Gaudy Baez-Montero, 41, works full-time in Massachusetts as a personal care aide for an 11-year-old boy with cerebral palsy. She wants to get a COVID-19 vaccine to protect herself and the child, but she’s struggling to get an appointment.

“My work gave me a number to call,” she said. “I’ve been calling and calling, but I haven’t been able to get any help.”

Health care workers were among the first U.S. residents eligible for a COVID-19 vaccine. But months into the vaccination rollout, survey data suggests that nurses and aides who work in people’s homes are less likely to have had shots than their counterparts in hospitals and nursing homes.

Just a quarter of home health care workers were vaccinated by early March, compared to about two-thirds of hospital workers and half of nursing home workers, according to a joint poll by the nonprofit Kaiser Family Foundation and The Washington Post.

Home health care workers serve older people, individuals with disabilities and those who are terminally ill, all of whom are at high risk of complications from COVID-19. Many workers are low-paid Black and Hispanic women, who have expressed more wariness about COVID-19 vaccines in surveys.

But lack of access, not hesitancy, is driving the low vaccination rate, said April Verrett, president of Service Employees International Union Local 2015, which represents over 400,000 home care and nursing workers in California.

“A lot has been made of vaccine hesitancy among communities of color,” Verrett said, “and it is true that there has been a high level of hesitancy. But I think what’s even more problematic is the barriers to access.”

Vaccinating home care workers poses a logistical challenge for state and local policymakers. Such aides and nurses work from people’s homes, rather than a central location. Some work directly for families, or for employers that lack the equipment needed to administer COVID-19 vaccines.

The federal government and states haven’t gone the extra mile necessary to reach these workers, home care employers say. While policymakers have set aside doses for hospital and nursing home staff, few states and localities have set aside doses specifically for home care workers or organized vaccination events for them.

Most home-based nurses and aides are trying to land vaccine appointments at pharmacies, public health departments and mass vaccination sites, just like the general population. Workers, employers and union leaders say some aides don’t have the technology and language skills needed to make an appointment online, let alone the ability to take time off to travel to one.

Some workers are now worried they could lose their jobs if they don’t get vaccinated soon, as their clients don’t want unvaccinated people in their homes.

Santos Guardado of New Bedford, Mass., works as a personal care aide for a 77-year-old woman. She said the client’s daughter has asked her why she doesn’t want to be vaccinated.

“I told her I did but it’s been difficult to get it,” said Guardado, 39. She and Baez-Montero both speak limited English and spoke to Stateline in Spanish.

Some state and local health departments, such as those in New Jersey and Boston, have organized vaccination clinics for home care workers, usually after being prodded by home care employers or unions.

“We’re unaware of any specific, policy-driven approaches to make the vaccine available to home care, without the instigation of the company going to the county health department, or the state health department,” said Bill Dombi, president of the National Association for Home Care and Hospice, a Washington, D.C.-based trade group.

“The story’s about a vacuum of policy,” he added, “rather than the pros and cons of a particular policy.”

State health agencies that responded to requests for comment reiterated that home health care workers have been eligible for vaccines for months, noting that there are now many vaccine sites around their states where such workers could get vaccinated.

“If a home health worker was not vaccinated in December or January as a part of Phase 1A, they are eligible to go to their neighborhood pharmacy, a federally qualified health center, local health department, or any other provider in Ohio to be vaccinated,” said Alicia Shoults, a spokesperson for the Ohio Department of Health, in an emailed statement.

Workers Left Behind

Most states included home care workers in their earliest vaccine phases. But some states, such as Louisiana, did not, and there was confusion in other places. Some Florida vaccination sites initially turned away home care workers, believing they weren’t yet eligible for the shots.

“There was just a huge amount of variation there at the beginning, and obviously there was limited supply,” said Mollie Gurian, director of hospice, palliative and home health policy for Leading Age, a Washington, D.C.-based nonprofit that represents nonprofit aging services providers.

Meanwhile, federal and state efforts to funnel vaccines to health care workers have largely bypassed home care.

State health departments have been shipping vaccines directly to hospitals, which made it easy for hospital systems to vaccinate their employees, including any home care workers they employ.

While some hospitals are vaccinating health care workers who aren’t on staff, others are not, said Nancy Foster, the American Hospital Association’s vice president for quality and patient safety policy, in an email to Stateline.

“Some hospitals are willing and able; some are willing but not sure if they are able; and some cannot because they want to act in accordance with the state/jurisdiction plan,” she said.

The federal government late last year teamed up with pharmacies to offer on-site vaccinations to residents and staff of long-term care facilities. That boosted nursing home worker vaccinations and reached some home care workers affiliated with such facilities.

Most home care agencies never got doses, however, nor benefited from a pharmacy partnership. This has made it hard for home care workers to get vaccinated on the job.

“In a hospital, you can walk down the hall and you can get your shot,” said Kim King, CEO of Home Care Network, Inc., a Centerville, Ohio-based company that provides home care services in Ohio and Indiana.

That’s not true of her company.

