Covid Vaccine Access

The current meaning of ‘getting a shot’

“Did you get your shot yet?”

“Which shot did you get?”

“Did you get your second shot yet?”

In the somewhat surreal world in which we live courtesy of Covid, talk of shots no longer refers to small glasses of liquor. Instead of salt and lime accompaniments or beer chasers, we talk about severity and degree of potential side effects.

I’ve watched as categories of eligible vaccine recipients has systematically broadened, and the distribution locations have expanded. There is even been much needed attention paid to getting the vaccine available distribution is underprivileged or underserved areas that were disproportionately affected by the coronavirus.

Unfortunately for me, I fall into the category that is always last for everything … I’m considered homebound.

Medicare considers you homebound if:

  1. You need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave your home, or your doctor believes that your health or illness could get worse if you leave your home
  2. And, it is difficult for you to leave your home and you typically cannot do so

Almost 6 percent of the Medicare population, or 2 million Americans, are homebound, meaning they rarely or never leave their house. It’s a pretty small number considering the size of the general population. But it’s more than the 1.4 million people estimated to be living in nursing homes.

It’s no secret that the health care system is overburdened and weighed down with incredibly huge costs. Everything done or delivered in a hospital setting is expensive. Hospital bills can follow a patient for years. It’s not uncommon for people to be bankrupted by them. One of most promising ways to improve care and reduce costs is to move care into the home whenever possible. An increasing number of organizations are developing ways to move primary and some acute care to the home. Home-based care can replace or delay the need for more expensive care in hospitals and other institutional settings.

Home health care reduces the need for emergency department visits, hospitalizations, and short turn-around readmissions for homebound patients. That saves money. It also increases patient and caregiver satisfaction. There are tremendous opportunities to improve care through home-based care models. There are risks and challenges involved in doing so, of course, so it requires thought and planning.

Some people who need care prefer to not receive it at home because they fear negative or abusive treatment by caregivers when there is nobody else present to witness or prevent it. Others are embarrassed about their living situation. I have witnessed real instances of such situations up close.

Personally, I have had trusted, at-home caregivers steal from me egregiously, and legal authorities not care at all.  I have also received ‘care’ from people in hospitals and nursing facilities who were uncaring and unprofessional. I have witnessed cruelty toward other patients in those places. Yes, there are some wonderful caregivers. But patients in those facilities are just as likely to receive apathetic or flat-out unkind treatment.  It’s not easy to be a caregiver, and if somebody has the wrong type of personality for it the result can be horrible for the recipient.

More medical schools and residency programs are preparing the next generation of doctors for the shifting care emphasis from hospital to home by integrating home-based care into required education and training. Some programs exist to increase knowledge, skills, and attitudes about home-based care.

If you’re somebody with a chronic illness or in need of medical support, there are so many difficult situations to navigate.  Insurance carriers don’t want to pay high facility costs.  They  also typically make it difficult to obtain life-sustaining and assistive durable medical equipment (DME).  Competitive bidding processes force companies to compete for contracts and agree to increasingly lower insurance reimbursement rates. As a result, more people have to settle for lower-cost, lower-quality equipment.

For patients receiving the less acute types of home-based care, help with things such as activities of daily living (including bathing, toileting, dressing, cooking, and moving around safely) is critical to their ability to remain independent and safe at home. However, insurance programs typically don’t cover support services to help people with those activities.

As best as I can figure out, home-based care is governed by an array of regulations not uniformly applied or monitored. There seem to be no national or state requirements for the quality of home-based care, except for care provided under Medicare home-health benefits.  There are limited regulations of education, training, and licensure of home-based care professionals.  I consider myself very fortunate to have found a home-care doctor who is a neurologist by specialty, and who therefore has a solid understanding of multiple sclerosis. I found him through an agency that helps homebound patients arrange for doctors and medical services needed

Covid vaccines

That same agency worked for months to figure out how Covid vaccines could be arranged for people who can’t just get in a car or on public transportation and go to a designated location. I was simultaneously contacting various agencies on my own asking the same question.

Finally, we discovered that they started taking names for a list of people who are stuck at home to eventually schedule for home visits. Several weeks later I found out that the list has been frozen because they were going to be administering the one-shot vaccination, which has been pulled off the market because of complications.  There is no plan in place yet for home vaccination with one of the 2 dose versions.

You might be wondering, why does it matter to people who are stuck at home anyway?

Well, I have 3 children who live with me who are out in the world every day, exposed to people at their schools, at places of employment, in stores, and everywhere else. There are a couple of people who work for me that I am exposed to every day, and others I’m in contact with in-person on a less often but consistent basis. I’ve cut back a lot on my contact with others, such as it was given my situation, but I can’t (and won’t) live in 100% isolation.

If you happen to know someone like me, it’s kind of easy to forget they exist most of the time. They can’t just go places with you or meet you somewhere. Hanging out with them can be a hassle. Trust me, they feel the isolation painfully even though they can’t really avoid it. You might think that Covid hasn’t affected them very much because they have to stay at home anyway. Believe me, it has. Even with something like accessing the vaccine, they are profoundly affected.

Have you chosen to be vaccinated? Are you still trying to get an appointment? Or have you decided to wait a while longer? I’d love to know any thoughts you’d like to share about it. Email me at and let me know.


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