On a frigid February afternoon, Mike Phelps had a sudden insight as he watched five buses packed with senior citizens, many using wheelchairs or walkers, pull up to a community center in Waconia for a mass COVID-19 vaccination event.
Why, the hospital executive thought, were elders with limited physical mobility and serious health problems expected to bring themselves to vaccination sites? Why not relieve them of that burden?
Phelps and his colleagues at Ridgeview Medical Center in Waconia quickly devised a solution. They would deploy home care nurses to bring vaccines directly to frail and older adults in their own apartments and other private residences.
In two weeks of going door to door, they administered shots to about 100 of Ridgeview's home care patients, including many with chronic conditions and weakened immune systems who had been afraid to go to pharmacies or clinics for the shots.
"It's clear there is a population of seniors that has a hard time getting the vaccine and getting to sites, and so we had to be strategic," said Phelps, president and CEO of Ridgeview, which operates a 109-bed hospital in Waconia and two smaller hospitals in Arlington and Le Sueur.
In recent weeks, hospitals and community nonprofits have opened a new front in the fight against the deadly virus by bringing the potentially lifesaving vaccines directly to isolated seniors where they live, rather than waiting for them to show up at clinics and vaccination sites.
They are administering shots inside people's private homes, opening pop-up vaccination clinics at senior apartment buildings and, in some cases, transporting older adults to vaccination sites when they are too frail or sick to drive themselves.
Successful test program
Hennepin Healthcare, one of the state's largest hospital systems, launched a pilot program this month to deliver the COVID-19 vaccines to dozens of homebound patients under its care. Nurses and community paramedics delivered shots directly into arms while people sat on their sofas or lay in their beds. While still in its early stages, the project has worked so well that Hennepin Healthcare plans to roll out the program to more homes.
And in the Twin Cities metro area, the nonprofit Trellis (formerly the Metropolitan Area Agency on Aging) has begun organizing pop-up vaccination sites at senior apartment buildings, churches, community centers and adult day programs. At a clinic last week in northeast Minneapolis, dozens of seniors filed into the lobby of the Monroe Village senior apartment complex to get their shots while teams of caregivers escorted them.
With help from community health providers, the area agencies on aging are planning up to 30 pop-up vaccination hubs in the coming weeks which together could deliver shots to at least 3,000 older adults living at home.
The efforts reflect a growing recognition that many isolated and homebound seniors risk being left behind amid the aggressive rollout of vaccines.
At least 200,000 older Minnesotans live alone in their own homes. Many have multiple health problems, such as lung disease, heart failure and dementia, that make it difficult or impossible for them to get to a pharmacy or other site for shots. Some do not have internet access or lack the cognitive ability to navigate the complicated patchwork of government and pharmacy websites to secure vaccine appointments.
"We know there are older adults with underlying health problems who have been self-isolating for more than a year, and making that transition to getting out into the community to get vaccinated is a big deal," said Dawn Simonson, president and CEO of Trellis, which serves about 17,000 seniors who live at home. "We are really worried about those folks."
When Catherine Rivard began searching online for vaccine appointments, the 68-year-old retired document-review specialist quickly became overwhelmed by the convoluted system.
The pharmacies offering the shots seemed too far away from her northeast Minneapolis apartment and she had no easy way to get there. She didn't understand the multiple phases of the state's vaccine rollout plan and whether she qualified for the shots. A friend offered to take her to a vaccination site in Blaine, but she had no idea if the doses would be there when they arrived. Her health clinic said it would call if doses became available.
"It all felt so chaotic, like everyone was so desperate to get the vaccine out that they hadn't developed the architecture," she said.
Even if she had secured a vaccine appointment, Rivard would have had difficulty getting to the site. She lives alone and is unable to drive because of previous bouts with seizures.
She also has struggled with a serious form of diabetes that causes her to become dizzy and even faint on long walks. Even short trips to buy groceries or walk around the neighborhood must be carefully planned. She prefers to go with a friend as a safety precaution.
So when a flier appeared under her door announcing that vaccines were being offered in the lobby of her apartment building, Rivard seized the opportunity. After receiving her first shot, she took the stairs to her second-floor apartment and poured herself a glass of white wine to celebrate.
"This is a godsend," she said of the pop-up sites. "Until now, there was this feeling that these vaccines were being administered far away and maybe we would never get our chance."
But going door-to-door to vaccinate this hard-to-reach population poses unique challenges. Hospital systems and nonprofits have been stretched thin by the yearlong pandemic, and federal insurance programs like Medicare do not compensate them for the extra time and expense of administering shots inside people's homes.
The vaccines are also highly fragile. Taking them on the road means health care workers must lug heavy cold-storage coolers and bags of syringes from home to home. Shots must be delivered within hours after the seals to the vials are punctured or they will go to waste.
In more remote areas, it can take as long as an hour to find a person's home. Sometimes people will change their minds about getting the shots when the workers arrive. In other cases, nurses and other health care workers who venture into homes will discover urgent health problems that can prolong the visits, providers say.
"It's no easy task," said Darla Groshens, a registered nurse with Hennepin Healthcare who helped launch the home vaccine program. "When you go into people's homes, you can encounter all kinds of problems — lack of food or people not taking care of themselves — that require immediate attention. The reality is it's really labor-intensive."
While the work is challenging, Groshens described vaccinating seniors in their homes as "one of the most fulfilling experiences" of her 28-year career as a nurse. Some of the homebound seniors she sees have been living with anxiety for the past year and have broken out in tears of joy and relief after getting their shots.
In several cases, Groshens has found multiple generations of family members living under the same roof. The shots have helped alleviate fears that an elder would contract the virus from a younger relative bringing it home, and get sick or die.
"After all this stress and anxiety, it's better than a Christmas present," Groshens said of the vaccine. "It's life-giving."
Lois Gatz, 90, of Waconia, was elated last week after receiving her first dose from a Ridgeview home care nurse. The former accountant has severe arthritis and would have been unable to get to a vaccine site on her own. A day after getting the shot, she felt refreshed and said she hoped to spend more time with her two grandsons, who have been reluctant to visit given the risks of spreading the virus.
Said Gatz: "Just to see their smiling faces would make it all worth it."
Chris Serres • 612-673-4308