Home Care Workers Vie for Access as US Surpasses 64M COVID-19 Vaccine Doses

Although the overall infection rate is dropping as vaccine efforts ramp up, the U.S. is nearing the grim milestone of half a million COVID-19 deaths.

Florida alone has reported more than 30,000 resident deaths linked to the coronavirus since the start of the pandemic, according to state data. And similar to other parts of the country, the Sunshine State continues to struggle with its vaccine rollout, particularly when it comes to home-based care workers.

To learn more, Home Health Care News connected with Bobby Lolley, executive director of the Home Care Association of Florida (HCAF), for our latest episode of “Disrupt.” Highlights from the conversation are below, edited for length and clarity.

For context, at least 64 million doses of COVID-19 vaccine have been administered in the United States, according to Monday data from the Centers for Disease Control and Prevention (CDC). About 13% of the overall population has now received at least one dose of vaccine.

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HHCN: What did Florida say it was going to do with home health and hospice workers? How is that actually playing out?

Lolley: I’m glad you mentioned hospice. Everything that I speak to, it would clearly apply to hospice providers and caregivers as well. To look at Florida, let’s first take one step back to the federal level.

The CDC, the U.S. Centers for Medicare & Medicaid Services (CMS) and the government’s special advisory panel studied how the COVID-19 vaccine should be sent out across the country. All of those bodies agreed that home care and hospice providers should be in the first quartile — or in the first round — of vaccinations, as they come out.

But what happened in Florida is that the vast majority of vaccines from the first distribution level went directly to hospitals. Now, the state of Florida would say they had allotted about 15% of vaccines going to hospitals for health care workers outside of that setting. Unfortunately, that did not happen. It could possibly be that there was just too little vaccine to go around. But we never got our share from the very beginning.

That’s probably the easiest way to say it.

I’ve also seen in the news that some of the individual vaccine sites were turning away home care workers despite a clear mandate that all front-line staff should be getting the vaccine.

Yes. The stories that have come out, they’re heartbreaking. Think about the home health aide who takes care of a senior in his or her home. Maybe they’ve been caring for that individual for years. We’re hearing about aides like that helping the senior into their car, driving them to a vaccination center, standing in line with them, supporting them while that vaccine is being administered — then themselves being turned away. The [center] gives the vaccine to the senior, but they turn the home health aide away. Those kinds of stories have come to us over and over again.

I believe there is some sort of a blind spot. I attribute it to a general lack of communication. Clearly everybody in Florida understands that 65-and-older individuals are to be offered the vaccine. But what some vaccine centers fail to realize is that the home care agencies — or any health care worker who is in direct contact with COVID patients — are also on the priority list. That’s being missed over and over again in Florida.

As we’re talking here on Feb. 11, what does the vaccine distribution process look like exactly? How many vaccination sites are there? Is there an online registration process?

It’s still very fragmented. The way that Florida went about this, state officials let every local county department of health sort of decide how they were going to approach the rollout. So you have just a multitude of different processes — some largely different than others, some just a little bit different.

Many people thought, “Oh, the most efficient way would be online registration.” They rushed to create that, just to find out there were a lot of people who did not have access to the internet. After figuring that out, there was state guidance on how we should probably explore some way to do a phone system. That seems to have been more successful than online registration.

But at the end of the day, every time there is a vaccine opening at a Walmart, pharmacy or some other central place, there’s always too little vaccine for the number of people who are in line, who have signed up. That includes home health workers.

Within the backdrop of this vaccine conversation is the ongoing pandemic itself. Every state is still dealing with new daily infection cases, though numbers are going down. What’s the situation look like in Florida?

The numbers are certainly going down. We can all be very thankful for that. But there are still a lot of risks out there. And with the vaccines, they’re just not flowing as freely as everybody wants. With home care, a big concern is, now that some seniors are vaccinated, you’ll have these homebound individuals saying, “I don’t want any home care worker coming into my home unless they are vaccinated.”

That sets up this sort of trajectory where they don’t get the care from the caregivers. They get sick. Then they get increasingly frail and have to go to a hospital. That scenario, it simply could be addressed if we would just target home care workers and get the vaccine to them.

That obviously sets up staffing challenges, right?

Exactly. We don’t have high numbers of home care workers who have been infected with the virus. But you have to think about it: These health care workers are going out, maybe seeing six, seven, eight … maybe as many as 10 patients a day. The risk to them of catching COVID is very, very high. You’re losing staffing from that element alone.

