No group suffered more during the COVID-19 pandemic than employees and residents of nursing homes, where high concentrations of elderly people with serious health problems created the perfect ground for killing the virus.
Still, the effort to vaccinate people in these homes is proceeding at a frustratingly slow pace, according to experts across the country.
On Friday, only about 17% of the more than 4 million doses of vaccine distributed to long-term care facilities were injected, according to the Centers for Disease Control and Prevention.
“Clearly, nobody cares if the elderly die,” said Dr. Michael Wasserman, former president of California Assn. Long Term Care Medicine, which represents doctors, nurses and other people who work in nursing homes. “We could have all these places vaccinated quickly if we approached it in the right way.”
Wasserman blames the federal government for not establishing a simplified plan and directly overseeing the delivery of the vaccine.
Instead, the crucial decisions about who gets the vaccines first were left to state and local governments, and the job of actually administering the injections was left to major national drugstore chains – CVS and Walgreens – that don’t have the same relationship with nursing homes such as specialized pharmacies that already serve the sector.
Slow implementation is “certainly a cause for alarm,” said David Grabowski, professor of health policy at Harvard Medical School. “I think that, like many other parts of the pandemic, the federal response was very slow.”
Among the obstacles is bureaucracy: the large amount of work required to complete forms and upload data to ensure that consent has been obtained and that each dose is tracked.
“It’s crazy,” said Jeff Sprinkle, administrator of the Lake Minnetonka Care Center, a home with only about 20 residents in Deephaven, Minnesota. When a team showed up to administer the injections in late December, they had six people with them, more than could safely fit in the small break room used for vaccinations, given the demands of social distance. And three of those people were just there to “insert information into their database,” said Sprinkle.
The team took 7 and a half hours to vaccinate everyone, a task that could have been completed by a single nurse at the same time without all the paperwork, said Sprinkle.
And because the vaccines come in batches, there are about eight doses left after all those qualified for the first round of vaccines have been vaccinated.
“I thought about vaccinating my family, giving it to my wife, but I figured that if it were news, it would insult us,” said Sprinkle. Instead, the doses went to waste.
Another obstacle has been the surprising degree of hesitation among the nursing staff to get the vaccine. A survey conducted last month by the Kaiser Family Foundation found that 29% of health professionals across the country were “hesitant about the vaccine”, a number slightly higher than the percentage of the general population, 27%.
“We don’t treat staff very well in this pandemic,” said Grabowski.
Approximately 40% of COVID-19 deaths across the country occurred among residents and employees in long-term care facilities, but workers have suffered a chronic shortage of the masks, gloves and aprons needed to keep them protected from the virus, and most have been denied payment for dangerousness, although they have done some of the most dangerous work.
“I think they are very suspicious now,” said Grabowski. “I understand why they may not be eager to step forward.”
Another factor that slows down the launch is the number of active cases in nursing homes, which has steadily increased along with the increase in post-holiday cases in the general public.
“If you have a nursing home with 100 residents and 20 had COVID in the past week, they can choose not to get the vaccine,” said Dr. Christian Bergman, an academic geriatrician at Virginia Commonwealth University. “You wouldn’t be able to monitor any adverse events and they would probably have protection for 90 days, so we are not giving them to these people.”
Life-saving vaccines did not start being administered in Virginia until December 28, Bergman said, and then vaccines stopped abruptly on New Year’s Eve and New Year’s Day, slowing things down from the start.
Despite the flaws, most households in the state expect to have their first doses administered in mid-January. “It will help a lot to contain the spread,” said Bergman.
So far, it is difficult to obtain data to document the progress of the vaccination effort in California nursing homes. Los Angeles state and county health officials did not respond to requests for numbers on Friday afternoon.
But interviews with local industry experts suggest that things are not going much faster in California than elsewhere in the country.
Raffaela Meyer, vice president of operations at Skilled Nursing Pharmacy, which specializes in providing medicine for nursing homes in California, said there are problems across the state.
His company has so far not been hired to administer the vaccines, but many of his customers said they are not scheduled to receive their first doses until the end of January. In Los Angeles County, where public health officials chose not to participate in the program run by CVS and Walgreens to deal directly with vaccines, households saw the opposite problem.
“Many of our nursing homes in LA County have hundreds of extra doses,” said Meyer. Once opened, these vaccines have a limited shelf life and nursing homes do not know what to do with them.
“I am in calls every week with LA County; they have no answer. In calls with [state health officials], they don’t know either, ”said Meyer.
Most homes with extra doses are specialized nursing facilities, places for people who need the highest level of medical care.
They have been a top priority for getting vaccines, along with first-rate hospital staff, due to the devastating number the virus has caused there.
One way to use your extra doses, said Wasserman, would be to share them with assisted homes, whose residents are the same age and are almost always sick, but were not included in the first group to be vaccinated.
“They are on fire with new cases now,” said Wasserman. He fears that frustration with the delays will lead to pressure to distribute the vaccine to the general public before state and local governments even vaccinate people in assisted living facilities.
“And who is pushed to the back of the bus then? Elderly residents and the poor black women who care for them, ”said Wasserman.