Massachusetts began administering COVID-19 vaccines on Dec. 15, 2020. One hundred four days later, on March 29, Gov. Charles Baker announced the launch of a new “Homebound Vaccine Program.” By that point in time, the commonwealth had already administered 3,409,635 doses of vaccine to the public. The Homebound Program was clearly not as high a priority as reaching patients in nursing facilities, where COVID fatalities were a daily headline. As a result, homebound elderly and disabled people waited three and a half months to get their turn at a shot. Some of these people had as many as three or four home health aides, visiting nurses, or physical therapists, coming into their homes daily — any of these workers were potential COVID spreaders. In-home COVID testing was also not widely available.
The state set up a central intake phone line for homebound people looking for vaccine. The Baker Administration used 25,000–2% of the 65+ population — as a proxy target for the number of “completely homebound” people in need. Disabled people age 18 to 64 were apparently not part of that projection of need. The program began with homebound definitions which were somewhat nuanced and complicated. But on May 24, the state simplified the definition of homebound to “anyone who could not get to a vaccine site.”
The entryway to the program was somewhat Balkanized: 150 local boards of health managed their own program, while 201 other local boards partnered with a statewide program vendor. In rural Franklin County, the 15 towns of Bernardston, Buckland, Charlemont, Colrain, Conway, Deerfield, Erving, Gill, Hawley, Heath, Leyden, Monroe, Northfield, Rowe, Shelburne shared one phone line. Three towns of Orange, New Salem, and Wendell shared another intake phone. Montague had its own program. The seven remaining towns of Ashfield, Greenfield, Leverett, Shutesbury, Sunderland, Warwick, and Whately, partnered with the statewide Homebound Program vendor. Lifepath offered a Vaccination Access helpline at 413-829-9285. The Massachusetts Vaccine Registration Hotline was a 2-1-1 call. For disabled folks not skilled with a laptop or a smartphone, getting inside the program could be more painful than the shot itself.
According to Phoebe Walker of the Franklin Regional Council of Governments, as of May 27, for the 15 health district towns listed above, FRCOG nurses Lisa White and Jackie Choate administered vaccines to a total of 46 homebound patients. Montague Pubic Health Nurse Cheryl Volpe reported 10 home visits as of June 3. Matt Fortier of the Orange Board of Health estimated the Orange/New Salem/Wendell collaboration, has provided 40 homebound doses as of May 22. MassHealth was unable to report data from the seven towns in Franklin County under the statewide program, including Greenfield. No statewide data by town has been posted on the state’s vaccine dashboard, but MassHealth claims that a total of 3,138 vaccines have been administered to the homebound across the state as of the beginning of June, with another 1,547 appointments queued up in the coming weeks. The Homebound Vaccination Central Intake Line has fielded over 19,000 calls, and passed 3,000 people to their local board of health, but local boards are not required to report their data to the state. An earlier start to the program, a simpler entryway, and clearer eligibility rules would have enhanced the numbers to date. The data thus far suggests that the program has fallen significantly below its target of 25,000 people.
Harvard Medical School told the Associated Press that there are an estimated 2 million homebound elders in the U.S. and another 5 million who need help to get vaccines. “Inoculation efforts are scattered, and much depends on local officials and medical providers,” the Medical School said. The National Patient Advocate Foundation told the AP that getting vaccines to the homebound was “a problem we knew we were going to have.” The foundation asked a basic question: “How are there not plans in place?”
The answer is: from the beginning of the pandemic, the federal and state governments were not focused on the homebound because they were not visible. Scattered across individual homes and apartments, the elderly and disabled were scared they would be an afterthought. And they basically were.
Maybe in the next pandemic we will put the homebound at the front of the queue — not at the back. If states and pharmacies can offer million-dollar lotteries, free college tuition, free beer and marijuana, plus gift cards to entice younger people to get vaccinated, perhaps we will do much better for the homebound who don’t need to be bribed to get vaccinated.
Greenfield resident Al Norman worked in the elderly home care system in Massachusetts for 38 years. He says he liked working with seniors so much, he decided to become one.