Ruth Ann Platt, who saw the news on television about effective vaccines against the coronavirus, couldn’t wait for them to get to her nursing home in Gainesville, Ga. “I thought it was great from the start,” she said.
When Ms. Platt, 88, moved to New Horizons Lanier Park last year after surgery for a broken femur, the facility had already put strict restrictions in place to contain Covid-19 outbreaks. “I lived in this room for seven months,” she said.
She still has to share a meal with another resident, attend a concert, or take an art class. The hair salon stayed closed, she said, so “I’ll be Rapunzel pretty soon.” She is tired of video chatting as a substitute for visits with her children, grandchildren, and eight great-grandchildren.
Fortunately, she received her second dose of the Moderna vaccine last month. New Horizons, part of the nonprofit healthcare system in northeast Georgia, has opted out of a federal partnership that relies on CVS and Walgreens to serve long-term care facilities. With its own pharmacy and nurses, the company quickly began vaccinating residents on December 29th.
Now Ms. Platt said: “I would like to find someone who plays a good game of pinochle.”
The testimony for vaccination in long-term care facilities, whose residents were supposedly on the front lines, shows a mixed performance.
Nationwide, nearly 3.4 million residents and long-term care workers received at least one shot, the Centers for Disease Control and Prevention reported on Thursday. Almost 800,000 got two.
By mid-January, Medicare data showed that cases in long-term care facilities had decreased nearly 46 percent from four weeks earlier, reflecting the decline in cases across the country but likely the impact of vaccination as well.
However, experts and advocates, who note that an estimated five million people live or work in long-term care, expressed great frustration with the slow adoption. “Long-term care has not lost any pace,” said David Grabowski, a health policy researcher at Harvard Medical School.
They are also concerned about the even slower rate in assisted living facilities and about workers suspected of being vaccinated.
Last fall, the Trump administration signed a deal with the two major pharmacy chains that agreed to keep three clinics in each facility: first dose, second dose, and one to catch previously missed stragglers.
The vaccination rate has increased significantly. Walgreens increased the number of doses administered from 165,000 in December to 1.3 million last month. It has completed the first doses in all 5,529 of the nursing homes it has contracted with and expects to deliver the second doses by February 25 and complete the third visits by mid to late March.
Similarly, CVS, which has the larger program, has dispensed first doses to all 7,822 nursing homes it serves, and about 77 percent of the second doses.
Company executives stressed that while the Centers for Disease Control and Prevention prioritized long-term care for vaccination, each state determined when programs began.
“We were actually planning a national rollout on the same day,” said Chris Cox, CVS senior vice president, pharmacy business. “We were ready to go.” While nearly all states activated nursing home clinics on December 21 or 28, most did not open assisted living clinics until January, often weeks later.
The virus didn’t wait. Long-term care infections peaked in December, according to an analysis by the Kaiser Family Foundation; also deaths in many states. Although residents and long-term care workers account for just 5 percent of the country’s Covid-19 cases, they account for 37 percent of deaths.
With a quicker answer: “We could have had more nursing home residents vaccinated more effectively four to six weeks earlier,” said Dr. Michael Wasserman, geriatrician and past president of the California Association of Long Term Care Medicine. “That’s a lot of deaths that could have been prevented.”
Updated
Apr. 5, 2021 at 1:51 am ET
Future business students may question this plan for years. “With over 30,000 facilities and millions of residents and employees, this has never been easy,” said Dr. Grabowski. “The states and the federal government have gladly transferred this to the private sector.”
Facility administrators had to deal with cumbersome consent forms early on, a problem that has since been resolved. CVS and Walgreens executives also report having to contact some facilities multiple times to simply schedule clinics.
The administrators, in turn, questioned the three-visit plan. How would these clinics reach employees who worked night and weekend shifts? Or newly admitted residents returning from hospitals and discharged after just one dose? The CDC is reportedly working on a transition plan.
Although the chains publish numbers updated daily, “we still don’t have the information we wanted,” said Tricia Neuman, executive director of the Medicare Policy Program at the Kaiser Family Foundation. The totals do not give any indication of which facilities the companies visited or how many residents and employees they vaccinated.
The residents reacted enthusiastically. The CDC estimated that in nursing homes with clinics, an average of 77.8 percent of residents received their first doses in the first month of the program.
“People who live in nursing homes would do almost anything to reconnect with the outside world and the people they love,” said Dr. Kathleen Unroe, a geriatrician at Indiana University School of Medicine who also practices at Northwest Manor, a nursing home in Indianapolis.
One of her patients initially had doubts. “I didn’t want to be a guinea pig,” said Norma Ware, 86. “I’m not crazy about shots anyway.” But after talking to her family and “a very kind nurse,” she received both doses and became a believer.
The bigger problem: reluctant staff. The CDC reported that in nursing homes with clinics, only an average of 37.5 percent of employees were vaccinated in the first month.
Other healthcare workers have also hesitated. In nursing homes in particular, many women workers are colored women who are familiar with long-term inequalities in health care and who distrust medical facilities.
“They were badly paid and overworked prior to the pandemic,” said Dr. Grabowski. Noting that workers also faced a shortage of personal protective equipment, he added, “They weren’t on sick leave or paid. So now let’s say,“ You need to get vaccinated. ”I’m not surprised that many say: ‘Wait a minute, why?’ “
Long-term carers, however, are susceptible to Covid-19; They can also spread the virus by entering and leaving facilities and doing secondary jobs to make ends meet.
At the two New Horizons homes in Gainesville, medical director, Dr. Swati Gaur, six staff town halls held in person or online, including one at 2am for the night shift, and offered rewards such as free meals. About half of the workers were vaccinated, said Dr. Gaur.
“If your co-workers, friends, co-workers, and co-workers are vaccinated, those numbers will go up,” said Dr. Wasserman ahead.
The slow pace of vaccination in assisted living facilities, where fatal outbreaks have also occurred, has also sparked fear. In some states, only about half of the population even received an initial dose.
At some point in March, the majority of those needing care and many employees will likely have vaccine protection, either Pfizer or Moderna. Then what?
Being able to see and hug their families is the top priority for residents. Geriatricians fear that the risks of extensive social isolation for residents rival those of the coronavirus.
“It is imperative that we see the restrictions relaxed,” said Robyn Grant, director of public order and advocacy for National Consumer Voice, which promotes quality long-term care. “The residents have suffered. This cannot go on. “Both Medicare and the CDC should prepare guidance on how and when to resume family visits.
Vaccinated residents could also re-establish contact with each other and gradually return to shared meals and activities. “The goal is to get these residents out of their rooms,” said Dr. Gaur.
Mrs. Platt gave some advice that could speed up this day. “This is no time for fear,” she advised roommates. “Get your shot. Just get your shot and get on with your life. “
