New York Moves Up COVID-19 Vaccination Eligibility for Home Care, Hospice Workers

Home care and hospice workers are now part of the pool of New Yorkers eligible to receive the COVID-19 vaccine.

The New York State Department of Health originally announced that home care and hospice workers would be eligible to receive the first dose of the vaccine starting on Jan. 11. This placed these individuals in the Week 5 group of the state vaccination program.

The department updated that plan last Monday, moving home care and hospice workers to the Week 4 group receiving the vaccine starting on Jan. 4. 

This development didn’t just happen overnight. In fact, it was the result of a significant push from New York home-based care associations, Roger Noyes, director of communications at the Home Care Association of New York State (HCA-NYS), told Home Health Care News.

“I would say that is a huge development, and it’s something that we’ve been pushing for several weeks to ensure that there was a prioritization in Phase 1A for home care and hospice workers,” he said. “It took a lot of conversations with the state department of health and the city department of health.”

HCA-NYS is a state trade organization that represents nearly 400 home- and community-based care providers and organizations.

Noyes noted that — because of the infrastructure currently in place, which involves the 10 regional hubs of New York overseeing the vaccination system — the distribution-planning process involved multiple conversations with various agencies and players. 

Home Healthcare Workers of America was also part of the overall advocacy push. The organization, which represents over 26,000 in-home care workers, saw firsthand the need for urgency when it comes to vaccination.

“During this time, tragically, we have lost 12 aides from the start of this to the present,” Joe Pecora Jr., the organization’s vice president, told HHCN. “Our members were desperately asking for access to the vaccine. We’re happy that the governor’s office and the department of health have agreed to move up their eligibility. This is a lifeline.”

New York state employs more than 210,000 home care aides, labor statistics show.

Home Healthcare Workers of America is a part of the International Union of Journeymen and Allied Trades (IUJAT). The organization represents workers primarily located in the five boroughs of New York City.

Throughout the COVID-19 emergency, visibility has been a major challenge for home-based care organizations. At times, this resulted in these organizations being overlooked.

Being prioritized for vaccine eligibility represents a shift, according to Noyes.

“Whether it was [personal protective equipment] status or authorization to visit patients in their own homes when there were travel restrictions in place, this has been an issue,” he said. “To now have, at this pivotal stage of the vaccination rollout, home care and hospice workers in early, that is an important accomplishment.”

For now, HCA-NYS has been keeping its members updated on the logistics and procedures for actually getting the vaccine.

It’s a process that has run the gamut, according to Noyes.

“For instance, some agencies, I understand, have ordered the vaccine, and I don’t know whether they’ve received it yet, but they have plans to vaccinate their own staff — to actually have their own agency be the point of dispensing a vaccine for their workers,” he said.

Meanwhile, other agencies have opted to instruct their staff to essentially make their own appointments with the various dispensing hubs that are being set up across the state.

In these cases, HCA-NYS has provided instructions around what information workers need to bring to these appointments in order to prove they’re Phase 1A. Similarly, it has helped its members understand what documentation they need to retrieve from the vaccination site.

So far, New York City’s mass vaccination efforts have gotten off to a rough start.

Despite a surge of new COVID-19 cases, few people have been vaccinated. This has left public health experts concerned, according to reports from The New York Times.

Overall, only 167,949 of 489,325 doses of the vaccine — roughly 34% — have been administered as of Friday. The rate for New York state overall is over 40%, according to The New York Times.

The vaccination rollout potentially creating hiccups that would impact home care and hospice workers is a concern, according to Noyes.

“Home care and hospice workers are now in priority 1A,” he said. “But if there’s concern that the vaccine is not being administered to health care workers at the rate it should be because of hesitancy, … then there’s going to be a big impetus to push through to the other phases. Certainly, there are other priority groups that need the vaccine quickly, but my concern is whether or not this push could squeeze out access for home care and hospice workers.”

Elsewhere, early last week Los Angeles County’s home care companies received confirmation that non-medical caregivers are part of the first group eligible for vaccination.

Prior to this confirmation, home care companies weren’t clear on whether their employees were part of this group, which includes their home health counterparts.

Home health leaders and clinicians in various parts of the country have also begun to highlight their vaccine experiences on social media. That group includes Dr. Steve Landers, president and CEO of the Visiting Nurse Association Health Group Inc.

Senior living operators have ramped up their vaccination efforts as well.

On Dec. 21, for example, Brookdale Senior Living Inc. (NYSE: BKD) announced it had held its first community vaccine clinics, with plans to schedule more across the company’s 726 communities.

