The city of Revere’s in-home vaccination team during one of their recent rounds in the city. Pictured are (l-r) Captain Robert Fortuna, Revere Fire; Steven Ferrante, Revere Fire; Deputy Chief Glen Rich, Revere Fire; Patricia Carmona, Revere Public Schools RN; Lauren Buck, Director of Public Health-City of Revere, RN; Bobby Belliveau, Revere Fire; Angela Ciccolo, Revere Public Schools RN. (Photo courtesy: Adrienne Maguire)

Poised to play a key role in the long-awaited COVID-19 vaccine rollout, Massachusetts cities and towns had to pivot last month when the Baker-Polito administration announced it would prioritize high-capacity state vaccination sites and only provide vaccine doses to municipal clinics in 20 disproportionately impacted communities and approved regional collaboratives.

Health and Human Services Secretary Marylou Sudders asked cities and towns to concentrate instead on “outreach to vulnerable, hard-to-reach populations,” particularly those who are eligible but cannot travel to a vaccine site.

The Department of Public Health introduced its Homebound Vaccination Program with a “soft launch” on March 8. By March 12, municipalities had to inform the DPH whether they would participate in the state program or administer vaccinations themselves for homebound residents, following guidance from the U.S. Centers for Disease Control and Prevention. According to the DPH, 168 boards of health (representing about 40% of the state’s population) opted to manage local programs, and 183 cities and towns will use a state system administered through the nonprofit Commonwealth Care Alliance.

The Homebound Vaccination Program will officially begin on March 29.

In-home vaccinations will be available to individuals who “have considerable difficulty and/or require significant support to leave home for medical appointments; require an ambulance or two-person assistance to leave home; or are not able to leave home for medical appointments under normal circumstances.”

The DPH is operating a toll-free number (833-983-0485) Monday through Friday, 9 a.m.-5 p.m., in multiple languages to help determine eligibility and schedule appointments.

Local response
Some municipalities got a head start. Salem, for example, created a screening system in February to identify homebound residents. Following eligibility screening by municipal health and social services staff, the city identified 143 residents, including those referred by the North Shore Physicians Group, to receive in-home vaccinations through a partnership with Cataldo Ambulance Service, according to Mayor Kimberley Driscoll’s office.

Collaborating on ideas and operations with private sector partners and neighboring communities is a recurring theme for municipalities that have opted for local oversight of in-home vaccinations. In Franklin County, 15 municipalities are participating in a program run by the Franklin Regional Council of Government’s Cooperative Public Health Service. Community Services Director Phoebe Walker said the FRCOG will work closely with Life Path, a nonprofit agency on aging in Greenfield, to vaccinate hundreds of homebound Franklin County residents.

In Central Massachusetts, Auburn has been planning its own homebound vaccination program since mid-February, working closely with the local Meals on Wheels organization, as well as the Auburn Senior Center and Housing Authority to identify eligible residents.

“Auburn was operating our own vaccination clinics starting back in January, and those clinics ran very well,” said Town Manager Julie Jacobson. “We are therefore poised to vaccinate our homebound residents.”

The North Suffolk Public Health Collaborative has facilitated the sharing of best practices for organizing and delivering homebound vaccines for the communities of Revere, Winthrop and Chelsea.

“Since the beginning of our Reach Every Senior campaign, our volunteers identified close to 100 seniors who were not able to leave their homes to get vaccinated,” said Revere Mayor Brian Arrigo. “The Revere Board of Health and Revere Fire Department teamed up with the East Boston Neighborhood Health Center to make sure each and every one of these residents got vaccinated.”

Public Health Director Lauren Buck said Revere’s program relies on a mix of referrals from doctors and social services providers as well as self-attestations to determine eligibility. She added that Revere modeled its program after one in neighboring Winthrop, which began its homebound vaccination program in mid-February.

Winthrop Public Health Director Meredith Hurley said the town promoted the program through its website and social media platforms as well as the Winthrop Senior Center and local medical providers. Between 60 and 75 homebound residents were served by the end of last week, she said.

“The town of Winthrop has focused our allocations on our most vulnerable populations,” said Town Manager Austin Faison. “We know there are members of our community that cannot get to the mass vaccination sites, so we prioritized the homebound populations.”

An aging population
One area of Massachusetts likely to shoulder outsized responsibility for at-home vaccinations is Cape Cod, due to the age of its population. Nearly one-third of Barnstable County residents are age 65 and older (compared to 17% statewide). While the recently formed Cape Cod Regional Vaccine Consortium — comprising municipalities, health care providers and others — is providing overarching support for outreach and appointments, targeted efforts for homebound residents are also proceeding.

The Yarmouth Health Department is partnering with Outer Cape Health Services to provide in-home vaccines, with assistance from the Yarmouth Fire Department. Yarmouth tapped the Council on Aging, Meals on Wheels, churches, and health care providers to get the word out.

“The Yarmouth Council on Aging has been keeping a list of homebound residents in need of vaccinations,” said Health Director Bruce Murphy. “At this time, we have approximately 130 homebound residents that we plan to vaccinate by the end of March to the first week of April.”

The town of Chatham began its in-home program on March 22, deploying paramedics and EMTs to vaccinate 24 residents in 17 homes with the single-dose Johnson & Johnson vaccine supplied through Outer Cape Health Services. Chatham is another example of a collaborative effort, involving members of its Health Division, Council on Aging, Housing Authority and Police and Fire departments.

“Their willingness and ability to work through the complexities of this process to protect some of our most vulnerable citizens is testament to their dedication as public servants,” said Town Manager Jill Goldsmith.

Written by Lisa Capone