In-home vaccinations remain a valuable strategy to support individuals with physical disability, chronic illness, injury or other condition, such as severe anxiety, or those who may require the help of another person or medical equipment to leave their home. Nationally, between 2 million and 4.4 million older adults cannot leave their homes, or can only do so with great difficulty. Most are in their 80s and have multiple medical conditions, including cognitive impairment.[1] Many of these individuals are eligible for both Medicare and Medicaid, and health plans serving these dually eligible individuals can play a significant role in supporting COVID-19 vaccination for this population. As noted in the May 5, 2021 Resources for Integrated Care COVID Vaccination blog post, individuals who have difficulty leaving their home may have particular challenges receiving a vaccination at physician offices, clinics, or mass vaccination sites. To address the logistical challenges and potential health risks for these members, some health plans that serve dually eligible individuals are offering in-home vaccinations.

The Centers for Disease Control and Prevention (CDC) provides current guidance on planning and implementing in-home vaccination. Many health plans offering in-home vaccinations are implementing these strategies:

1. Training for both clinical and non-clinical staff on the safe storage, handling, preparation, and administration of the specific vaccine being offered. The CDC outlines training requirements on their COVID-19 Training and Education page. The CDC also recommends training on accessibility-specific issues, such as working with people who are blind or have limited vision; those who are deaf or hard of hearing; those who work with service animals; and those with various language, physical, social, or sensory needs.

Several health plans are partnering with local Emergency Medical Services (EMS), home health providers, or visiting nurse services for in-home vaccinations and to coordinate training for those who administer in-home vaccinations. Some health plans have advocated in their states to receive direct allocations of the vaccine and to begin in-home vaccinations using their own trained clinical staff. One health plan is partnering with their state department of health to provide in-home vaccination for individuals with Intellectual and Developmental Disabilities (I/DD) by clinicians with training in working with these individuals.

Staff involved in vaccination activities will need adequate training on:

1. • • • Preparing and administering the vaccine in clinically appropriate ways using aseptic techniques, even in home settings;
       • Preparation for conversations with members, since recipients should have the opportunity to ask any questions they may have about the vaccine;
       • Vaccine recipients should be monitored for reactions following vaccination, including the second dose, so staff will need to plan for this monitoring time, know what to watch for in terms of reactions, and have a plan to implement for a reaction emergency; and
       • Vaccinations must be properly recorded according to state guidelines, so health plans should consider who will do the recording, and make sure staff are trained accordingly.
2. Pre-vaccination planning to take into account logistic and safety concerns when developing procedures for in-home vaccinations. Planning activities include accurate estimation of number of doses needed, providing all vaccine-related information in a variety of accessible formats, mapping logistics to ensure vaccine is utilized within the approved timeframes, and ensuring readiness to maintain and monitor the temperature of the vaccine.

One health plan is using an integrated care management platform to coordinate outreach calls in both English and Spanish, arrange in-home vaccination appointments, and assist trained community Emergency Medical Technicians (EMTs) in scheduling and delivering in-home vaccinations. This plan is also vaccinating caregivers and relatives of members in their homes at no cost. The care management platform facilitates communication and coordination between the EMTs, the plan’s care managers, and the members, and addresses some of the logistical concerns that may create barriers to in-home vaccination.

Health plans that provide ongoing home visits by nurses or primary care providers are scheduling vaccinations to occur during those visits, to increase acceptance of the vaccine, and to manage logistics. Many other health plans are actively collaborating with their state departments of health in planning for in-home vaccinations.

Some health plans are creating work flows and algorithms for vaccine outreach, tracking, and documentation. One health plan has created task notes in their electronic medical record to capture conversations with members and to provide the capacity to track vaccination. They have developed a registry of vaccination data received from multiple sources, including federal data, state registry data, pharmacy feeds, and member self-reports. This registry includes race, ethnicity, zip code, and gender, enabling assessment of trends and additional targeted outreach to members as needed.