Advocacy groups say homebound Iowans have been ‘forgotten’ by state vaccination system

Newly disclosed data identifies the privately run nursing homes in Iowa that have had the most infections among residents and staff, the most outbreaks, and those that have spent much of the past year in outbreak status. (Photo by Centers for Disease Control and Prevention)

Phyllis Mussman of Cedar Rapids spent 2020 painting, writing poetry and staying home.

Mussman, 84, has no car and has been largely homebound. She uses supplemental oxygen, making travel difficult and rendering her more vulnerable to respiratory illness brought on by the COVID-19 virus.

“When the virus hit, I was scared and I didn’t go anywhere,” Mussman said. She left the house rarely, she said, for trips to the pharmacy or to the doctors’ office.

For Iowans like Mussman, the COVID-19 vaccine offers some hope if they can access it. In addition to technological challenges, Iowans who cannot leave their homes for medical reasons or who do not have transportation face additional barriers to get their shots.

Some advocacy groups for seniors and people with disabilities say the state hasn’t done enough to reach vulnerable Iowans who cannot safely leave their homes. Jane Hudson, executive director of Disability Rights Iowa, said people who cannot easily access pharmacies and clinics are being “forgotten or neglected” under the current system.

“I know the state is trying to help seniors and people who don’t have computers or the time to do vaccines, but this is where the hole is,” she said. “The people who are homebound.”

Homebound vaccination initiatives roll out on the local level

Iowa has no central system to make vaccine appointments. Instead, the primary website for the state’s vaccine rollout, coronavirus.iowa.gov, directs users to a county-by-county list of vaccine providers. In Polk County, for instance, the website lists 32 vaccine providers, each with its own website and phone number to consult.

In March, the state included vaccine scheduling on the 211 hotline for older Iowans who need help navigating the system. Joe Sample, executive director of the Iowa Association of Area Agencies on Aging, advised use of the hotline for anyone overwhelmed by the online scheduling.

Outreach to those who cannot leave the home or who don’t have transportation to a clinic, however, has been limited and localized.

In Webster County, the public health department organized a force of retired nurses to deploy the COVID-19 vaccine to people who couldn’t attend a clinic in-person.

“We actually sat down with a giant map of Webster County and mapped out how can we get to all of these individuals’ homes… and make it the most timely and also not waste any doses,” said Kelli Bloomquist, public information officer for the Webster County Health Department.  

The first round of vaccine delivery included 50 people. Bloomquist said the county compiled a list of homebound individuals from home health care providers and social media. As of Monday, 130 people had been vaccinated through the program, with another round of visits planned for Wednesday.

“Children are calling in for parents and grandparents and saying, ‘Hey, I heard that you were vaccinating homebound (people), there’s no way that my grandma can get out, can you make this happen?’ ” Bloomquist said.

Bloomquist and leaders from disability and senior advocacy groups said they were not aware of any statewide initiatives to vaccinate homebound individuals. Sarah Ekstrand, spokesperson for the Iowa Department of Public Health, said Medicaid Managed Care Organizations have worked with people with disabilities and homebound individuals to coordinate vaccine appointments.

But Laura Gibson, executive director for the Central Iowa Center for Independent Living, said managed care case managers were “overwhelmed” by the task.

“I have not known anyone who has gotten their vaccine that way,” Gibson said. “Most everybody is relying on parents (or) caregivers.” 

Iowans who aren’t tech-savvy or who don’t have a support system may struggle to find information and appointment slots, Gibson said, especially without a centralized system.

“Even if you have all the vaccines for every single person in the state, if you aren’t meeting them where they are to be able to vaccinate them, it won’t do a lot of good,” Gibson said.

Other states offer at-home vaccines

States and cities across the U.S. have handled the vaccine rollout differently, and expanding access for homebound individuals is no different. Some state governments have led the charge to get vaccines to homebound individuals, while local efforts spurred action in other areas.

In neighboring Minnesota, a hospital system delivered dozens of vaccines to homebound seniors, the Minneapolis Star-Tribune reported. The hospital plans to expand the program.

Florida, which has the highest share of people 65 or over, launched a pilot program for vaccinating homebound seniors in February. Gov. Ron DeSantis tweeted the next month that over 1,500 individuals had been vaccinated through the program and he opened it to all Floridians. Individuals who are elderly or disabled can request a visit through an email address or a phone number.

The Tampa Bay Times reported Florida had allocated doses for an additional 2,000 homebound seniors

Iowa advocates say they’d like to see similar, widespread systems here for people stuck at home. They recommended working through pre-existing networks like Meals on Wheels or home health agencies that already know where people are living and who might need the extra help.

“If we receive information on our case load or are aware of individuals who are homebound, once the system is set up, we probably can help at least find some of those folks,” Sample said.

Sample said some communities were also working with regional transit authorities to organize rides for people who may be medically able to leave home but lack transportation.

Hudson, of Disability Rights Iowa, noted that new vaccine innovations could help states create at-home vaccine programs. Whereas the Moderna and Pfizer vaccines require two doses and colder temperatures, the Johnson & Johnson vaccine requires one dose and can be stored in a standard refrigerator.

“With the Johnson & Johnson vaccines hopefully becoming more available in Iowa, they don’t have all the refrigeration issues to go to people’s homes, or the double-dose issue,” Hudson said. “You could do it in one shot, so to speak.”

Pandemic creates additional isolation for vulnerable populations, vaccine brings hope

People who cannot leave their home face dual challenges during the COVID-19 pandemic, advocates said. Their age or health conditions make them among the most vulnerable to the virus, but the pandemic also compounds their isolation, making them increasingly lonely. 

“We know that there’s been a tremendous amount of social isolation for older Iowans due to COVID-19,” Sample said. Getting the vaccine, he said, was the first step toward allowing those people to “live their life again.”

Gibson said that vaccinations are also essential to allow people with disabilities to reengage with their support systems and communities.

“People with disabilities, depending on what level of disability, they already may have been relying on outside people for so many services, and that’s only been made harder,” Gibson said. “They’ve maybe already experienced isolation, and this has only made it worse.”

Mussman, the Cedar Rapids resident, said she relied more heavily on her phone to stay in touch with friends during the pandemic. 

“Especially on the weekends, I notice the loneliness,” she said. “You don’t like to bother people on the weekends, because I consider that family time.”

But the end of isolation is in sight for Mussman. A friend drove her to Mercy Hospital last week to get her second dose of the COVID-19 vaccine. She’s hopeful that, with the vaccine and the declining number of COVID-19 cases, she’ll be able to visit soon with her family, including a grandson who underwent a heart transplant.

“We’d have a good weekend together, we’d play games or something,” she said. “My one grandson really likes dominoes, and so we always play dominoes.”