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Elderly people returning home are still waiting for the Covid-19 vaccine, so doctors and nurses will go to them

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The Boston Medical Center, which operates the country’s oldest home healthcare service, launched on February 1st. Wake Forest Baptist Health, North Carolina’s healthcare system, followed a week later.

In Miami Beach, Florida, fire department rescue workers are delivering vaccines to frail elderly people at home. In East St. Louis, Missouri, a home-visit nursing service provides home-based vaccines to low-income sick elderly people who receive meals from Meals on Wheel.

In central and northern Pennsylvania, Geisinger Health, a large healthcare system, identifies and provides vaccines to 500 older people. Nationally, the Department of Veterans Affairs provides more than 11,000 vaccines to veterans receiving primary care at home.

These and other efforts recognize the urgent need. Two to 4.4 million elderly people are returning home. Most are in their 80s and have multiple medical conditions, including heart failure, cancer, and chronic lung disease, and many have cognitive impairment. They can’t leave the house or can do so with considerable difficulty.

Due to their age and medical condition, these older people have a very high risk of illness and death when they reach covid-19.Still, unlike patients in similarly frail nursing homes, they are not recognized as a priority group for vaccines, and the Centers for Disease Control and Prevention have just been offered. guidance About serving them.

“This is a hidden group that would be overlooked if we didn’t step up our efforts to reach them,” said President of the Visiting Nurse Association Health Group, which provides home health care and hospice care to more than 10,000 people. Dr. Steven Landers, also and CEO, said. People in New Jersey, northeastern Ohio, and southeastern Florida. His organization plans to launch a pilot home vaccination program for frail patients next week.

Dr. Stephen Landers, President and Chief Executive Officer of the Health Group of the Home-Visit Nurses Association, will administer the Covid-19 vaccine to Sam Ferguson in Asbury Park, NJ.

Jane Guerehoff, 91, from Ocean Township, NJ, is waiting for the group to vaccinate her. She had a stroke over a year ago and has difficulty breathing due to a serious lung disease. “I can’t walk. I’m in a wheelchair. If the vaccine doesn’t reach me, there’s no way in the world to get the vaccine,” she said in a telephone interview.

Gerechoff doesn’t go out, but she lives with an adult son who interacts with people outside the house, and she is helped by a physiotherapist and occupational therapist at home. One of them can carry the virus.

There are many challenges in reaching the elderly who have returned home. At the top of the list: Home healthcare and hospice organizations do not have access to the covid vaccine for either staff or patients.

“There was no distribution of vaccines to our members and no plans to surround us to meet the needs of the people we serve,” said William Donbi, president of the National Home Care and Hospice Association.

Vaccinated organizations also complain that they do not have enough Medicare payments to cover costs, primarily staff time and effort. (Injections are free because the federal government pays for them.) According to the program leader, to call the vaccine home after travel, patient interaction, and vaccination for potential side effects. It takes about an hour on average, including monitoring. ..

More doses, less

Medicare redemption for the first shot is $ 16.94. The second shot is $ 28.39, according to consultant Shawna Ramey, who presented the data at the recent American Academy of Home Care Medicine webinar. “The actual cost of these visits is close to $ 150 or $ 160,” Donbi said.

Second, there is a problem with refrigeration and transportation of Pfizer-BioNTech and Moderna vaccines. Both vaccines are fragile after thawing and should be handled with care according to the new CDC guidance on vaccination of home adults. After opening the vaccine vial, injections should be given within 6 hours, as directed by Pfizer and Moderna.

These requirements have proven too burdensome for Prospero Health, which serves 9,000 critically ill patients at home in 20 states, including nearly 2,000 home-based patients. Dr. Dave Moen, president of Prospero’s medical group, said less than 10% were vaccinated.

He suggested that if the Johnson & Johnson and AstraZeneca vaccines were approved as expected, things would be easier. Both of these vaccine candidates are more stable than the Pfizer and Modana vaccines, making them easier to administer at home, Moen said.

Permark Roster, 84, from Bradley, Illinois, is being cared for by Prospero under a contract with UnitedHealth Care, an insurer at Medicare Advantage. He is a survivor of almost immobile polio who has undergone cardiotomy and is cared for four hours a day by a paid helper.

“I really need someone to come here and give me a shot,” he told me in a phone conversation. “I don’t want that illness [covid-19].. At my age it is very harmful. “

In Boston, Mary Galefa, 84, thanked Dr. Wong Lee, a doctor she knows and trusts, for coming to her home to vaccinate her in early February. doing. “Except for the ambulance, I haven’t been out of the house for about eight years,” said Galefa, who suffers from stomach cancer, weighs 73 pounds and broke his hip this summer after a severe fall.

Geriatric doctor Lee, who works for a home program at the Boston Medical Center, said it was imperative to reach out to patients like Galefa. “Providing quality of life and reducing suffering is worth it, and covid-19 only causes suffering,” she said. The Boston program has vaccinated 84 people as of February 12.

The vaccine comes from a medical center supply. Before going out, the staff calls the patient and addresses concerns about the patient taking shots. Mostly African-American, many families want to know if the vaccine will make their frail parents or grandparents sick. “They need to hear that it’s safe to be shot by someone who knows their medical problems,” Lee said.

Wakeforest’s House Call program dispatches doctors, nurses, or helpers who are paired with pharmacy residents to provide vaccines. Dr. Mia Yang, director of the program, said that about 200 people are serving through the program, most of whom are in their late 70s or early 80s and have five or more medical conditions.

Wakeforest’s goal is to provide vaccinations to up to 40 patients per week and include family caregivers if adequate supply is available.

Robert Purcell, 69, and his wife, Gale, 72, who have severe osteoporosis and fluid retention in the legs and legs, received a Pfizer vaccine from Geisinger at their home in Milnesville, Pennsylvania in late January. At first, Robert said he was skeptical, but now it’s okay to say so. Had Gaisinger’s nurse not been to them, he would not have been able to leave himself.

“I can’t put on my shoes” because of the swelling, and “I have to walk barefoot in the snow and ice,” Robert said.

KHN (Kaiser Health News) is a non-profit news service dealing with health issues.It’s an editorial independent program KFF (Kaiser Family Foundation) We are not affiliated with Kaiser Permanente.

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