Hoping to Prevent Community Spread, Home-Based Care Advocates Vie for ‘Critical’ Vaccine Access

A number of national home-based care advocacy organizations have come together to address the CDC’s Advisory Committee on Immunization Practices (ACIP). In a new letter penned to ACIP Chairman Dr. José Romero, the group called for the inclusion of in-home caregivers when it comes to priority access to the COVID-19 vaccine.

The letter was born out of a collaboration between seven organizations, including the Home Care Association of America (HCAOA), the National Association for Home Care & Hospice (NAHC), the Partnership for Medicaid Home-Based Care (PMHC) and the Partnership for Quality Home Healthcare (PQHH).

“I’m really thrilled that all of the home care associations got together and are speaking in one voice on such an important issue as vaccines,” Vicki Hoak, executive director of HCAOA, told Home Health Care News.


Last week, ACIP specified which groups should be granted priority access for Phase 1 of vaccine distribution.

ACIP determined that health care workers and residents of nursing homes should be on the list. The CDC committee also said that essential workers, older adults and individuals with underlying medical conditions should also be granted priority access to a vaccine.

During a Tuesday meeting, ACIP voted 13 to 1 in favor of those recommendations.


Vaccine distribution has garnered national attention since last month’s news that COVID-19 vaccine manufacturers Pfizer and Moderna filed for emergency use authorization with the Food and Drug Administration (FDA). Oxford and AstraZeneca are also close to rolling out a vaccine.

In their letter, the national home-based care advocacy organizations commended ACIP’s recommendations but urged the committee to be specific in its definition of health care workers in order to ensure that all caregivers are included. That includes home health aides, hospice aides, personal care aides, home care workers, direct support professionals and others.

“Our concern is that under the most recent CDC COVID-19 Vaccination Program Interim Playbook for COVID-19 Vaccination Program Jurisdiction Operations, home care workers, specifically personal care aides and home health aides, are not explicitly mentioned as Phase 1 or Phase 1A critical populations for vaccinations,” PMHC Chairman David Totaro told HHCN in an email.

The distinction is important because caregivers working on the non-medical side of home-based care are sometimes overlooked when it comes to federal policy, according to Hoak.

“Sometimes when you think of COVID, you think ‘medical,’ and a personal care aide helping people with activities of daily living doesn’t always come to mind,” she said. “But they are just as critical, especially during this pandemic.”

In the letter, the group also stated that the home care population should be afforded high-priority status for access to the vaccine.

The letter also stressed the importance of the adoption of these recommendations at the state and local levels. ACIP recommendations will serve as a guideline, but ultimately the decisions happen at a state level.

In Massachusetts, for example, physicians and community leaders on the Massachusetts COVID-19 Vaccine Advisory Group have expressed that front-line workers such as caregivers should be early recipients of the vaccine.

Texas has also placed home health workers in its “Tier 1” prioritization category, along with hospice staff.

“What we’re doing next is encouraging all of our members to send letters to their various state officials who are developing these plans,” Hoak said. “Now that we have tried to encourage the federal agency to adopt our recommendations — making sure that they’re all-inclusive — the next step is to advocate at the state levels to make sure that same message is carried forward.”

In addition to the previously mentioned organizations, the American Network of Community Options and Resources; the Council of State Home Care & Hospice Associations; and the National Hospice and Palliative Care Organization also signed the letter.

Combined, the seven organizations represent in-home care providers caring for over 12 million individuals annually. Collectively, those home-based care providers have served “tens of thousands of patients with active COVID-19 infections,” according to the letter.

Over 60% of home care and hospice providers are currently reporting COVID-19-infected patients on service, with many of those patients often living in facility-based settings.

“We want to emphasize that the individuals we serve often have complex service needs and are

at high risk for COVID-19,” The letter reads. “While we recognize the need for vaccinations for those that live in long-term care facilities, it is important to remember that our workforce, on a daily basis, frequently goes to multiple homes. They also provide care in other health care settings, including nursing homes, assisted living facilities and in-patient hospice facilities. The greater protection that both the workforce and individuals receive, the less likely there will be a community spread of the virus.”

U.S. nursing homes are experiencing the worst outbreak of weekly new COVID-19 cases since last spring due to community spread among the general population, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) announced on Tuesday.

Nursing home cases have officially surpassed the previous peaks since the Centers for Medicare & Medicaid Services (CMS) started tracking cases in nursing homes.

“Our worst fears have come true, as COVID runs rampant among the general population and long-term care facilities are powerless to fully prevent it from entering due to its asymptomatic and pre-symptomatic spread,” Mark Parkinson, president and CEO of AHCA/NCAL, said in a statement.

Additional reporting by Tim Regan.

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