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NAHC, NHPCO, Others Release Vaccine Guidance for In-Home Care Providers

The dichotomy in the U.S. right now is evident, especially for those in health care: While vaccines and coinciding hope are being injected into Americans, the number of new COVID-19 cases each day continues to climb.

And while every home-based care provider and worker keeps reading that the vaccines — both Pfizer’s (NYSE: PFE) and now Moderna’s (Nasdaq: MRNA) — are here, they’re wondering where.

Vice President Mike Pence and his wife, Karen Pence, were both vaccinated on video Friday. Senate Majority Leader Mitch McConnell (R-Ky.) tweeted out a picture of himself post-vaccination as well. Hospital workers have danced on TikTok celebrating the Pfizer-BioNTech vaccine’s arrival at the Boston Medical Center.

But for the home-based care world, key information regarding the vaccines is still hard to find.

“We don’t know not only when but where,” David Totaro, the chairman of the Partnership for Medicaid Home-Based Care (PMHC), told The Philadelphia Inquirer last week. “We don’t even know how we’re going to be notified.”

Over the last week, most of the major home-based care trade organizations have released guidance for providers on how to handle vaccinations in the workplace.

Home-based care workers have been labeled 1a — or highest priority — to receive the vaccine in most states.

The National Association of Home Care & Hospice (NAHC), for instance, is telling providers to “encourage all home care and hospice staff to receive a COVID-19 vaccination at the earliest possible time consistent with vaccine guidance.”

The national association suggests providing the support necessary to help workers gain access to the vaccine as soon as possible as well as access to comprehensive and fact-based information regarding immunization. It also reiterated the importance in following safe protocols throughout the pandemic in the meantime.

The Home Care Association of New York State released similar guidance, and the National Hospice and Palliative Care Organization (NHPCO) released a statement of its own.

“Hospice and palliative care professionals are on the front lines of health care delivery in this country. Not only are they serving the most vulnerable population with complex medical needs, but they are caring for people in their homes, interacting with family caregivers, and traveling throughout the communities they serve,” NHPCO President and CEO Edo Banach said. “For their own protection, the safety of those under their care, and the welfare of their families and communities, NHPCO encourages these dedicated professionals to receive the COVID-19 vaccine.”

Each state’s plan to roll out the vaccine is different, so organizations that work in multiple states will have to do their due diligence in each region to ensure that their workers have access to one of the two vaccines as soon as possible.

Still, the home-based care organizations stopped short of encouraging mandatory vaccinations for workers, despite their assurance that immunization will be safe and effective in stopping the spread of COVID-19.

“The next thing that we’re trying to address right now is whether or not vaccines should be mandatory among our staff,” Totaro said during Home Health Care News’ Capital+Strategy event earlier this month. “And that’s a very, very complex issue. We’re taking it very seriously.”

San Francisco-based law firm Littler Mendelson released a client alert to home-based care organizations this week regarding that issue.

For many reasons, Littler is urging providers to wait before taking a firm position on mandatory vaccinations for workers.

“Employers really cannot make vaccinations completely mandatory,” Angelo Spinola, a shareholder at Littler Mendelson, wrote. “They must always allow exceptions based on health and religious beliefs.”

Spinola urged home-based care clients to consider a handful of questions: Firstly, are there exclusions regarding who should receive the vaccination, from a medical perspective?; Will there be side effects to the vaccine that could hurt employees?; Are your employees reticent or or enthusiastic about the vaccine?; And how are others in the industry responding?

Those questions all suggest that providers should wait before making the call. In some states, health care workers are required by the government to receive flu shots, for instance. If the government could make vaccines mandatory, Spinola urges providers to let lamakers do it first.

Plus, there are other things to consider.

“Mandatory vaccinations may lead to potential workers’ compensation claims from employees who suffer an adverse reaction to a potential vaccine,” he wrote.

In any case, encouraging vaccination, but stopping short of mandating them, seems to be the resounding guidance right now from industry insiders.

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The Forgotten Field: ‘Invisible’ Home Care Workers Seek Agency Support

Despite being on the front lines of care during the COVID-19 emergency, New York City caregivers often felt “invisible” and faced a higher risk of contracting the virus.

That’s according to a study published Tuesday by JAMA Internal Medicine. As part of the study, researchers interviewed 33 caregivers who were employed by 24 different home care agencies across New York City.

“The findings are alarming but not surprising to those who are familiar with the work of home care workers,” wrote Dr. Theresa A. Allison in a corresponding JAMA op-ed. Allison is a professor of medicine in the division of geriatrics at the University of California San Francisco.

