Ruth Ann Platt, who was watching the news on television about effective coronavirus vaccinations, could not wait to reach her nursing home in Gainesville, Ga. “I thought it was a wonderful thing from the beginning,” she said.
Toe me. Platt (88) moved to New Horizons Lanier Park last year after surgery for a broken femur, the facility has already imposed strict restrictions to prevent Covid-19 outbreaks. “I’ve been living in this room for seven months,” she said.
She has to share another meal with another resident, attend a concert or take an art class. The hair salon then remained, she said, so “soon I’m Rapunzel.” She is tired of video calls as a substitute for visits with her children, grandchildren and eight great-grandchildren.
Fortunately, she received her second dose of Moderna vaccine last month. New Horizons, which is part of the nonprofit health care system in Northeast Georgia, has opted for a federal partnership that relies on CVS and Walgreens to serve long-term care facilities. With the help of its own pharmacy and nurses, it began vaccinating residents quickly, from 29 December.
Now Mrs Platt said: “I would like to find someone who plays a good game of pinochle.”
The vaccination report card for long-term care facilities, whose residents presumably were at the front of the queue, shows a mixed performance.
Nationally, nearly 3.4 million longtime residents and staff members received at least one shot, the Centers for Disease Control & Prevention reported Thursday. nearly 800,000 got two.
By mid-January, Medicare data showed that cases in long-term care facilities had fallen by almost 46 percent compared to four weeks earlier, reflecting the decline in cases across the country, but likely also the impact of vaccination.
But experts and advocates, noting that about five million people live or work in long-term care, have expressed intense frustration over the slow initial implementation. “There was no turning back to long-term care,” said David Grabowski, a health policy researcher at Harvard Medical School.
They are also concerned about the even slower rate in relief facilities and about workers being suspicious of vaccination.
Last fall, the Trump administration contracted with the two major pharmacy chains, which agreed to hold three clinics at each facility: first-dose, second-dose and one to catch up on the earlier failures.
The rate of vaccination has increased significantly. Walgreens increased the number of doses it administered from 165,000 in December to 1.3 million last month. He completed the first doses at all 5,529 nursing homes he 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, delivered first doses to all of the 7,822 nursing homes it serves, and about 77 percent of the second doses.
Operations managers stressed that while the Centers for Disease Control and Prevention prioritizes long-term vaccination care, individual states determine when programs begin.
“We were actually planning to take a national impact on the same date,” said Chris Cox, senior vice president of pharmacy business at CVS. “We were ready to go.” But while almost all states activated nursing home clinics on December 21 or 28, most just started outpatient clinics until January, often weeks later.
The virus did not wait. According to an analysis by the Kaiser Family Foundation, infections in long-term care peaked in December; so too deaths, in many states. Although long-term care residents and staff make up only 5 percent of the country’s Covid-19 cases, they account for 37 percent of deaths.
With a faster response, “more than four to six weeks earlier, we could have vaccinated more nursing home residents effectively,” said Dr. Michael Wasserman, a geriatrics and former president of the California Association of Long Term Care Medicine, said. “There are a lot of deaths that could have been prevented.”
Future business students can explore this plan for years to come. “It would never be easy, with more than 30,000 facilities and millions of residents and staff,” said Dr. Grabowski said. “States and the federal government have been happy to pass it on to the private sector.”
From an early age, facility administrators struggled with cumbersome consent forms, a problem that has since been resolved. Managers of CVS and Walgreens also report that they need to contact various facilities to plan clinics.
Administrators, in turn, questioned the plan for three visits. How would these clinics reach staff members who worked night and weekend shifts? Or newly admitted residents, those returning from hospitals and those discharged after only one dose? The CDC is apparently working on a transition plan.
In addition, although the chains post daily updated numbers, ‘we do not yet have the amount of information we would like,’ said Tricia Neuman, executive director of the Program for Medicare Policy at Kaiser Family Foundation. The total numbers do not indicate which facilities the businesses visited, or the extent of residents and staff members who vaccinated them.
Residents responded enthusiastically. The CDC estimated that an average of 77.8 percent of residents received their first doses during the first month of the program, in nursing homes with clinics.
“People who live in nursing homes will do almost anything to reconnect with the outside world and the people they love,” said Dr. Kathleen Unroe, a geriatrician at the Indiana University School of Medicine, who also practices at Northwest Manor, a nursing home, said. in Indianapolis.
One of her patients initially had doubts. “I did not want to be a guinea pig,” said Norma Ware, 86. “I’m not crazy about shots anyway.” But after talks with her family and a ‘very friendly nurse’, she received both doses and became a believer.
The bigger problem: an unwilling staff. The CDC reported that only 37.5 percent of staff members were vaccinated with clinics in nursing homes in the first month.
Other health workers also show reluctance. But especially in nursing homes, many workers are women of color, who are familiar with the inequalities in health care and who are distrustful of the medical institution.
“They were poorly paid and had too much work to do before the pandemic,” said Dr. Grabowski said, noting that the workers also had shortages of personal protective equipment, adding: “They did not receive sick leave or a hazard payment. So now we say, ‘You need to be vaccinated.’ I’m not surprised that many say, ‘Wait a minute, why?’ ‘
Yet long-term caregivers are vulnerable to Covid-19; they can also transmit the virus as they enter and leave facilities and work second jobs to get their pocket.
At the two New Horizons homes in Gainesville, medical director Dr. Swati Gaur held six people’s town halls in person or online, including one at 2 a.m. for the night shift, and offered rewards such as free meals. About half of the workers have been vaccinated, said Dr. Gaur said.
“If their colleagues are vaccinated, their friends and colleagues and associates will increase the numbers,” said Dr. Wasserman predicts.
The deterioration of vaccination in emergency facilities, which also experienced fatal outbreaks, also caused anxiety. In some states, only half of the population even received a first dose.
In March, the majority of long-term care residents and many staff members are likely to protect the vaccines, Pfizer or Moderna. Then what?
For residents, the top priority is to be able to see their families – and embrace them. Geriatricians fear that the risks of prolonged social isolation pose the risks of coronavirus to residents.
“We absolutely must reduce restrictions,” said Robyn Grant, director of public policy and advocacy at the National Consumer Voice, which promotes the quality of long-term care. “Residents have suffered. It can not continue. It is said that both Medicare and the CDC are preparing guidance on how and when to resume family visits.
Vaccines were also able to reconnect with each other and gradually return to communal meals and activities. “The goal is to get these residents out of their rooms,” said Dr. Gaur said.
Ms Platt gave advice that could speed up the day. “This is no time for fear,” she advised fellow residents. ‘Take a chance. Just take your chance and get on with your life. ‘