LOS ANGELES — Inside their Glassell Park home, Louis Salazar Jr. gently rubbed the foot of his elderly mother, who lay in bed as a nurse prepared her COVID-19 booster shot.
"I'm going to vaccinate you now, OK?" licensed vocational nurse Angela Tapia told the 88-year-old woman, who has Parkinson's disease and is immobile.
Salazar, 64, watched and counted down out loud from the foot of the bed. "Three, two, one — see?" he said as Tapia swiftly applied a bandage. "Perfect."
The newest booster shot, which targets both the original strain of the coronavirus and omicron subvariants that have swept across the country, had been available for weeks at pharmacies, clinics and pop-up sites including schools and recreation centers. But for Salazar, making such a trip with his elderly mother would be a mammoth undertaking. Maria Salazar cannot get out of bed and relies on a feeding tube, attached to a machine that starts beeping if the formula bag gets clogged.
So instead, the COVID-19 booster came to the Salazars in their home on a winding street in Glassell Park, ferried in by nurses from the county department of public health.
"It's a godsend," Salazar said as Tapia and another nurse monitored him and his 90-year-old father, who also had gotten their booster shots, in their living room. "Especially for seniors that are homebound."
More than 7,400 people had been vaccinated through the Los Angeles County program targeting homebound residents by late September, according to county data. The majority of them were seniors, although the L.A. County Department of Public Health has also brought vaccines to younger people who cannot easily leave their homes because of medical conditions.
But as health officials urge residents to get an updated bivalent booster before any winter wave of coronavirus infections, physicians and advocates concerned about homebound patients fear that L.A. County has not reached many others who could be at high risk from COVID-19.
"Not one of my patients had ever heard of the in-home vaccination program from L.A. County. Not one," said Dr. Gene Dorio, a house call physician specializing in geriatrics who is based in Santa Clarita. "If they had not heard it from me, they would never have known. My concern is, how many more people don't know about the program?"
And with winter approaching, "there is concern that the surge is coming — and that there's going to be more catastrophic stuff for older adults," said Jerry Gaines, a member of the Los Angeles County Commission for Older Adults.
The L.A. County numbers do not include shots provided through other local programs that vaccinate homebound residents, but the statistics have nonetheless troubled Dorio and others in the Coalition for Mobile In-Home Testing, which has sought to draw attention to the issue.
Exactly how many people are in need of home vaccinations is unclear. In a motion last year urging the county to get vaccines directly to homebound residents, Los Angeles County Supervisor Hilda Solis stated that national estimates would equate, in L.A. County, to a homebound population of more than half a million people.
More than 220,000 people were relying on in-home support services in L.A. County, and 55,000 seniors were receiving free meals delivered to their homes, but many other homebound people may not be getting such services, Solis cautioned. "The paucity of data on the number of homebound seniors in Los Angeles County highlights one of the major barriers faced by this population: it is nearly impossible to offer appropriate services to a group that may have difficulty advocating for themselves and whose true population size is not known," the supervisor argued.
One study published in the Journal of the American Medical Association found that the numbers of homebound adults had more than doubled after the pandemic arrived and that rates were highest among Latino and Black people. Half of homebound people surveyed did not have a computer, and more than half had not used email or gone online in the last month — a factor that could limit the effectiveness of online outreach about vaccination programs.
When COVID-19 vaccines first became widely available last year, many feared that people unable to leave their homes were being left behind. Elderly people were among the first to be eligible, but those who were medically frail were unable to brave the long lines, spurring efforts by firefighters and other emergency workers to come to their doors instead. Salazar remembers the fire department coming to their home earlier in the pandemic to give them one of their shots; L.A. County Public Health partnered with "outside vaccinators" to help get out shots.
Now, as the sense of urgency around COVID-19 has faded, the latest push for booster shots has been strained. In L.A. County, only 7% of eligible residents had gotten a bivalent booster as of mid-October. National rates have also been paltry.
Health officials believe some people may be holding off on getting the new shot until closer to Thanksgiving or the winter holidays, but a Kaiser Family Foundation poll found that half of adults surveyed had heard little or nothing about the newest booster, including nearly 40% of seniors 65 and older.
The booster numbers "need to increase pretty dramatically before we get into the holiday season," L.A. County Public Health Director Barbara Ferrer said this month. If uptake remains slow, "my real concern is with older people, people with underlying health conditions. This will make a difference in their lives."
Dr. Janina Lord Morrison, medical director of the mobile vaccine team at L.A. County Public Health, said that "for vulnerable populations, now is the best time to get the booster." As of mid-October, the county homebound vaccination program had administered more than 800 bivalent boosters to residents, she said. Flu shots are also now available to homebound residents.
"We'll keep going as long as people are asking us" to bring out vaccines, Morrison said. People interested in the L.A. County program can call (833) 540-0473 or fill out an online form. Even now, Morrison said, the vaccine team is still hearing from people who want to get their first-ever dose of a COVID-19 vaccine.
To Salazar, the decision to get the latest booster was simple. "We want to make sure they don't get COVID or have any more difficulties," he said of his elderly parents. And "if I get sick, then they get sick."
At a meeting last month, County Supervisor Janice Hahn asked the county director for aging and community services how they were doing on getting COVID-19 vaccines to homebound people. Executive director Laura Trejo said it was difficult to provide clear numbers for homebound residents, but that when it surveyed a representative sample of that group — people served by Meals on Wheels — it appeared that "we're doing very well." The survey found that roughly 85% had gotten at least the initial series of vaccinations.
Hahn applauded those findings, but pointed out that with new boosters available, vaccination is "not a onetime project. It's something we have to keep up with."
The same survey, conducted this spring before bivalent boosters were available, found that less than half of those surveyed had gotten a booster or additional dose in addition to the initial series of vaccinations, according to figures provided by the public health department. Getting more boosters can help protect older adults: As of July, people 50 and older who were vaccinated and had gotten two or more boosters had half the risk of dying from COVID-19 as vaccinated elders with just one booster, the CDC reported.
For homebound residents, "whether it's getting them vaccines or a host of other services that they depend on, we need to do better," Hahn told The Times in a statement.
Morrison said the program has been promoted through social media, county clinicians and other networks that serve seniors. But members of the Coalition on Mobile In-Home Testing argue that outreach has not gone far enough. Ernie Powell, president of the advocacy group Social Security Works California, said that he talks to people all over the county and "the problem is that people just don't know about this."
Dorio argued that the county should be spreading the word on television and the radio. "Get LeBron James to get out and say, 'Here's my grandmother,' or, 'Here's my mother, and I'm making sure that she gets the shot,'" Dorio suggested.
The public health department said that at this point, it has more than two dozen people on its homebound vaccination team, including seven or eight nurses providing vaccinations each day, with the ability to add more nurses if needed.
"We are hoping to again work with outside vaccinators soon to maximize our flexibility," the department said in a statement.
But as the country has shifted out of crisis mode on COVID-19, "it means that the resources that were there before to do a lot of outreach are not necessarily there" for public health departments, said UCLA Fielding School of Public Health professor Vickie Mays. As winter approaches, if booster uptake remains low, "are we going to draw resources from somewhere to make a big outreach to get to those people who are homebound?"
———
(Los Angeles Times staff writers Luke Money and Rong-Gong Lin II contributed to this report.)
———