In many ways, New York was ground zero for the public health emergency in the U.S.

The first cases of the virus in New York City were reported at the start of March. In the following months, the U.S. would have more than 1 million confirmed cases of COVID-19, with one-third of these cases coming from New York City, according to the study.

Caregivers have been positioned as essential workers during this crisis, with many continuing to provide daily care to patients with complex and chronic conditions — or to individuals actually battling the COVID-19 virus.

But while serving in their essential roles, many caregivers felt like the “forgotten field” in relation to the larger health care community.

“You hear people clapping, thanking doctors and nurses, even the hospital cleaning staff,” one of the surveyed in-home care workers said. “I’m not doing this because I want praise; I love what I do. But it would be nice for people to show us gratitude.”

The COVID-19 emergency also placed caregivers at higher risk for transmission, as workers took on errands such as grocery and pharmacy runs in an effort to protect their patients. Many caregivers relied on public transportation, which they felt further increased the risk of contracting the virus.

The JAMA study also highlighted other themes that emerged from interviews with New York City caregivers. One theme was the differing levels of support from their in-home care agencies in terms of receiving information about COVID-19, personal protective equipment (PPE) and training.

While some agencies were able to respond quickly, some caregivers reported they barely received communication about the public health emergency.

Additionally, some caregivers reported that they received insufficient masks, gloves and other PPE from their agencies, in turn leaving them vulnerable. Some caregivers noted they did not receive COVID-19 training from their agencies, though some agencies had them perform self-assessments to screen for symptoms. 

“Although lack of sufficient PPE has been widespread throughout the first few months of the pandemic in the United States, inadequate PPE in the home increases transmission risks for not only the home health worker and care recipient but also other household members and visitors,” Allison wrote.

Without agency resources, caregivers relied on other sources of support, according to the JAMA study. Specifically, caregivers who didn’t receive information about COVID-19 from their agencies turned to the news, social media, government briefings and their worker unions.

In some cases, caregivers bought their own PPE, or turned to family and friends for help.

The study does suggest that some agencies were quick in their COVID-19 responses.

Based on her observations as the president and CEO of the New York State Association of Health Care Providers, agencies used several methods to support workers, Kathy Febraio told Home Health Care News in an email.

“Communication with staff became a daily event through as many channels as possible: social media, texting, email, web postings, phone calls and good old-fashioned snail mail,” Febraio said. “Agencies kept their employees informed about infection control procedures, proper donning and doffing of personal protective equipment, policy updates, as well as information on child care resources, government updates, school closings and wellness resources.”

The New York State Association of Health Care Providers is a trade association that represents 350 offices of home care providers, home health providers and other health-related organizations.

The study reported that caregivers often found themselves navigating difficult choices. For instance, caregivers had to decide whether to care for COVID-19 patients and risk contracting the virus, placing themselves in a financially unstable position.

Generally, caregivers felt it was their duty to provide care during this time.

Overall, the findings of the study are instructive for providers and policymakers as they continue to work on remedies, Roger Noyes, director of communications at the Home Care Association of New York State (HCA-NYS), told HHCN in an email. 

“Many of the key themes in this study echo what our organization has identified in our own survey of the home care field,” Noyes said. “This includes the need for a more coordinated effort at all levels of emergency management to overcome personal protective equipment supply challenges.”

HCA-NYS is a state trade organization that represents nearly 400 home- and community-based care providers and organizations.

Noyes points out that many home care leaders participated in grassroots efforts to establish voluntary PPE distribution sites in all boroughs of New York City to coordinate with city officials and partner organizations on this area of need.

In her op-ed, Allison said she hoped the pandemic will lead to future home care reform moving forward.

“Just as COVID-19 has accelerated other aspects of medical and social progress, it is time to use the pandemic as an opportunity to engage in social justice for home care workers, recognizing the value of their work by investing in their health and financial security,” Allison wrote.

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Time for Policymakers, Hospitals to Bet Big on Home-Based Care

It’s time for policymakers, hospitals and everyone else at the health care roulette table to bet all their chips on proactive, pre-acute home-based care.

During the coronavirus pandemic, the U.S. health care system has undergone a massive change marked by the skyrocketing use of telehealth technology and the shift away from brick-and-mortar medical appointments. In fact, from April 2019 to April 2020, telehealth claim lines have increased by more than 8,300% nationally, according to FAIR Health data.

For the most part, though, traditional home-based care has felt like a secondary priority over the past few months, with home health providers and home care agencies largely overshadowed by telehealth trends, hospital capacity concerns and the general state of nursing homes, which continue to be devastated by COVID-19.

