(Denny Chan, Silvia Yee)
Q. How can we push COVID-19 Vaccines for the disabled, at home? I have 2 disabled, bed bound seniors that are high risk and can’t leave the house to get a vaccine. URGENT action is needed to get mobile clinic vaccinations.
A. Advocates for the vaccine priority of disabled people living at home can address public comments to the California Community Vaccine Advisory Committee, https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Community-Vaccine-Advisory-Committee.aspx/, but should also be addressed to county public health departments, which have considerable discretion in setting vaccine priorities. The way county departments are considering this issue varies greatly by county. Some counties may have some plans in place for mobile vaccination but be unwilling yet to finalize or announce them because of rapidly changing federal and state circumstances, and other counties may not even have thought to address this situation. The more that local authorities can be reminded about the need for accessibility, community outreach, and setting up alternative home-based infrastructure, the better.
Q. Are hospice companies part of the Phase 1?
A. Regarding hospice companies: the state is establishing a call-in number where individuals can give their job title and get some guidance on which tier they are in. They haven’t put out exhaustive lists of who is or is not in a tier. In addition, each specific county is responsible for establishing how people in each tier will be informed about vaccination and actually vaccinated.
Q. I’ve heard of people who aren’t healthcare workers or long-term care facility residents getting vaccinated in CA. Is that a fluke?
A. We are aware of such reports, but in California these incidents seem to arise most commonly when a facility has ordered more vaccine doses than it needs. Because packaged vaccines spoil rapidly once opened, excess vaccines have sometimes been given to anybody who happens to be available to minimize waste.
The incoming Biden administration has signaled that it may support departing from existing priority groups to increase the volume of vaccination, so stay tuned.
Q. I’ve heard from social media sources that some states are proceeding at a faster rate, possibly because of state discretion and size. Is there a reliable source that compares the different rates of progression across the country?
A. Total Number of People Initiating Vaccination (1st Dose Received) Reported to the CDC by State/Territory and for Selected Federal Entities per 100,000, available at: https://covid.cdc.gov/covid-data-tracker/#vaccinations
Q. What is the California COVID-19 hotline?
A. Hotline 1-833-422-4255.
Also — Eligibility determination resources:
• Online tool-in development
• COVID-19 Hotline: 1-833-422-4255
• Email firstname.lastname@example.org
Q. Hospice falls in 1A for employees, but what about the homebound hospice patients that need the vaccine?
A. In California, a hospice patient living at home is most likely to either fall into a priority group based on their age, or into 1C if they are 16-49 (presuming the reason they are in hospice is an underlying medical condition or disability). The ultra-low temperature storage requirements of both of thesome vaccines that have been approved so far and lack of prioritization by the State of individuals who are unable to leave their homes present challenges to mobile clinic distribution.
In New York State they are fining hospitals 100x more for vaccinating someone who isn’t tier 1 than for throwing away vaccines. As a result, a lot of the doses are getting dumped.
I think the issue of getting mobile clinics needs to be pushed very much at the local county level since, that has to be addressed logistically ahead of time with a lot of planning.
Q. The AstraZeneca vaccine should help the bed bound patients. Can we push for that prioritization of that vaccine? Some patients can’t fit/sit in a wheelchair.
A. Approval of the vaccines is happening first at a federal level, and then there is regional medical approval that CA, Oregon, WA and other states in the Western US have created that also is looking at vaccine safety and approval. Each vaccine cannot be distributed or administered without Federal Drug Administration (FDA)/CDC approval. While individuals could write to the FDA, that agency tries to make it clear that it makes decisions and approvals on a scientific and medical basis, and not on the basis of pressure from individuals, including politicians, or organizations.
Crisis Standards of Care
(Claudia Center, Brandie)
Q. Where can you find those guidelines that you are speaking about?
A. The CDPH Crisis Standard of Care Guidelines are at: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19/California%20SARS-CoV-2%20Crisis%20Care%20Guidelines%20-June%208%202020.pdf
The URL is also in the COVID-19 toolkit that was created for this meeting.
Q. What happens when the hospitals don’t post their Crisis Standards of Care / Rationing policies by next Wednesday?
A. The deadline was January 6, 2021, so it has already passed. The state has promised to send the links our way — we need to follow up about getting these links. We will try to identify hospitals that have not posted their policies. We will report these to hospitals to our contacts at the state, and we will do social media and other advocacy to force hospitals to post links.
