By Elizabeth Weise and Tom Mooney, USA TODAY, December 15 2020
The vast majority of nursing homes in the United States won’t start vaccinating staff and residents against COVID-19 until Dec. 21, and some won’t start until Dec. 28, the Centers for Disease Control and Prevention said.
Monday’s rollout of the Pfizer-BioNTech vaccine brought confusion nationwide as it became clear most long-term care facilities and nursing homes were not taking part in the initial immunizations, despite the CDC’s decision last week to include residents in the first phase of distribution.
That’s because the majority of long-term care facilities opted to take part in a federal program that uses pharmacy chains, including CVS, Walgreens and others, to facilitate vaccination of staff and residents.
“We know this has been an agonizing year for families with medically fragile loved ones in long-term care facilities and equally hard on the people who work and care for those residents,” CDC spokeswoman Kristen Nordlund said. “We are hopeful widespread vaccination of residents and staff in nursing homes and assisted living facilities will pave the way for families to see their loved ones again soon.”
The Federal Pharmacy Partnership for Long-term Care program will launch Dec. 21 for jurisdictions that opted to use the Pfizer-BioNtech vaccine. More than 1,100 vaccination clinics at long-term care facilities across the country are scheduled on that day, Nordlund said.
Another round will come on Dec. 28 for jurisdictions that opted to use Moderna’s COVID-19 vaccine. That vaccine has not yet been authorized by the FDA but is expected to be within the next two weeks. It does not have the ultracold storage requirements of the Pfizer vaccine, which makes it easier to use in areas without access to the specialized equipment.
A handful of facilities will start later this week to test the system so it can be scaled up next week, she said.
That will include selected long-term care facility sites in Florida, Ohio, Connecticut and West Virginia, with others receiving doses as state leaders coordinate with pharmacies, the Department of Health and Human Service said in a statement. Ultimately it is up to governors to determine when vaccinations in nursing homes will begin, according to HHS.
Other states also plan to begin vaccinations at long-term care facilities this week, HHS said.
“CVS Pharmacy teams will administer vaccines in a handful of facilities in Connecticut and Ohio on Dec. 18,” said T.J. Crawford, vice president for external affairs at CVS Health.
The later launch dates were chosen to account for the time needed to ensure enough vaccine supply and for pharmacy partners to schedule and coordinate clinics at each facility, she said.
At a briefing Monday, Gen. Gustave Perna, chief operating officer for the federal government’s Operation Warp Speed, said planning to get vaccine to America’s more than 70,000 long-term health facilities and nursing homes was “incredibly difficult.”
The longer lead time for the facilities was necessary given the complexity, HHS Secretary Alex Azar said during the briefing.
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“They asked us to be sure … to give them headroom to be able to just get the logistics and operations established,” he said. “But there’s no prohibition on distributing and vaccinating sooner.”
The extra time was required in part to allow facilities to prepare so vaccinations can be done efficiently and with as few visits as possible “so we’re not going back and forth,” Perna said.
One issue is getting the necessary permissions signed for residents who may not be able to sign for themselves, he said.
“You have to make sure that all the patients have a signed contract which means sometimes you have to reach out to several layers of family to get the final approval,” Perna said.
Many nursing homes are still struggling with that requirement, said Kathleen Heren, Rhode Island’s long-term care ombudsman.
The CDC allowed nursing homes to get verbal permission from residents, she said, but the pharmacies that will do the vaccinations have mailed out written permission forms for residents to sign.
“We’re still working on how we’re going to get people vaccinated who do not have someone to sign for them, or for those with dementia,” said Heren, adding that homes were hoping to get clarification from the state Department of Health.
In CVS’ case, those were printed forms in triplicate, said Dr. Richard Feifer, chief medical officer at Genesis HealthCare, which runs more than 325 short- and long-term care facilities in 24 states.
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He said he doesn’t believe the wait is unreasonable because the vaccine was authorized only on Friday, and it will take time for his staff to get consent forms for everyone who is to be vaccinated.
They must be completed before the visit “because the pharmacy needs to know exactly how many doses need to be administered,” he said.
Some states heard different reasons for the lack of vaccine.
Brent Willett, president of the Iowa Health Care Association, said he was told the delay was the result of a federal rule requiring states have on hand 50% of the vaccine needed for their nursing home residents before starting vaccinations.
Sarah Ekstrand, a spokeswoman for the Iowa Department of Public Health, confirmed the requirement.
The confusion was frustrating for those who work in the field.
“I’m hearing from some members that they’re not happy, but it has to do with this being a whole different process” of distribution, said James Nyberg, executive director of LeadingAge Rhode Island, a group of 15 not-for-profit nursing homes in Rhode Island
“Obviously we wish we can get it as soon as possible, because every day counts.”
Contributing: Karen Weintraub, Tony Leys, Des Moines Register