The federal government prioritized long-term care facilities because they’re places where groups of people vulnerable to COVID-19 live together. And it would have been difficult to include home care agencies in the pharmacy partnership, said Centers for Disease Control and Prevention spokesperson Kate Grusich in an email to Stateline.

For instance, home care agencies typically don’t have the refrigerators needed to store the temperature-sensitive vaccines developed by Pfizer and Moderna.

“(Home care) staff often do not work out of a centralized location or facility, which would have complicated efforts to plan on-site vaccine clinics,” Grusich wrote. “In addition, the strict vaccine storage and handling requirements — especially in the initial days of the vaccine rollout — required a more sophisticated infrastructure.”

Home care workers, Grusich added, “have had many options to be vaccinated at other locations.”

But home care workers, employers and union leaders say that getting vaccine appointments at pharmacies, mass vaccination sites and other places open to the general public has been difficult.

Verrett said SEIU 2015 members have struggled to make appointments, particularly if they lack reliable internet, tech skills or time to dedicate to refreshing web pages and waiting for available appointments to appear.

“Our members simply don’t have the time it takes to master this type of technology,” she said. Then there’s the need to travel to an appointment. “Because this workforce is not connected to a worksite, many of them are isolated, and need to stay attached to the person that they care for—some of them 24 hours a day,” Verrett said.

King said her team has tried to help workers get appointments and travel to them. “We have to get their shift covered for them, so they can go to wherever the vaccine appointment is,” she said. So far, she said, about half her company’s workers have been vaccinated.

Guardado said she’s waiting for her employer to help her make an appointment. “At first they would update me and say they were still working on trying to get me a vaccine,” she said, “but now they haven’t told us anything.”

Looking for Partnerships

Some state and local health departments have teamed up with home care employers and unions to coordinate vaccinations.

The New Jersey health department, for instance, worked with employers and Rite Aid to offer vaccinations in late December and January. Workers signed up on Rite Aid’s website and the company administered the doses at home care employers’ offices over a four-week period, said Nancy Fitterer, president and CEO of the Home Care & Hospice Association of New Jersey.

The pilot program vaccinated 10,000 people — not all of them home care workers, Fitterer said. A glitch in the sign-up link allowed other eligible New Jerseyans, such as older adults, to use it to make appointments.

The program ended because state officials wanted to send New Jersey’s limited vaccine doses elsewhere, Fitterer said.

“The state’s partnership with Rite Aid was a short-term initiative to provide a priority access point reserved just for home care and hospice workers, in addition to the hundreds of vaccination sites open to all eligible individuals,” said Nancy Kearney, a spokesperson for the New Jersey Department of Health, in an emailed statement. She added that the state now has more than 770 vaccination sites.

Plenty of New Jersey home care workers are still trying to get vaccinated, Fitterer said, including people who were initially wary. “There are definitely a lot of people who did not want it then who want it now.”

In Massachusetts, 1199SEIU United Healthcare Workers East — which represents more than 70,000 health care workers, including Baez-Montero and Guardado — has teamed up with local health departments to run vaccination clinics.

“I literally went down the list of health commissions in Massachusetts and just started calling them,” said Rebecca Gutman, the union’s vice president. Union leaders have organized events for workers who don’t speak English, given out free masks and gloves and staffed the events with greeters to help attendees feel welcome.

At least two-thirds of 1199SEIU home care worker members have been vaccinated so far, Gutman said.

But even events created just for home care workers are hard for some to reach. Baez-Montero, who doesn’t get paid time off, said she hasn’t made it to the vaccination events her employer has organized.

“I had to go to another city and it was too far for me to go,” she said. “I would have lost an entire day of work traveling.”

SEIU 2015 in California also has organized vaccination events with community health centers in Los Angeles and at a church in Oakland.

Some home care employers have been lobbying states to send them vaccine doses and allow them to vaccinate their own staff and homebound patients. That could happen in New Jersey, where Fitterer has been talking to health officials about creating such a program.

It would be hard to repeat the Rite Aid partnership now, as pharmacies are so busy vaccinating the general public, said Stephanie Kulak, corporate clinical director of Preferred Home Health Care & Nursing Services Inc., a home care business with locations in Delaware, New Jersey and Pennsylvania.

“It might be more realistic for us to get our own vaccine,” she said. She said her company already has bought the vaccine refrigerators and EpiPens needed to run a vaccination program and has asked the New Jersey Department of Health for permission to provide COVID-19 vaccines.

Not all home care employers are so eager, however. Fitterer said some New Jersey companies have balked at becoming vaccinators, as it would require buying expensive equipment and completing paperwork. “Some are saying yes, some are saying no,” she said.

Texas home care employers face an additional problem: Under state law, home care employees can’t administer COVID-19 vaccines. The state House earlier this month passed a bill that would allow home health workers to administer any vaccine used to reduce the spread of infectious diseases.

“That will help things, going forward,” said Rachel Hammon, executive director of the Texas Association for Home Care & Hospice. “But it doesn’t help us right now.”

Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy.