Across the country, some nursing home directors and health officials say the partnership is hampering the vaccination process by imposing paperwork and cumbersome corporate policies on facilities that are sparsely staffed and have devastating effects on coronavirus. They argue that nursing homes are unique medical facilities that can be better served by medical workers who already understand how they work.
Mississippi State Health Officer Thomas Dobbs said the partnership was a failure. ‘
The state has dedicated 90,000 doses of vaccines to the effort, but pharmacies have administered only 5% of the shots since Thursday, Dobbs said. Pharmacists told him they were having trouble finding enough people to man the program.
Dobbs pointed to neighboring Alabama and Louisiana, which he says vaccinate long-term care residents at four times the Mississippi percentage.
“We get very angry people because it’s going so slowly, and we’re unhappy, too,” he said.
Many of the nursing homes that have successfully vaccinated willing residents and staff members do so without federal assistance.
For example, the Los Angeles Jewish Home, with approximately 1,650 staff members and 1,100 residents on four campuses, began vaccination on December 30th. By January 11, the house’s medical staff had administered the 1,640th dose. Even the chief medical director of the facility, Noah Marco, helped vaccinate.
The home is located in Los Angeles County, which did not want to participate in the CVS / Walgreens program. Instead, the nursing homes have instructed them to administer vaccines themselves and use only Moderna’s easy-to-handle product, which does not need to be stored at ultra-cold temperatures, such as the Pfizer vaccine. (Both vaccines require two doses to provide full protection, between 21 and 28 days apart.)
In contrast, Mariner Health Central, which operates 20 nursing homes in California, relies on the federal partnership for its homes outside LA County. One of them will only receive his first doses next week.
“It was so much worse than anyone expected,” said Dr. Karl Steinberg, medical head of the chain, said. “That light at the end of the tunnel is dim.”
Facilities participating in the federal partnership typically plan three vaccine clinics over the course of nine to twelve weeks. Ideally, those who are eligible and want a vaccine will receive the first dose at the first clinic and the second dose three to four weeks later. The third clinic is considered a makeup day for anyone who misses the other. Before administering the vaccinations, the pharmacies must obtain permission from residents and staff members.
Despite complaints about a slow rollout, CVS and Walgreens said they were on track to complete the first doses by January 25, as promised.
“Everything went as planned, except for a few cases where we were challenged or had trouble contacting long-term care institutions to schedule clinics,” said Joe Goode, a spokesman for CVS Health.
Dr Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, acknowledged some delays by the partnership, but said it was to be expected because no such attempt had been made before.
“There is a feeling that they will act quickly with it, and that will be useful, as health departments are pretty much too much,” Plescia said.
But any delay puts lives at risk, says Dr. Michael Wasserman, the immediate former president of the California Association of Long Term Care Medicine.
“I’m about to get core about this,” he said. “There should never be an excuse for people not being vaccinated. There is no excuse for delays.”
To get vaccinated
Nursing homes are equipped with resources that could help the vaccination – but are often not used.
Most already work with specialized pharmacists who understand the needs of nursing homes and administer medications and annual vaccinations. These pharmacists know the patients and their medical history, and are familiar with the equipment of nursing homes, said Linda Taetz, head of compliance at Mariner Health Central.
“It’s not that they are incapable,” Taetz said of the retail pharmacists. “They just weren’t embedded in our buildings.”
If a facility participates in the federal program, it cannot use any other pharmacists or staff members to vaccinate, said Nicole Howell, executive director of the ombudsman services in the provinces of Contra Costa, Solano and Alameda.
But many nursing homes want the flexibility to do so because they believe it will speed up the process, build trust and get more people to say yes to the vaccine, she said.
Howell pointed to West Virginia, which relied primarily on local, independent pharmacies instead of the federal program to vaccinate nursing home residents.
The state chose against the partnership primarily because CVS / Walgreens would take weeks to launch shots and Republican Gov. Jim Justice wanted them to start immediately, said Marty Wright, executive director of the West Virginia Health Care Association, which the state s long-term represents, said. care facilities.
Wright has done most of the work through more than 60 pharmacies, giving the state greater control over how the doses are distributed. Walgreens joined the pharmacies in the second week, although he was not part of the federal partnership.
“We had more interest in local pharmacies than facilities we could work with,” Wright said. Preliminary estimates show that by the end of December, more than 80% of residents and 60% of staff in more than 200 homes had received a first dose.
Goode of CVS said his business’s participation in the program is led by his long-term care division, which has deep experience with nursing homes. He noted that tens of thousands of nursing homes – according to the CDC nationally about 85% – found it reassuring enough to participate.
“It underscores the community’s confidence in long-term care in CVS and Walgreens,” he said.
Vaccines pay nothing out of pocket for the shots. The cost of purchasing and administering it is covered by the federal government and health insurance, which means CVS and Walgreens make a lot of money: Medicare reimburses $ 16.94 for the first shot and $ 28.39 for the second shot.
Bureaucratic delays
Technically, federal law does not require nursing homes to obtain written permission for vaccinations.
But CVS and Walgreens require that they get oral or written permission from residents or family members, which must be documented on the forms provided by the pharmacies.
Goode said consent has so far not been an obstacle, but many people on the ground disagree. The requirements slowed the process as nursing homes collected paper forms and Medicare numbers from residents, said Tracy Greene Mintz, a social worker who owns Senior Care Training, which trains and deploys social workers in more than 100 facilities in California.
In some cases, social workers sent paper consent forms to families and waited to get them back, she said.
“The facilities are keeping residents alive,” Greene Mintz said. “If you want to pay from Medicare, do your own paperwork,” she suggested to CVS and Walgreens.
The planning was also a challenge for some nursing homes, in part because people who are actively ill with Covid should not be vaccinated, the CDC advises.
“If something comes up, say an entire building becomes Covid-positive, you don’t want the pharmacists to come because no one is going to get the vaccine,” said Taetz of Mariner Health.
Both pharmacy companies say they work with facilities to reschedule when needed. It took place at the Windsor Chico Creek Care and Rehabilitation in Chico, California, where a clinic was pushed back a day because the Covid test results were waiting for residents. Melissa Cabrera, who manages the facility’s infection control, describes the process as streamlined and professional.
In Illinois, about 12,000 of the state’s approximately 55,000 nursing home residents received their first dose by Sunday, mostly through the CVS / Walgreens partnership, said Matt Hartman, executive director of the Illinois Health Care Association.
While Hartman hopes the pharmacies will administer the first round by the end of the month, he noted that there is a lot of “headache” surrounding the planning of the clinics, especially if the houses break out.
“Are we glad we did not make it through the first round and finished West Virginia?” he asked. “Absolutely not.”
KHN correspondent Rachana Pradhan contributed to this report.
This story was produced by KHN (Kaiser Health News), which publishes California Healthline, an editorial independent service of the California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.