Adult family homes are a vaccination priority in Washington state, but many have no clear path to getting shots

When Washington state health officials announced how they would prioritize who receives COVID-19 vaccinations, nursing-home residents and staff were among the first in line, a reflection of how deadly the virus has been in those settings.

Assisted-living facilities and other long-term care facilities come soon after nursing homes on the priority list. But one type of care provider, adult family homes, has lagged behind.

Weeks after other facilities have started vaccinating residents and staff by the dozens, most of the state’s more than 3,000 adult family homes still don’t have a clear path to accessing the shots. The state’s advocacy group that represents adult family homes, along with providers and residents and their loved ones, has asked state health officials to provide more resources toward ensuring the residents and staff are vaccinated.

“We strongly believe that to connect the remaining homes with a vaccine program, the state must take a proactive approach of reaching out to these homes immediately,” said John Ficker, the executive director of the Adult Family Home Council, in an email.

Even as Gov. Jay Inslee announced Monday that state residents age 65 and older were now eligible for vaccinations, access to the shots for those living in adult family homes was not immediately clear.

About 19,000 people live in the state’s 3,386 adult family homes, which provide 24-hour care for up to six non-related people in a residential setting. Approximately 17,000 people work at adult homes, according to Ficker.

Between 1,200 and 1,400 homes have registered with CVS and Walgreens to receive vaccines through a federal pharmacy partnership, but only about a quarter have a scheduled clinic date, according to Ficker.

For adult family homes in King County, which account for about a third of the state’s homes, help is on the way for those not in the federal partnership program. Last Thursday, the Seattle Fire Department began vaccinating residents and staff of the city’s non-enrolled 149 homes.

This week, Bellevue Fire Department teams will go door-to-door at adult family homes in East King County, according to Ingrid Ulrey, policy director at Public Health — Seattle & King County. Puget Sound Regional Fire Authority will send vaccination teams to homes in South King County, where more than 40% of the county’s homes are located.

“We are strongly aware of the urgency needed to focus on getting our staff and residents in adult family homes vaccinated,” Ulrey said. “People don’t realize that residents who live in these homes are equally as at risk and vulnerable as those in nursing homes. It’s a really important issue. I can’t emphasize that enough.”

At the state level, the Department of Health (DOH) said it considers adult family homes to be on the same priority level as assisted-living facilities but noted that adult homes make up the majority of the roughly 1,800 long-term facilities not enrolled in the federal program. Ficker attributed the lack of registrants to confusion from the online registration process, which, according to Ficker, had several issues, including not showing adult family homes as a provider type, making the users think they weren’t eligible.

DOH said it is coordinating with pharmacies and will be sending messages to facilities soon about additional resources. The department is also working with the Department of Social and Health Services to call facilities directly and provide help, if needed, for registration. DOH pointed to the partnership’s goal of having all non-nursing home facilities get the first dose by the end of January.

“Given we’re only a month in, we’re moving along,” DOH spokesperson Danielle Koenig said in an email.

Ficker said he was disappointed by what he perceived as a lack of urgency in the state’s overall response.

COVID-19 has been especially deadly in long-term care facilities, which account for more than half of Washington’s deaths from the virus. Adult family homes have the highest number of sites with at least one case of COVID-19 compared with nursing homes and assisted-living facilities, but they have a much lower percentage than the others.

Since the start of the pandemic, 13% of the state’s homes have had at least one case of COVID-19; 4% now report at least one active case, according to the Department of Social and Health Services. In comparison, 36% of the state’s assisted-living facilities currently have an active case and 72% of the state’s assisted-living facilities have reported a case since the start of the pandemic.

Adult family homes have additional challenges not as common in other types of facilities related to COVID-19 and vaccinations. Owners and operators are often the primary caregiver for residents, Ficker said, and don’t have the administrative and support staff of a provider like a large assisted-living facility. With frail residents and a smaller staff, it’s not realistic for operators to take their residents to a vaccination site, Ficker said, noting that adult homes often serve the most acute patients.

Linda Sherry was told this month that her 94-year-old mother would be getting the vaccine at her Kirkland adult family home, so she went to the home to sign an authorization form. But the day before the scheduled vaccine clinic, she received another call from the homeowner: The vaccine date had been canceled, with no explanation.

The date for her mother to receive a shot hasn’t been rescheduled, Sherry said. She worries about the potential for exposure as staff come in and out of the house and is anxious to get her vaccinated.            

“ (Adult family homes) should be prioritized with all long-term care,” she said. “I understand that when you have a larger facility and you have staff going in and out of 20 rooms a day with the potential for exposure it’s important, but still, she’s 94, and living with other people.”