_{By Jane Carmody, The John A. Hartford Foundation; Megan Wolfe, Trust for America’s Health; Jennifer Fuller, Cambia Health Foundation}

Older adults and people with disabilities who are homebound are receiving the COVID-19 vaccine at lower rates than the general population. Until recently, it was very challenging or nearly impossible for this population to access the vaccine at all. While national and state public health officials continue to coordinate vaccination centers and form partnerships to get the vaccine to as many people as possible, they must consider strategies to reach people unable to leave their homes.

It’s estimated there are between two to 12 million older adults who are homebound in the United States and they often have complex needs and multiple illnesses that affect their ability to leave their homes safely. They are more likely to have lower incomes and be from racial minority groups. They also often rely heavily on an unpaid family caregiver who themselves may not be able to leave the house for long periods of time given their caregiving responsibilities. Recent data has shown that there are significant racial disparities in vaccination rates.

With all this in mind, Trust for America’s Health, with support from The John A. Hartford and Cambia Health Foundations, convened experts and providers and conducted interviews with public health practitioners, home-based care providers, and aging services leaders to gather best practices and develop policy recommendations for addressing the challenges and barriers to COVID-19 vaccinations. Drawing from this work, a recent report provides guidance on how to increase vaccine access for older adults and people with disabilities who are homebound. The report outlines how federal, state, and local government agencies and their partners can facilitate equitable vaccination for this population and how to include the needs of homebound individuals in future public health strategies and planning. The most critical recommendations are summarized below. 

Recommendation 1: Define the Population, Share Information, and Leverage Trusted Relationships

Define the Population

One of the main challenges to reaching people who are homebound is the absence of a shared definition of what it means to be homebound, much less community-level data about who is homebound. The definition should be broad in order to not exclude anyone based on whether they have a specific medical condition or not. Creating a definition that leads to identification will go a long way in ensuring this population is integrated into public health planning.

Share Information Among Trusted Stakeholders

Existing community-based organizations and social service providers like Area Agencies on Aging, emergency response teams, pharmacies, physicians, churches, caregiver support groups, and fire departments can share information about people who are homebound to ensure they are not left out of critical planning. Ideally, public health officials and partners can create a formal system where that information is shared across entities. This kind of information flow can lead to a more effective, integrated system of care for everyone.

Recommendation 2: Equitably Vaccinate People Who are Homebound and Diversify and Expand the Vaccinator Pool

Equitable Vaccination

Creative outreach methods that are focused on equity are essential to connect with older adults and people with disabilities who are homebound where they are. Internet access can be a barrier and public health officials, community partners, and others should consider strategies such as phone banking, door-to-door canvassing, and advertising targeted to reach people who are homebound and their caregivers. Furthermore, to ensure outreach is being conducted equitably, stakeholders should collect and share data on race, ethnicity, and other demographics as they identify and contact individuals and administer vaccines.

In addition to people who are homebound, public health departments must prioritize vaccinating caregivers and other family members living in the same household. This ensures the people primarily responsible for caring for people with complex medical needs are able to continue meeting their needs and reduces potential vaccine waste. Public health practitioners should share positive messaging to address hesitancy among caregivers about getting vaccinated. Caregivers can further support those in their care by sharing these positive messages and serving as a positive example by getting vaccinated themselves.

Diversify and Expand Vaccinators

Teams conducting outreach to older adults who are homebound and those providing vaccines should reflect the population they serve and/or be recognized and trusted community members or partners. This familiarity will foster trust and reassure people who are homebound and their caregivers who may be hesitant about getting the vaccine.

The pool of vaccinators can be expanded by looking to home health providers and other trusted health care professionals like emergency medical technicians, dentists, paramedics, physician assistants, medical students, and retired health care providers. All are possible vaccine administrators once they have appropriate training on both COVID-19 vaccine delivery and working with homebound populations. Expanding the pool of vaccinators will help distribute the vaccine to larger numbers of people more quickly and reach a more diverse population.

Future Implications in Caring for Older Adults

Public health strategies and campaigns that address the needs of older adults and others who are not able to easily leave their homes must be prioritized moving forward. In addition to focusing on issues like infant mortality and maternal health, public health stakeholders must ensure that they are addressing the needs of older adults and centering healthy aging as part of their mission. Collaboration between health systems, public health stakeholders, community-based organizations, and others is critical to the creation of age-friendly ecosystems, a paradigm where the needs of older adults are considered and met across sectors.

Older adults and other people who are homebound are a population that often do not receive the support they need, as is the case with the dissemination of COVID-19 vaccinations. Defining what it means to be considered homebound, collecting and sharing data, and convening a broad array of stakeholders to work together will go a long way in meeting crucial needs moving forward, including embedding these new policies and practices to prepare for future emergencies. Some states and cities have adopted and implemented innovative efforts to reach people who are homebound. These bold practices, detailed in the full report, should continue to be praised and replicated as examples of how best to meet the needs of those who are homebound.