At the beginning of January, an oft-overlooked sector of the frontline healthcare workforce scored a significant win in New York state: officials classified home healthcare workers as priority 1A to receive COVID-19 vaccines, a move pushed by advocacy groups and unions.
But weeks later, many home healthcare agencies in the state — especially smaller ones with limited resources — are facing new challenges in getting their personnel inoculated.
There are shortages of the vaccine, and difficulties reaching a decentralized workforce. Most agencies lack the resources to set up their own inoculation sites, and vaccine hesitancy is still a significant concern.
The challenges are especially troubling to those who represent agencies and staff. Most of the 200,000-plus home healthcare workers in New York are women of color, and the profession is at high risk of exposure to COVID-19 due to providing care inside patients’ homes. Additionally, patients who receive home care are elderly or disabled, often both; most have conditions that make them more vulnerable to severe outcomes should they contract the virus.
Weeks into January, 85% of home care and hospice agencies reported that 10% or less of their staff had received at least one dose of the COVID-19 vaccine, the Home Care Association of New York State told MedPage Today.
“We had the week of January 4 where home care was explicitly identified [for priority vaccination] and that was something that was a challenge in the beginning — we so appreciated being included,” said Roger Noyes, director of communications for the association. “However, by the end of the week, due to federal guidelines, the state opened up priority 1B. That brought in 3 million New Yorkers newly eligible outside the healthcare space.”
That left just one week for home healthcare agencies to take advantage of their staff being recognized as a priority population, Noyes said. And vaccine supply — as in other states — hasn’t yet been sufficient to meet demand.
“They’re on the front line like other workers,” said Joe Pecora, vice president of Home Healthcare Workers of America, a union with some 20,000 workers in New York.
Tragically, Pecora said, the union has lost more than a dozen home healthcare workers during the pandemic. “There’s a need, there’s a desire to get the vaccine,” he said.
Pecora said he continues to call health departments multiple times a day to see if new shipments of the vaccine have come in. “Maybe I call too much?” he wondered.
As he waits for doses, the union is doing what it can to help its members get vaccinated, including through inoculation appointments at clinics that already provide their regular medical care, Pecora said. But as of the end of January, only about 2,000 of the union’s members had been vaccinated.
Aside from supply shortages, there are logistical challenges. Unlike hospital-based workers receiving the vaccine at their place of work, or pharmacies descending upon nursing homes to inoculate staff on-site, there isn’t a universal approach for reaching home healthcare workers, Noyes and Pecora noted. Frontline workers in the field are spread out across areas of service, are challenged to reschedule appointments, and spend much of their time taking public transportation to their next patient.
As of Feb. 10, the statewide percentage of hospital workers vaccinated was 75%, according to the New York Department of Health. A little less than half of staff at skilled nursing facilities had been vaccinated. The state is not publicly tracking the same data for home healthcare workers.
However, one home healthcare agency that has been able to take vaccination into its own hands is the Visiting Nurse Service of New York (VNSNY). The sprawling organization serves tens of thousands of patients and health plan members a year and, unlike smaller entities, has the resources to set up an inoculation site for staff.
Since early December, VNSNY’s regulatory and government affairs team worked with regulators and associations to help ensure that home care and hospice workers were a priority for vaccination, the organization told MedPage Today. VNSNY immediately registered as a vaccine administration facility, and continues to work with local and state health departments, as well as the Greater New York Hospital Association on its efforts.
The organization is making appointments for and vaccinating eligible staff at its main office near New York City’s Grand Central Terminal, a central public transportation hub, said Andria Castellanos, executive vice president and chief of provider services at VNSNY.
VNSNY currently has about 9,500 eligible employees, Castellanos said. As of last week, it had vaccinated some 2,500 of those employees, using every vaccine it had received from the city. By the end of this week, it’s expecting to up that number to 3,400.
The organization is spending tens of thousands of dollars per week to do so, according to Castellanos, and hopes to secure federal reimbursement for its efforts.
One of the most significant challenges has been reaching staff who hesitate to receive the vaccine.
“You can’t ask people one time,” Castellanos said. “When they say ‘no’ or ‘not yet,’ you have to go back. We are seeing the ‘no’s’ and ‘not yet’s’ turn into ‘yes’s.'”
Noyes of the Home Care Association of New York State also noted the concern.
About 55% of the association’s member agencies saw 1% to 10% of their staff refusing the vaccine, with higher numbers for the other 45%, he said. About 40% of agencies plan to offer incentives such as paid time off, gift cards, lottery prize drawings, and other strategies.
“It’s hard to gauge how that translates into the rates because of all of these logistical challenges,” Noyes said. Once the vaccine supply increases, “we’ll know a little more about how much hesitancy is a factor.”