“We know these communities. We know these people. I can’t tell you the dozens and dozens of people who have reached out to me on social media to tell me they have a loved one in Knox or Albany who could use this service and so we add them to our list.” — Albany County Sheriff Craig Apple