Here is the link to the December 28, 2020 guidance requiring posting the policies, https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-91.aspx
This is what it says: “CDPH expects that all facilities have crisis care continuum guidelines and if experiencing surge (as majority of facilities currently are), are implementing those guidelines. Facilities are expected to have plans that best fit their facility and regional needs and processes, while following ethical principles, health equity goals, and civil rights laws. Facilities that do not have current guidelines should consult with their MHOACs for technical assistance. By January 6, 2021, all facilities must notify their local CDPH district office and local public health department via email that they have adopted and publicly posted (include link to posting) one of the following: their own crisis care continuum guidelines, another facility’s guidelines, or the State’s California Crisis Care Continuum Guidelines.”
Q. Where do you find these hospital guidelines–on their website?
A. The guidelines should be on the hospital websites. To volunteer to help locate the individual hospital policies: https://nobodyisdisposable.org/
“In disaster scholarly works, I found that the field of disasters and disability (and also age) had not considered higher weight at all – I spoke with disability disaster scholars directly. I am busy writing up my research currently.” (Lesley Gray)
“They need to provide transportation to those who are in need, are provide home visits are trailers/accessible.”
“They see us as too sick to get care yet not valuable enough for early vaccination” (Loren)
From Lesley Gray: Here is a paper three of us wrote about the problematisation of fat in COVID-19 – we cite the No Body is Disposable coalition and the awesome work of the coalition – the paper is still ‘in press’ but the pre-proof is online now: https://www.sciencedirect.com/science/article/pii/S2212420920315235
CDPH has the guidelines and their “all-facility letters” giving guidance to hospitals on their website, but it’s easier to have a specific link than look around generally on their site. The advocacy interpretation guides are on DREDF’s, DRC’s, and JIA’s website.
Here’s the link to the guidance, https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-38.aspx?_cldee=Y2RldmlAY2FsaG9zcGl0YWwub3Jn&recipientid=contact-fe5edad0afc9e911a842000d3a3b4cee-162fcb237d944b6eba41cc112715ff2f&esid=09dc1678-a97e-ea11-a811-000d3a3abdcf
Q. The CDPH Guidelines appears to be in reference to medical hospital patients. It does not appear to guide on acute psychiatric patients.
A. Yes, I think it’s hard with psychiatric hospitals because they already (pre-COVID) have limited visitation …
I believe there is a distinct guideline from California that deals with visitation to LTC nursing facilities.
Q. Are hospitals obligated to post their visitation policies online and if yes can you provide the link to this requirement?
A. There is no state requirement to post visitation policies, but many hospitals do
Q. In situations when a conservatee is “placed” in an acute psychiatric facility, and this placement appears to be a long-term situation (awaiting LT placement), would it be appropriate to advocate that this conservatee receive visitation as that currently apply to a long-term care facility (SNF/STP)?
A. It’s very hard to say whether it’s “appropriate” to try to use the LTC visitation policies, but I think that if are in a situation where you need to visit with a persons with a disability in a psychiatric facility, you should bring forward every tool and argument that you can get a hold of. Even when a policy directly applies to a facility, it can take a lot of self-advocacy to get somewhere.
From Yolanda Toure: I would like to speak to this. I lost 3 Tamil members and almost a 4th. Access to visit a family member is set by the charge nurse’s understanding of the rules. not by state guidelines.
Yes, to @Yolanda. We have had to escalate to in-house counsel for hospitals
Some good news that Ligia Montano (SDA) found: Sutter Health says they’ll follow the CA Crisis Care Guidelines. “Taking steps to assure continued availability of care. If resources become constrained, we’ll implement the CA Crisis Care Guidelines as needed.”
Additional Links & Resources
Link to COVID Updates Meeting January 8, 2020 (Note that this event is captioned. Sincere apologies that ASL did not appear on the video.)
Facebook recording can be found at: https://www.facebook.com/SeniorandDisabilityAction/
SF COVID Vaccination Plan and rollout, 01/08/2021: https://photos.app.goo.gl/Ac4W9wpEQnuCPGeJA
California Vaccination Priority Tools
List of occupations that fall within prioritized sectors: https://covid19.ca.gov/essential-workforce/
Personal care assistants/attendants=healthcare sector=Phase 1a
Farmworker=food and agriculture=Phase 1b, Tier 1