Molly Cooley, 76, tried calling her doctors, but gave up after long waits on the phone. She and her daughter both tried to get through the Oregon Health Authority’s online signup — the “chatbot” — to secure a slot at one of Portland’s mass vaccine clinics.
Cooley’s caregiver, Loana Grejuc, tried to help, too. She called a local pharmacy through the Federal Retail Pharmacy Program, hoping someone would come to the adult care home she operates for Cooley and three other adults.
“But nothing happened for a long, long time,” Cooley said Saturday, relaxing in her bedroom as she waited for a doctor from the Multnomah County Health Department to call her into the group home’s kitchen for her first COVID-19 vaccine. “I had faith, but the worst was waiting.”
Cooley was among nearly 150 people who received their first COVID-19 vaccine doses at their own homes as part of a mobile vaccine project launched Feb. 27 by Multnomah County’s Emergency Operations Center — the County’s COVID-19 response team. The project is a partnership with the Public Health Division and the Department of County Human Services, which helps provide care for seniors and people with disabilities among other vulnerable groups.
The County hopes the door-to-door teams will be able to vaccinate all residents of adult care homes by the end of this week, but it may continue using the mobile teams to reach other homebound residents who qualify for vaccines and cannot travel to a clinic.
“This is an enormous undertaking, and County Human Services did a tremendous amount of work to make this happen,” Public Health Director Jessica Guernsey said. “This is such important work, to reach people who can’t come in to see us. And it’s a preview of what we’re looking at for homebound seniors. We know there are roughly 5,000 homebound seniors that we will need to partner to reach in the coming weeks.”
Mobile vaccination is a significant lift
Each week, the state allocates a small number of vaccines — usually 1,000 to 1, 500 — for the County to administer directly. The County uses those doses to fill the gaps in vaccine distribution by healthcare providers by reaching residents who meet the Governor’s criteria for vaccine eligibility and are least able to access the large clinics because of issues including mobility challenges, disability, incarceration and language access.
The state has tasked local public health agencies to employ an equity lens in all their vaccine planning, and Multnomah County uses disease trend data to prioritize people who are at greatest risk. But as more people become eligible, the County is concerned that those who are the most vulnerable, and who might struggle to access mass clinics, are falling further back in line.
Beyond launching the door-to-door team, Multnomah County has been working — with its limited vaccine doses — to partner with community groups and stand up focused clinics for elders, community health workers, traditional healers, adults in custody, and people living with disabilities or who have conditions requiring in-home services, along with their household members and family caretakers.
But not everyone can attend even a small, community-based clinic.
Since October, Multnomah County has been identifying people who would need vaccination and who live in small congregate settings that are not covered by the federal pharmacy program. County Human Services and the Health Department identified approximately 5,000 individuals in the Adult Foster Home and Intellectual and Developmental Disabilities systems who needed a vaccine.
Shortly after vaccines first became available, County Human Services staff began calling every home every week, helping sign people up. County staff was able to help 3,500 residents obtain vaccinations, despite limited vaccine allocations, thanks in large part to dedicated case managers, caregivers and family members who have helped register residents at events at the Oregon Convention Center, OHSU’s Portland Airport clinic site, and Multnomah County Public Health’s various clinics.
Roughly 1,500 people remained in the Adult Foster Home and Intellectual and Developmental Disabilities systems who were more difficult to connect with a vaccine. They are homebound or bedbound, or they require significant transportation assistance and do not do well with long wait times in vehicles.
The County was able to identify some who could attend very small drive-through clinics. But others needed the vaccines to come to them. And so the County developed a plan to send medical volunteers directly to adult care homes.
Mobile vaccination is a significant lift and requires careful mapping and coordination. Adult care homes generally have five or fewer people; and many have only one person needing vaccination. Overall, there are about 150 separate locations in Multnomah County where some or all of the residents have yet to be vaccinated.
And the vaccine being used, Moderna, has restrictions on storage, transportation and movement once thawed or opened. The vaccine comes in vials of 10 or more doses. Requirements limit how long shots can be administered after the vials are opened, and they require monitoring people for 15 to 30 minutes after vaccination.
The Department of County Human Services mapped out each facility, and divided that map into a grid of geographic areas that could be reached easily by medical teams. That mapping was vital for ensuring doses reached homes as quickly as possible, while minding all required wait periods and time limits.
The County paired Medical Reserve Corps volunteers — licensed medical practitioners, including physicians and nurse practitioners — with additional volunteers, often County Human Services staff who work with adults in care, to assist with administering the vaccines.
Leading to Saturday’s launch, the Department of County Human Services contacted each facility that had requested vaccine doses to ensure residents would be available during their scheduled times, and to provide required health screening forms.
