Betty Pippin, 92, has been eligible for the COVID-19 vaccine since January. She’s still waiting.
Pippin is homebound. Like many other Georgians, she’s not physically able to get to the sites that administer vaccines. As Georgia’s vaccination campaign moves from the challenge of scarce vaccines to a race to attract vaccinees, the state is struggling to reach the homebound, who often are some of the most vulnerable to severe outcomes from the coronavirus.
Once again, experts say, the pandemic is spotlighting a shortcoming that already existed in Georgia and nationwide. There is no reliable list of homebound people. Officials don’t even know how many there are. And unlike nursing homes for elderly residents, or hospitals for front-line staff, or schools for teachers, there is no sure-fire middleman to ask, either.
The Georgia Department of Public Health has asked the Department of Human Services and the Department of Community Health for help locating homebound people. But when it finds some, DPH doesn’t have the staff to visit all of them and administer the vaccines. The state has called on Area Agencies on Aging to help coordinate transportation services to get the homebound to vaccination appointments, but they can only do so much. Meanwhile, in some areas of the state mobile vaccination programs have been launched, so those who are homebound won’t need to travel. For example, DeKalb County, in concert with the county Board of Health, is deploying its fire department paramedics to administer the shots. In others areas, DPH plans to visit the patients with local public health staff.
First, though, they must identify the homebound. Those who have reached out for services to an agency that works with the state may be on a list—unless the list becomes outdated because they move, change their phone contact, or lose their ability to communicate. But officials who work with the homebound say the vast majority probably just aren’t on anyone’s radar.
“We’ve advocated for help for the homebound elderly to get the vaccine,” said Kathy Floyd, director of the Georgia Council on Aging. “And we also, whenever we hear of anything, we share it on our Facebook page. I know advocates have had trouble estimating the number,” she said.
“The unmet need, you just never know.”
Old numbers
There is no universally accepted definition of homebound. Some people, like Pippin, are mentally sharp, but because of injuries or advanced age their muscles are no longer strong enough for them to stand or move about safely. Some have dementia. Some are young but disabled. Some can be driven in a car but can’t walk well. Some can only be transported by stretcher.
A 2015 research paper some advocates point to estimated the number of homebound nationwide at two million. Researchers at the Atlanta Regional Commission said there’s no estimate of homebound people here, but at the request of the AJC they found numbers that might give an idea: In the 10-county area alone, there are likely tens of thousands.
DPH has been working with other state agencies and regional organizations for months to identify homebound people to whom they can offer vaccine. At a March 16 press conference with Gov. Brian Kemp, Public Health Commissioner Dr. Kathleen Toomey announced they had come up with about 3,000 names statewide.
However, “As district staffs statewide reached out to individuals on the lists, they found that of the 3,000 names originally provided, only a fraction of them truly required in-home vaccination services,” a spokeswoman for Toomey, Nancy Nydam, said in an email. For example, she said, of the 179 people the Macon-area office reached out to so far, “20 require homebound services,” she said. Others declined, didn’t need a home visit or were unreachable, she said.
In fact, the majority on the Macon-area list have simply been unreachable, said Carol Babcock, director of palliative care and healthy communities for Atrium Health Navicent, which is making those calls and sending nurses to vaccinate the homebound.
The lists were probably outdated by the time vaccination staff started calling, she said. That can happen easily with people of few means, she said, who may call to register for services at one point and then drop off the map—perhaps not have their own telephone or change cell phones or contact numbers.
That’s the broader problem of coordinating for the homebound: A patchwork of service organizations, for example when people call an Area Agency on Aging to register for “Meals on Wheels” type services. And then many people simply age at home and barely get by without knowing of services.
Becky Kurtz, managing director of aging and independent services at the Atlanta Regional Commission, which runs the local Area Agency on Aging, hopes that new funds the federal government has just awarded states for vaccination outreach can help. Georgia is to receive nearly $96 million, but grants have not yet been awarded.
“We’re in conversation right now about, if we had additional funding, could we amplify the outreach and have the infrastructure in place to handle those remaining folks and get a better handle on who they are?” Kurtz said.
DPH administers most of its services through regional and county-controlled offices which it helps fund. The DPH did not request additional funding for staff the next year’s budget, though the Legislature voted to fund a new vaccine computer registration system.
‘She’s a human being’
Velmer Watkins wonders if she had something to do with kicking DeKalb County into gear. She cares for her mother, who has dementia. Watkins could get to Mercedes-Benz Stadium for her vaccine, but there was no way she could get her mother there. “I’m like, ‘Well I can get my vaccine, but she needs one,’” Watkins recalls. “She’s a human being.”
After calling county officials and the media, Watkins’ mother finally got her shot, when DeKalb Fire Rescue Department staff came and administered the one-shot Johnson & Johnson vaccine.
Pippin got lucky. Her doctor, Melissa Black, makes house calls, and decided to try to become a vaccine provider. That step has taken weeks.
Dr. Black registered with the state and went through training. She paid for special freezing equipment in order to store vaccine and will eat that cost. She could bill insurance $21.93 per dose, but the red tape wouldn’t be worth it.. She tried several times to find out from the state when she might get a delivery of vaccine doses. Then suddenly Black got an email this week telling her that Moderna doses would be arriving the next day.
She had hoped to start vaccinating this week, but there wasn’t enough time to plan. Black’s doses are in the freezer while she makes calls to her patients to round up a visitation schedule and line up the volunteer nurses who’ll make the trips if Black can’t. Pippin’s wait may come to an end next week, when she expects to get her shot.
It’s important, Black said.
“Early on in this pandemic I lost almost 10 patients to COVID who were homebound,” she said. “These people are completely dependent on caregivers. Eventually someone’s going to bring in COVID.”
Credit: Jenni Girtman
Credit: Jenni Girtman
That is true for Pippin, who has daily caregivers and visits from her daughter. She has gone from wanting the vaccine, to fearing it, to wanting it again. The avid gardener is watching the blooms from her years of planting as she waits for a date from Dr. Black.
“Something will take me out,” Pippin said. “But I don’t want it to be COVID.”
VACCINES FOR HOMEBOUND GEORGIANS
The elderly can seek information or referrals for vaccination transportation assistance by calling one of the state’s 12 Area Agencies on Aging. In metro Atlanta, that’s at the Atlanta Regional Commission. These agencies help with information on a range of resources on aging or disability services, regardless of ability to pay.
In some areas, the best source of information may instead be the local county health department.
The Area Agency on Aging for people in the 10-county metro Atlanta area: www.empowerline.org or 404-463-3333.
To find an Area Agency on Aging statewide: https://www.georgiaadrc.com/ or 866-552-4464 (866-55AGING). The people at this number may also be able to give you the phone number for your own county health department.
The Georgia Department of Public Health statewide vaccination help line is 888-457-0186.
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