By Melissa Powell
Virtually every segment of society has felt the coronavirus pandemic’s effects, but they’ve hit long-term care facilities (LTCFs) especially hard. The approval in December of the Moderna and Pfizer/BioNTech vaccines for LTCF distribution brought relief to residents and staff, and that momentum has continued into 2021.
There is obviously much still to accomplish, but it is clear that things are trending in the right direction.
Here is a progress report:
In mid-December, an early round of vaccinations for LTCFs occurred in West Virginia, Ohio, Connecticut, and Delaware. These states were ahead of the federal program distributing vaccines through CVS and Walgreens.
According to the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL), a study of 797 facilities found that by mid-February, 85 percent completed their second-round shots and 75 percent completed their first. Among the participating LTCFs, new resident and staff cases decreased by 48 and 33 percent, respectively.
That was part of a larger trend that by late April had seen the U.S. reach a point where 2.7 million shots were being administered per day, resulting in 43 percent of the population receiving at least one shot, and 29 percent having received both.
The AHCA and NCAL set March 1, 2021, as the target date for all LTCFs to complete their injections. However, pharmacies have not reached all facilities, and many residents and staff have been unable or hesitant to get the shot. Confusion about the availability of the remaining vaccines also persists.
Many of the early issues were the result of distribution glitches. As the first vaccines emerged, federal officials reserved a large supply of them for LTCFs and coordinated their distribution through the CVS and Walgreens drugstores. Unfortunately, millions of doses either went to facilities that didn’t require them or ended up in storage and out of reach of Americans wanting shots.
By late January, both CVS and Walgreens experienced a one-month delay. Winter storms added to the distribution problems, slowing down or thwarting delivery schedules. Many healthcare providers had to cancel or postpone vaccination appointments.
The Biden Administration and other officials worked to speed up inoculation rates and improve coordination efforts, and by late April the Centers for Disease Control and Prevention reported that nearly 7.8 million long-term-care residents and employees had received at least one dose of the vaccine, and that over 2.8 million were fully vaccinated. That had led to a 96 percent decline in the cases in such facilities.
Additional Concerns for LTCF Residents and Staff
Even with the catch-up, there were some troubling trends, one of them being that roughly half of the nation’s long-term-care workers had received the vaccine as of mid-March, according to the CDC. In seven states and the District of Columbia, the rate was below 33 percent.
According to an NPR report, these workers have traditionally been reluctant to receive any sort of vaccine. Specific to COVID-19, they are leery of its effectiveness, and were hesitant to be among the early recipients of the vaccine. As David Grabowski, a professor of health care policy at Harvard Medical School, told NPR:
“We knew this coming in — that this was a group that was not very trusting of leadership and frankly not very trusting of the vaccine so it was going to take some work in terms of building that trust.”
At The Allure Group, a network of six New York City-based skilled nursing facilities, we shared on our social media and company Intranet photos of myself and our veteran union staff all receiving the shots along with messages of encouragement. In addition, we allowed a Reuters photographer unprecedented access during the vaccine rollout. The intent of all those measures was to make clear the vaccines’ safety and effectiveness.
Some residents, however, faced delays because of the hurdles involved in obtaining their consent. Patients with dementia and other cognitive limitations have little to no ability to independently accept or refuse the vaccine. Such complications have caused backlogs in most states. It can take weeks for LTCFs to get in touch with families and attorneys to vaccinate these individuals. Disputes among relatives about whether to vaccinate can add to the complications and time lag.
Some advocates assert that the federal government should have acted sooner to streamline the consent process. With the CDC’s backing, the government gave CVS and Walgreens authority to secure permission however they saw fit, including accepting verbal consent. Pharmacies pushed back, arguing the rules were too lenient but relented after receiving several grievances.
Both CVS and Walgreens have since eased up on their consent policies. CVS currently accepts verbal consent from capable residents and takes emailed consent on behalf of patients who cannot give consent. Walgreens provides consent forms that note verbal consent.
In mid-March the CDC collaborated with The Centers for Medicare & Medicaid Services (CMS) to issue updated guidance for visitation to long-term-care facilities. This guidance allowed all residents to receive visitors unless they had been diagnosed with the virus or were in quarantine, or in the event they were unvaccinated and the county positivity rate was greater than 10 percent and fewer than 70 percent of the residents were fully vaccinated.
The new guidelines also stipulated that visits with residents whose health had sharply declined — i.e., “compassionate care” visits — would be allowed, no matter whether the resident met any of the above criteria.
In the meantime, individual facilities took steps to ensure the safety of all concerned. At The Allure Group, for instance, we have installed Advanced Entry kiosks at the entrances of each of our buildings. They automatically check temperatures and ask key questions of all those seeking to gain entry.
In sum, progress has been made in the fight against the virus, and its impact on long-term-care facilities in particular. It is, however, an ongoing battle, and vigilance is paramount.
Melissa Powell is COO of The Allure Group, a network of six New York City-based skilled nursing facilities.