In December, I wrote about how important it is to get the Covid-19 vaccine to millions of homebound older adults, younger people with disabilities,  and their caregivers.  It won’t be easy, but here are some ways to build on existing programs and housing arrangements.

People with severe chronic disease and functional or cognitive limitations are extremely vulnerable to severe illness and death from coronavirus. And because they are living with disabilities or are 65 and older, the vast majority already are eligible for the vaccine. But just because they are eligible, it doesn’t mean the doses are within reach.

And that is what is most frustrating. Those who need it most are least able to get it because they cannot navigate the nation’s disorganized maze of vaccine distribution. A vaccine to save their lives is tantalizingly within their reach, but without help, they will not be able to benefit from it. And some will die as a result.

Find people and register them

We need to find a better way to register these people—and their caregivers– to get the vaccine. To say the existing system is chaotic is an understatement, even for those who are mobile, have access to the Internet, and can manage confusing online registration. In many states, it requires hours online navigating multiple sites—an effort that is simple impossible for these seniors.

In Washington, DC, the Eldavitch Jewish Community Center is recruiting students at George Washington University to help older adults enroll in local vaccine programs. So far, about 35 students have volunteered.

That’s a terrific program that could easily be replicated around the country. But many frail, homebound seniors will never know such help is even available.

Build on existing programs

Thus, the first step is for public health officials to identify these frail seniors and younger people with disabilities. They can do this by building on existing relationships. For instance, they could reach out to Meals on Wheels recipients or senior center participants. There also may be ways to use Medicaid enrollment or Medicare claims data to identify those at-risk.

However, making an appointment is just the first step. People still have to get to a vaccination location, where they may have to stand in line to await the shot. And, with the currently available vaccines, they have to do all this twice. Now imagine you are an 85-year-old widow with some dementia and no caregiver to help you.

In some communities, local non-profits are offering rides and other assistance to help frail older adults get to vaccination centers. Often, these community-based organizations already have experience transporting older adults to senior centers or medical visits—programs that have been scaled back or shut down due to the pandemic.

But what about those who are unable to get to a remote vaccination center? The solution is to make the process as simple as possible for them.

Mapping technology

Use mapping technology to identify apartment buildings or other places with large populations of frail older adults and set up vaccination centers in activity rooms or even lobbies. Pre-register residents for a specific time (though they can change it if they need to). Those who are able can just come down from their apartment at their given time, show their Medicare or Medicaid card, and get the shot—as well as a date and time for dose #2. Help getting to the lobby could be provided for those who need it.

Finding these people should easy for senior public housing. It also should be doable for Medicare Advantage managed care plans which have detailed records on their members–more than one-third of Medicare beneficiaries. It will be tougher for those in traditional Medicare, but still manageable.

For those unable to leave their apartments or homes, the vaccinators can come to them. This could be done through home health or home care agencies, by visiting nurses, or by volunteer retired medical professionals.

One dose or two?

Getting one-off vaccinations to those who are more isolated, including those living in suburban homes or rural communities, will be more costly and time-consuming. These seniors also could be identified by programs that already have contact with them, such as Meals on Wheels. Corpus Christi (TX) is using its fire department to deliver the shots. Marion (IN) is using its EMS to give shots in people’s homes.

Public health officials should consider another solution: If the FDA approves the Johnson & Johnson vaccine for emergency use, should some doses be reserved for homebound seniors and people with disabilities? Storage is far less complicated and having to receive just one dose instead of two can make a huge difference for this population. However, trials show the J&J vaccine is slightly less effective than the Moderna and Pfizer vaccines. Which will be best for these older adults and people with disabilities?

Distribution vaccine to those who are homebound or with limited mobility will be time-consuming and complex. But there are solutions. And public health officials need to find them.