There’s the availability of vaccine for individuals who want it, but then there’s also the question of hesitancy. What are you seeing and hearing from caregivers in your state?

You know, we’re not hearing much about refusals because so few have been offered the vaccine. I would like to make a point that the refusal rate, if we could use that term, was high in the facilities, especially in some of the assisted living facilities (ALFs) and the skilled nursing facilities (SNFs). There was a large percentage of caregivers working in those facilities declining or rejecting [vaccine]. What I suspect is that you’re not going to see that kind of high level of “saying no” in the home care sector.

Why? Most of the clinicians and caregivers who are visiting the seniors in their home, they basically don’t get paid unless they are allowed into that home. They don’t get paid unless they provide that service. That is going to be a motivation for the home care worker, specifically for the home health aide or the CNA, for instance.

Are you seeing a lot of facilities in Florida only granting home care workers entry if they’ve been vaccinated?

There have been some of those complaints. But here’s a bright spot: One of the things that we have heard is that those facilities, especially ALFs, have included home care workers in their vaccinations processes. They were allowed to do that by the state’s department of health.

Most of HHCN’s readers and podcast listeners know the answer to this question, but for those who don’t: Why is it so important that home-based care workers be prioritized for the vaccine, the same as anybody else directly caring for COVID-positive individuals?

If we just look at Medicare seniors and homebound seniors, we’re talking somewhere between 300,000 and 400,000 people. That does not include the Medicaid population or those who are privately paying for home care services. So there is a huge number of seniors who rely on in-home care providers. Those providers are their lifelines. Many of those hundreds of thousands of seniors, they’ll never be able to get to some vaccination center. The home health and home care workers going into their home are, again, their main lifeline and their best chance of receiving a vaccine vaccination.

Have you heard from peers in other states dealing with similar vaccine challenges?

I’d say so, especially the larger states. I’ve talked to Texas a lot. I’ve talked to California a lot. You do have some states that are doing the vaccination rollout exceptionally well, including Utah, West Virginia and New Mexico.

When I look at the states that are successful, it seems like they did not try to recreate the wheel. It’s like they pushed the vaccine out to any local pharmacy or whatever, just like they have been doing for the flu vaccine for all these years. That flow of vaccines out to local pharmacies or local health departments seems to have given them a leg up on getting the vaccine out to the population, whether we’re talking about health care workers or seniors.

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Disrupt Podcast #41: Bobby Lolley of Home Care Association of Florida

Across the country, home health, hospice and home care workers continue to struggle when it comes to COVID-19 vaccine access. Nowhere is that challenge more evident than in Florida, industry insiders note. 

In our latest episode of Disrupt, Home Care Association of Florida (HCAF) Executive Director Bobby Lolley sits down with Home Health Care News to provide an on-the-ground update on vaccine progress. During the episode, Lolley touches on how in-home care workers are in a vaccine “blindspot,” vaccine hesitancy among home care staff and more.

Listen to this episode of Disrupt to learn more about:

— The COVID-19 vaccine rollout in Florida and elsewhere
— The strategic importance of vaccinating home-based care professionals
— Unique challenges facing home health, hospice and home care workers across the board
— And more! 

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‘An Absolute Travesty’: Home Health Advocates Make Last-Ditch Effort to Delay Review Choice Demonstration

When the U.S. Centers for Medicare & Medicaid Services (CMS) announced that the Review Choice Demonstration (RCD) would resume for participating states in August, home-based care providers and advocates were up in arms over the decision.

But as the resumption date approaches, industry advocates are making a last-ditch effort to get CMS’s attention and persuade regulators to reconsider the move.

“I think it’s one of the most heartless, callous and hypocritical decisions that CMS could make at this time,” Tim Rogers, the president and CEO of the Association for Home & Hospice Care of North Carolina, told Home Health Care News.

RCD states include Illinois, Ohio, Texas, North Carolina and Florida. The latter two are just being introduced to the improper billing initiative.

In part, the resumption of RCD is so brutal due to recent developments in the battle against the coronavirus. Both Florida and North Carolina have rising COVID-19 case trends, according to data from John Hopkins University.

Currently, RCD is supposed to begin again on Aug. 3. Originally, the thought was that as long as a public health emergency persisted, CMS would continue its suspension of RCD.

But the public health emergency has been extended to at least Oct. 23, and CMS — as of now — is planning on moving forward with the demonstration despite that extension.

