Iowa home health caregivers, clients balance COVID-19 vaccine question

CEDAR RAPIDS — Dawn Batie has not hesitated to tell people she’s fully vaccinated against COVID-19.

Batie has been a caregiver at a Cedar Rapids-based home health agency for several years, and said she has been open with all her clients about her vaccination status since the day she got her shots. She works for Right At Home, a Cedar Rapids-based home health care provider that administers care to about 150 patients.

“I don’t want to be responsible for making my clients sick,” Batie said. “By protecting myself, I’m protecting them, too.”

It’s a fact for which Marleen Boots of Marion, who relies on Batie to help her run errands and complete some chores around the house, says she’s grateful.

The 85-year-old woman decided to get the vaccine series and booster because of her age and the risk factors posed by her health conditions. She said it also was very important that the people around her have their vaccinations up to date for the same reasons.

But for some caregivers and clients, the vaccination status of the other person is unknown. Many home health agencies say disclosing whether their staff are vaccinated against COVID-19 violates privacy rights under HIPAA, the Health Insurance Portability and Accountability Act.

The law does not prevent employers from requesting that information from employees, but it prevents the employer from disclosing that private health information it to outside parties — such as patients.

Alternatively, there’s no requirement for clients to share whether they’ve had the shots with the home health staff member in their home.

Those conversations must take place between the caregiver and the client, as well as the client’s families, said Stephanie Humphries, owner of Right at Home in Cedar Rapids.

“If everyone’s on the same page, that’s fine,” she said.

The COVID-19 vaccination rate among the direct care workforce is unclear. Home health care agency staff vaccination rates are not reported at either the state or federal level, according to the Iowa Health Care Association, the trade organization that represents home health agencies and other health care centers, such as nursing homes.

Instead, individual agencies would need to maintain their own records of vaccination data — which they would not be required to disclose.

Furthermore, many home health aides nationwide are hired through private, unregulated channels that make it difficult to track.

Federal vaccine mandates — issued in November by the Centers for Medicare and Medicaid Services and upheld by the U.S. Supreme Court last month — are in place for all Medicare- and Medicaid-certified home health providers, according to the latest guidance.

Iowa is among the 24 states involved in the Supreme Court case that have until March 15 for its home health workers to be fully vaccinated. The workers must receive their first shots by Monday, Feb. 14, if they plan to receive one of the two-dose vaccine series.

However, agencies that strictly rely on private pay are not subject to federal mandates.

In addition, the vast majority of home health workers — 91 percent —are employed in agencies with fewer than 100 employees, meaning they wouldn’t be subject to federal requirements for vaccines or regular testing at companies with 100 or more employees.

As a result, the exact vaccination rate among this workforce in Iowa is unclear, even with mandates going into effect next month.

And with agency officials unable to disclose vaccination status of employees, some vulnerable patients are facing the possibility of having an unvaccinated caregiver in their home.

‘It’s incredibly dangerous for me’

As a result, one immunocompromised Springville resident has decided to forgo home help for the foreseeable future.

Emily Johnson is a 31-year-old with a type of Ehlers-Danlos syndrome that affects her vascular function, a serious condition that also lower her immune system. She was also diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome, a condition that is appearing in many long-haul COVID-19 patients.

Johnson has gone without an aide since she moved to Eastern Iowa this past October.

“This is just one example of health care I have not been able to access because of the pandemic,” she said.

She receives medical supplies from a local home health agency, but otherwise handles her own daily infusions and dressing changes related to the central venous catheter that’s placed on her chest. Johnson’s mother, who is a nurse, assists her with her monthly metabolic home health labs, which also are connected through the chest catheter.

Johnson hoped to find a local home health agency, but said she didn’t want to risk interacting with an unvaccinated home health aide after previous negative experiences in Atlanta, where she lived last year.

“It’s incredibly dangerous for me,” she said. “Some home health companies are willing to assign a vaccinated worker, but some won’t let patients ask the nurses ask if they are vaccinated.”

Right at Home’s Humphries initially saw more push back early in the pandemic among clients who wanted to be privy to the information on whether the caregiver in their home was fully vaccinated. In recent months, as the pandemic reaches the end of its second year in Iowa, Humphries said she has heard less from clients on this question.

“I don’t hear about it from people quite like it was a few months ago. I think this has gone on long enough, that people have figured out how best to live with it,” she said.

Humphries has encouraged her staff to receive the COVID-19 vaccines, and believes anyone who is able to should be immunized. She also said she believes the novel coronavirus “is never going to go away.”

"We just have to adjust and learn to go about lives as safely as possible,“ Humphries said.

But for people like Johnson who are immunocompromised, it’s difficult to feel safe navigating the health care system while the coronavirus remains so widespread.

“For someone with severe disabilities caused by severe post-viral illnesses, I can’t afford to get COVID-19," she said.

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