New Report: U.S. Must Prioritize COVID-19 Vaccines for People Who Are Homebound

Experts provide strategies to ensure equitable vaccine distribution for homebound people -- supported by Cambia Health Foundation

By Rhea Farberman, Trust for America's Health
(Washington, DC – May 3, 2021) – At least 2 million older adults are homebound a number that increases when including younger people who are homebound due to illness or disability.  Ensuring that this population group receives the COVID-19 vaccination requires focused attention, collaboration and resources according to a policy brief released today by Trust for America’s Health (TFAH).

The brief, Ensuring Access to COVID-19 Vaccines for Older Adults and People with Disabilities Who are Homebound, recommends actions that federal, state, and local government, state and local health agencies, the healthcare sector and community partners should take to ensure that people who are homebound are vaccinated.

According to the report, all parties involved in the COVID-19 vaccination effort have a responsibility to ensure people who are homebound are vaccinated, which means redirecting or creating the infrastructure, workforce, and funding support to bring the vaccination process to them.  Adding to the importance of equity in vaccine access is the fact that people who are homebound often have underlying health conditions that put them at heighten risk if they were infected by the COVID-19 virus.  In addition, the processes created or improved to meet the challenge of this pandemic will strengthen the nation’s public health infrastructure for the growing segment of the population who are homebound and help better safeguard their health during future public health emergencies.

“Ensuring that every person is vaccinated against the COVID-19 virus is not only a matter of health equity, its critical to ending the pandemic, said John Auerbach, President and CEO of TFAH. “But millions of people in the U.S. cannot travel to a vaccination site. Government and community partners must work together to protect the health of the homebound population by bringing the vaccine to them.”

Among the report’s recommendations are:
  • Prioritize the administration of COVID-19 vaccination for people who are homebound and their caregivers (both paid and unpaid) by providing sufficient vaccines and the resources needed to administer them in the shortest time possible.
  • Develop a standardized operational definition of “people who are homebound” in order to identify this population and prioritize their vaccination. 
  • Ensure that the COVID-19 vaccine is equitably available across the homebound population and that no subset of the population is less served due to race, ethnicity, SES status or where they live. Use data to identify pockets of under-vaccination.
  • Develop and actively promote multiple communications channels for vaccine appointments scheduling, including use of channels that minimize reliance on computers and internet access.
  • Leverage partnerships and establish new ones with public and private sector organizations that already serve the homebound population to ensure equitable and efficient vaccine administration.
  • Ensure, to the degree possible, that in-home vaccination teams include people who are trusted by those being vaccinated and who represent the diversity of the population they serve.
  • Government agencies and private payors should ensure that all costs associated with in-home vaccinations are covered including administrative expenses, travel time and transportation costs, and observation time.
The report is an outgrowth of two national expert convenings hosted by Trust for America’s Health.  Funding for the report and convenings was provided by The John A. Hartford Foundation and the Cambia Health Foundation.
“Older adults and those with disabilities who are homebound have been the forgotten faces of this pandemic,” said Terry Fulmer, PhD, RN, FAAN, President of The John A. Hartford Foundation. “We now know about cutting-edge solutions, as well as failed strategies we can learn from, to ensure that everyone has equitable access to vaccinations going forward.”

“We are committed to ensuring equitable vaccine access for all, including homebound older adults and people with disabilities who may face obstacles scheduling online appointments or getting to vaccination sites,” said Peggy Maguire, President, Cambia Health Foundation. “We funded the Trust for America’s Health national grant with thought leaders from other parts of the country so that we could share learnings and best practices that will help homebound people and their caregivers in our four states access the COVID-19 vaccine and achieve health equity.”
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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.

The John A. Hartford Foundation, based in New York City, is a private national philanthropy dedicated to improving the care of older adults.

Cambia Health Foundation is the corporate foundation of Cambia Health Solutions, a total health solutions company dedicated to making health care more person-focused and economically sustainable. Founded in 2007, the foundation has funded over $80 million in grants to advance whole person care models at every stage of life and build a just and inclusive health care system for all.