Rogers worked with the executive director of the Home Care Association of Florida (HCAF), Bobby Lolley, as well as the Partnership for Quality Home Healthcare, among other advocacy groups, to originally get a delay implemented when the COVID-19 crisis began.

“They listened to our concerns months ago, and they implemented the delay,” Rogers said.

“We never were led to believe that it was going away.”

Two weeks ago, Lolley helped lead an effort to get U.S. senators involved. Republican Senator Marco Rubio had helped similarly with the Pre-Claim Review Demonstration (PCRD), RCD’s failed predecessor.

Naturally, HCAF and Florida home health providers looked to enlist his help once again.

And those efforts paid off: Rubio’s staff reached out to CMS on behalf of the providers who voiced concerns to them about the resumption of RCD. In turn, CMS asked that providers send them emails directly about their reservations.

As of Friday, over 1,000 emails had been sent to CMS. More than 4,600 RCD-related emails have been sent total, whether that be to politicians, advocacy groups or government agencies, Lolley told HHCN.

“That is a good-sized number, but it needs to be bigger, and we’re going to be pushing this week to make that number larger,” Lolley said. “So if these emails from providers get the attention we think, I think that’ll lead into us getting some sort of meeting with someone higher up in CMS.”

Advocates involved in the effort hope to double those numbers by week’s end.

Lolley said that he is hoping that CMS’s decision was simply an oversight and that, once things get talked out, the agency will understand why this is the wrong move amid a national health care crisis.

“If we can just talk to them and make sure that they understand how difficult things are for the home health sector here in Florida … I can’t imagine anybody going forward with this,” Lolley said. “I don’t think it will go away. But I do feel fairly confident that they would delay it. How long would they delay it? I’m not sure. But I do believe that if it just can be brought to the attention of the right people, they’ll see clearly that this should not happen.”

Why RCD hurts right now

In Florida, the hospitals have teetered around full capacity for over a month. When it gets to that level, hospitals need to start pushing out their more stable patients — and that’s when home health really comes in handy.

That means that referrals for home health agencies have been through the roof, Lolley said, and that running an agency is more hectic than ever.

Additionally, because of the virus’s resurgence in the state, many administrative and clerical staff are still working from home or working in a COVID-19-related position for the time being.

In North Carolina, many home health agencies owned or managed by hospital systems have begun helping out by sending workers to conduct testing where they’re needed or doing other COVID-19 type work, Rogers said. Those are the ones that would be utilized in RCD work previously.

“These staff members that would be the ones doing the documentation or reviewing the documentation prior to the claim submission are now remote,” Rogers said.

Even without COVID-19 circumstances, RCD is a bit of an undertaking for home health providers.

Now, given the increased referrals and new regulations, providers feel that it is just unfair to bestow another burden on them right now, Linda Murphy, the founder and COO of Concierge Home Care in Florida, recently told HHCN.

“I think CMS’s timeline is aggressive considering the state of emergency,” Murphy said. “We are seeing a spike in quarantined team members due to outside exposures. We are now mandated to test our team members every two weeks. … We are [already] asking so much of our clinical teams to meet the challenges and demands.”

Concierge Home Care is a home health provider with nine locations in northern Florida.

While CMS is resuming RCD, it is simultaneously still allowing — and encouraging — remote patient monitoring, non-physician home health certification and hospital-to-home health hand-offs, in general. That seems backwards to advocates for RCD suspension.

CMS is acknowledging the increasingly large and tough role home health plays while also increasing its burden amid COVID-19, they feel.

That’s why Lolley, Rogers and others feel so strongly about their cause. They’re going to keep hitting up members of Congress, CMS and anyone else who will listen over the next week.

Congress withholds the right to halt CMS from moving forward with RCD re-implementation.

“They classify home health as such an important aspect of the clinical continuum during COVID-19,” Rogers said. “And then they augment them and push them aside during COVID-19 in order for them to do RCD, audits and paper chase, and ultimately diminish their role in clinical care — it’s an absolute travesty.”

Rogers and Lolley are both cautiously optimistic that they’ll be able to get something done and are hoping it will be by this upcoming Friday, July 31.

“Granted, if it were implemented, we would complete our learning curve just like Illinois, Ohio and Texas,” Lolley said. “But they didn’t have a learning curve in the middle of a worldwide pandemic, and their state wasn’t in the center of that virus. The timing, it’s just crazy. It’s crazy to try to do this.”

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