Most nursing homes won’t use pharmacy chains to administer coronavirus booster shots

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By Lena H. Sun, The Washington Post, August 27 2021

Judie Shape, center, at the Life Care Center in Kirkland, Wash., visited last year through the window of her room with her daughter Lori Spencer, left, and son-in-law Michael Spencer. (Ted S. Warren/AP)

The Biden administration does not plan to rely on national pharmacy chains to give booster doses of coronavirus vaccines to millions of nursing home residents this fall, as officials did last winter, federal health officials said.

Instead, almost all nursing homes have told the federal government they plan to work with their existing long-term care pharmacies to provide the shots to residents, as soon as boosters are authorized by federal health officials. Another option might be for residents to get the boosters as part of regular shopping outings the facilities arrange to retail locations such as Walmart, said a federal health official, who spoke on the condition of anonymity because logistics are still being worked out.

Residents “are coming and going from places where vaccines are offered very regularly,” the official said. “A lot of these facilities, they already maybe plan a weekly outing to Walmart for people to get their groceries. So what we want to say is, ‘Look, if you’re already doing that, is that an opportunity where that population can get their booster shot while they’re on one of those usual visits?”

The administration is stepping up preparations to provide boosters to priority groups — health-care providers, nursing home residents and other seniors — after last week’s announcement that it would begin offering the shots the week of Sept. 20 because of concerns about waningimmunity. Officials plan to offer third shots to people who received the Pfizer-BioNTech or Moderna vaccines eight months after they received their second dose.

Nursing home and assisted-living facilities are a priority because of the devastating waves of infections and deaths in earlier phases of the pandemic. About 134,000 nursing home residents have died of covid-19. Cases and deaths have fallen in recent months because of residents’ high vaccination rates.

Residents may also be given incentives to encourage them to get the shots, such as a coupon for grocery discounts.That would be preferable to “setting up some sort of new system that actually may take longer, or may be more cumbersome to implement to take vaccines to long-term care facilities,” the official said.

But some long-term care facilities do not have access to vaccine providers.

An estimated 600 to 700 — less than 5 percent of the roughly 15,000 nursing homes in the United States — have told federal officials they do not have relationships with pharmacies or access to providers and will need assistance. The Centers for Disease Control and Prevention is working with those facilities to connect them to vaccine providers.

“We’re sort of playing matchmaker,” the health official said. “If you have a skilled nursing facility in Indiana who wants some pharmacy chain to come in and help provide vaccines to them … we’re making those matches,” the official said.

Representatives of nursing homes and other elder-care organizations said widespread availability of vaccines should mean fewer delays in administering the shots.

“This time around, supply is not limited,” Lisa Sanders, a spokeswoman for Leading Age, an association of nonprofit providers of aging services said in an email. “Our nursing home members regularly work with their long-term care pharmacy partners, and most have access to them for boosters.”

The coronavirus vaccine rollout in the winter was an “exceptional situation” because of scarcity of vaccine, she noted. “We’re hopeful the booster rollout will go smoothly in nursing homes.”

Advocates and others involved in vaccination effort say many issues still need to be addressed.

“We haven’t seen a plan,” said Mike Dark, a staff lawyer with California Advocates for Nursing Home Reform, an advocacy group. If the federal government is no longer relying on the large pharmacy chains, “we need to be asking the hard questions about how long it will take, especially in the rural and poor areas of the country.”

Assisted-living facilities, which are often small mom-and-pop operations, do not have strong relationships with health-care providers and “have historically fallen through the cracks in the rollout efforts for vaccines,” Dark said.

“We just have a lot to work through, while at the same time maintaining an intense focus on getting unvaccinated people vaccinated,” said Claire Hannan, executive director of the Association of Immunization Managers, which helps coordinate vaccination campaigns across the United States. Immunization personnel did not know there would be an eight-month clock, or that the federal government would not be using CVS and Walgreens, she said.

“Anyway you slice it, [long-term care facilities] have a lot of work to do,” Hannan wrote in an email. That includes coordinating and potentially contracting for vaccinators to give the shots on-site, and reporting the doses administered.

An estimated 4.5 million residents and staff live and work in nursing homes and assisted-living facilities, according to industry figures. Nursing homes have about 1.3 million residents and 1.6 million staff; assisted-living facilities have about 1 million residents and 455,000 staff.

Spokesmen for CVS and Walgreens said that despite the changes, they continue to work with federal officials to plan for booster vaccinations.

Omnicare, a long-term care pharmacy owned by CVS with locations in 49 states, is already supplying vaccines to nursing homes, said CVS spokesman Michael DeAngelis.

CVS Pharmacy stores can also do online scheduling or walk-ins for vaccination appointments, and these options “will continue to be offered to our [long-term care facilities] once booster shots are available,” DeAngelis said in a statement. CVS will also be providing an online resource for nursing homes and other facilities to contact CVS directly to schedule on-site vaccination clinics, if needed.

“Due to expected demand for booster shots in our pharmacies, the availability of on-site vaccination clinics at facilities will be determined by local resources,” DeAngelis said.

When vaccinations began in December, the Trump administration contracted with pharmacy giants CVS and Walgreens to coordinate, schedule and administer vaccines because of complicated storage, handling and reporting requirements and scarcity of vaccine. That program, which ended in April, administered almost 8 million doses of vaccine to staff and residents at more than 62,000 long-term care facilities, according to the CDC.

State health officials have complained that the initial vaccine rollout in nursing homes was slow. Pharmacy officials have said they ran into delays in vaccine deliveries to their regional hubs and more vaccine hesitancy than they anticipated among residents and staff. About 83 percent of nursing home residents have been vaccinated, and 61 percent of staff have received their shots, according to federal government data.

But with the spread of the highly transmissible delta variant, health officials have reported increasing coronavirus cases in long-term care facilities in several states over the past few weeks, including in Colorado, Iowa, North Carolina, and Texas. CDC data show cases of covid-19 among nursing home residents have risen to 4,105 for the week ending Aug. 22, the highest figure reported since mid-February.

To increase vaccination rates, the Biden administration also announced last week that it is requiring nursing homes to mandate that all of their workers be vaccinated against covid-19 as a condition for those facilities to receive federal funds. The Department of Health and Human Services, which is developing the new regulations, will enforce them with the threat of withholding Medicare and Medicaid dollars, the major source of funding for more than 15,000 nursing home facilities, which employ roughly 1.3 million workers.