“I think that [policymakers] have been very responsive to the needs in the hospital setting,” a Maine home health executive previously told Home Health Care News. “I do not feel that they fully understand the complexity of the patients seen by home health and hospice providers.”

Health care stakeholders may have missed the opportunity to aggressively invest in home health and home care during the initial coronavirus spike, but that door is opening wide once again. Or rather, it never really closed.

The country’s rolling seven-day average of daily new COVID-19 cases shattered all previous records on Monday for the 28th day in a row, the Washington Post reported. At the same time, hospitals across the Sun Belt are being overwhelmed by coronavirus patients, with Arizona reaching 89% capacity for intensive care unit beds and California, Georgia, North Carolina, Texas and a handful of additional states experiencing unprecedented hospitalization numbers.

The new coronavirus spikes in the South and West aren’t part of a different, second COVID-19 wave. They’re continuations of the first wave that was never properly addressed.

Overall, the U.S. death toll linked to the coronavirus hit 130,000 this week, statistics from Johns Hopkins University show. The number of total infections is approaching 3 million.

With those numbers in mind, Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases and a leading member of the Trump administration’s coronavirus task force, is calling for urgent action.

“It’s a serious situation that we have to address immediately,” Fauci said during an online interview Monday with Dr. Francis Collins, who leads the National Institutes of Health as its director.

As part of the nation’s renewed response to the coronavirus, home health and home care need to now be front and center. Fortunately, there are several readily available actions out there that the federal government and other health care players can take to support all shapes and sizes of in-home care providers.

When it comes to home health care agencies, in particular, the U.S. Centers for Medicare & Medicaid Services (CMS) can start by reopening its advanced and accelerated payment programs, allowing operators to focus on patient care and not their finances.

Home health agencies experienced huge financial losses during the early days of the coronavirus due to patients canceling visits and the general suspension of elective surgeries. Cash flow disruptions have somewhat stabilized, but the recent resurgence of COVID-19 cases may retrigger the same anxieties and roadblocks that agencies had to previously overcome.

From March through April, CMS distributed more than $100 billion in advanced and accelerated payments to all Medicare providers. Home health providers received just $1.7 billion of that before CMS shut down the programs — and many home health agencies in emerging hotspots never even had the opportunity to apply for payments, as they’re just now feeling the impact of the coronavirus.

On top of reopening its advanced and accelerated payment programs, CMS should also consider giving home health providers a more robust Medicare rate adjustment. While the National Association for Home Care & Hospice (NAHC) and other industry advocates have called for a 15% rate increase, CMS recently suggested a 2.6% reimbursement bump in its proposed payment rule for 2021.

Many home health providers won’t be able to stay afloat for much longer without additional financial lifelines. In New York alone, home-based care providers expect to lose upwards of $200 million in 2020, according to financial estimates by the Home Care Association of New York State (HCA-NYS).

“These losses have alarming implications for the viability of New York’s home care system and the necessary support it provides for patients,” Roger Noyes, director of communications at HCA-NYS, previously told HHCN.

Meanwhile, when it comes to supporting home care agencies, Congress should start by seriously considering the creation of a fund that helps operators finance hazard pay and other benefits for front-line workers in its next relief package.

It’s an idea that had been floated by House Democrats in their Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act unveiled in May. Specifically, the House bill included a $200 billion fund for hazard pay for all essential workers.

Interim HealthCare Inc. CEO Jennifer Sheets previously told HHCN she would “love to see” government-supplemented hazard pay for health care workers.

“We need to incentivize people to be on the front line, especially in a pool that’s already prone to high turnover,” she said.

Apart from financial assistance, the Trump administration and FEMA should also organize a personal protective equipment (PPE) push for in-home care providers, similar to what they did for nursing home operators back in April. In-home care agencies have had just as difficult a time securing PPE, if not greater, as they’ve been excluded from most priority lists during the COVID-19 crisis.

Outside of the government, hospitals also need to accelerate the shift toward in-home care. Many already have, including North Memorial Health Hospital in Minnesota, which recently partnered with whole-person, home-based care provider Lifesprk to offer a hospital-at-home model.

“With the outbreak and shortage of personal protective equipment (PPE), one of the just really sad things that all of us have witnessed is when someone goes into the hospital right now and is very sick, their loved ones can’t be there with them,” Dr. Carolyn Ogland, North Memorial’s CMO, previously told HHCN. “This is a way to really help our families and our patients stay together when they are sick.”

If the U.S. health care system acts quickly and invests in home-based care, it will emerge from COVID-19 stronger than ever. But the window of opportunity is closing, so stakeholders must act now.

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