“It’s been really amazing. Staff are so excited to be involved. They can see this has a real direct impact on the health and wellbeing of our clients,” said Lee Girard, deputy director of County Human Services. We are quickly moving to focus on home-bound and often bed-bound adults, seniors and people with disabilities; it’s a much broader population and that includes people who are our clients and also people who mgh not be connected to us directly.”
That work will take time to ramp up. For now, Girard encourages anyone who may need a vaccination at home to dial 2-1-1 or to call the Aging and Disability Resource Connection hotline at 503-988-3646.
‘The safety net mission is coming to life!’
Alice Busch, a unified commander with the County’s Emergency Operations Center, sp
Jill Williams, a social worker with adult behavioral health, packed alcohol wipes, vaccine cards, bandages, and containers for used needles into plastic bins for the vaccine teams. Nurse Angela Nguyen prepared to open vials of the Moderna vaccine, which would trigger a six-hour window when the dose needed to be administered.
Busch beelined between staffers and stations, answering questions and assigning tasks. “I’m excited,” she said without breaking stride. “This is a service to the community, our hardest-to-reach residents. The safety-net mission is coming to light!”
By 8 a.m. about 40 volunteers and County employees, dressed in colorful vests, had gathered in the main lobby for a mission and medical briefing.
“Spread out. If you’re not six feet from someone who is not in your vaccine pod, space out. Six feet. That’s taller than me,” Busch projected down the hall.
Their mission that day: Visit 44 adult care homes and vaccine about 150 people.
“Thank you for being here. We’re going to make a lot of mistakes and learn a lot today,” Busch said. “This is the first time we’ve done this. The lessons you document today will save another person’s bacon next week.”
Busch gave a shout out to the Medical Reserve Corps.
“You’ve been working with us the past two weeks, and we have been able to vaccinate thousands of people because of you,” she said. “You’ve been a really exciting addition.”
Once the mission was clear, Multnomah County Health Officer Dr. Ann Loeffler provided a medical safety briefing, reminding staff and volunteers not to administer vaccines to anyone with certain conditions or who’s ever had an immediate response to allergens.
Loeffler said volunteers might come across someone who says they no longer want the vaccine. She encouraged volunteers to talk to those people and their caregivers, and even to call their families, to try and help them understand why getting a vaccine is so important.
“But if someone says, ‘No way, no how,’ we’re not going to give it,” Loeffler said. “If someone says ‘no,’ and that person is insistent, we’re not going to give it.”
Volunteers then broke into their teams. Dr. Loeffler led Team 3, composed of Adult Protective Services staff and retired doctors and nurses. They headed to Molly Cooley’s adult care home in Northeast Portland, where they met her caregiver, Ioana Grejuc, and the other residents.
Grejuc and other caregivers at the home received their vaccines first, and then Grejuc invited residents from their rooms, one-by-one, to receive theirs.
Cooley was looking forward to her chance to be vaccinated.
The past year has been hard on her, not so much out of a fear of dying from COVID-19 but the pain of social isolation.
“There’s that fear of dying alone. But I don’t have that as much. I’m so protected by my daughter and my caregivers,” she said. “What I really don’t like is being isolated from my friends. I’m a really social person.”
She gets out less than she used to, but her daughter takes her out and she has made a few trips to the grocery store.
These days she reads a lot; whatever people bring to her: “The Mighty Queens of Freeville,” “Britt-Marie was Here,” and “Native Roots” were some of the books that covered every surface in her bedroom, including on her walker. A pair of boxing gloves sat in a basket near her laptop. Her virtual Boxing for Parkinson's class would begin at 11, she explained, and she hoped she wouldn’t miss it. It’s good for brain function and her triceps, she said.
When her turn came, the volunteer medical staff and Dr. Loeffler were waiting in the kitchen. Cooley raised her arms and waved, “I feel like I’m on a TV set,” she said with a chuckle before sliding into a chair and offering her right deltoid.
After months of trying to secure an appointment, the shot took but a moment. Then it was Jason Edenburn’s turn.
Edenburn hadn’t left the home much in the past year, except for the rare medical appointment, but he didn’t think his life would change much after the vaccine. Still, he said, people might be able to visit, and it’s just safer to get protected. He rolled out in his wheelchair, got his shot and then joined Cooley for their observation period in the living room, where he joked with Dr. Loeffler and the volunteers. He would look forward to their next visit, a month from then, he said.
Cooley spent her 15 minutes chatting with the volunteers, checking on Edenburn and watching the clock.
Finally she was free to go. She thanked the team for the visit, and then walked to her room — impatient to get back to her laptop and her boxing gloves.