Across the country, some directors of nursing homes and health officials say the partnership is actually disrupting the vaccination process, imposing heavy paperwork and corporate policies on low-staff facilities and suffering from the devastating effects of the coronavirus. They argue that nursing homes are unique medical facilities that would be better served by medical professionals who already understand how they work.
Mississippi state health officer Dr. Thomas Dobbs said the partnership “was a failure.”
The state has committed 90,000 doses of vaccines to the effort, but pharmacies administered only 5% of those vaccines by Thursday, Dobbs said. Pharmacy officials told him that they are having trouble finding enough staff to work on the program.
Dobbs pointed to neighbors Alabama and Louisiana, who he says is vaccinating long-term care residents four times more than in Mississippi.
“We are making a lot of people angry because it is going very slowly, and we are also unhappy,” he said.
Many of the nursing homes that have successfully vaccinated residents and employees are doing so without federal aid.
For example, the Los Angeles Jewish Home, with about 1,650 employees and 1,100 residents on four campuses, began vaccinating on December 30. On January 11, the home medical team administered its 1,640th dose. Even the facility’s chief medical director, Noah Marco, helped vaccinate.
The house is located in Los Angeles County, which refused to participate in the CVS / Walgreens program. Instead, it has tasked nursing homes to administer the vaccines alone and is using only Moderna’s easiest-to-handle product, which does not need to be stored in deep-frozen temperatures, such as the Pfizer vaccine. (Both vaccines require two doses to offer full protection, with an interval of 21 to 28 days).
In contrast, Mariner Health Central, which operates 20 nursing homes in California, is counting on the federal partnership for their homes outside of LA County. One of them will not receive the first doses until next week.
“It has been much worse than anyone expected,” said the network’s medical director, Dr. Karl Steinberg. “That light at the end of the tunnel is dim.”
Facilities that participate in the federal partnership typically schedule three vaccine clinics over the course of nine to 12 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 those who miss the others. Before administering vaccines, pharmacies require that health facilities obtain the consent of residents and employees.
Despite complaints of a slow launch, CVS and Walgreens said they are on track to finish giving the first doses on January 25, as promised.
“Everything went as planned, except for a few cases where we were challenged or had difficulty contacting long-term care institutions to schedule clinics,” said Joe Goode, a spokesman for CVS Health.
Dr. Marcus Plescia, medical director of the Association of State and Territory Health Officers, acknowledged some delays in the partnership, but said this was expected because this type of effort has never been attempted before.
“There is a feeling that they will update quickly and it will be useful, as health departments are overwhelmed,” said Plescia.
But any delay puts lives at risk, said Dr. Michael Wasserman, immediate past president of the California Association of Long Term Care Medicine.
“I’m about to become nuclear about it,” he said. “There should never be an excuse for people not to be vaccinated. There is no excuse for delays.”
Bringing vaccinators
Nursing homes are equipped with resources that could have helped with the vaccination effort – but are generally not being used.
Most already work with specialized pharmacists who understand the needs of nursing homes and administer annual medicines and vaccines. These pharmacists know patients and their medical histories and are familiar with the apparatus of nursing homes, said Linda Taetz, director of compliance at Mariner Health Central.
“It’s not that they’re not capable,” said Taetz of pharmaceutical retailers. “They are simply not embedded in our buildings.”
If an institution participates in the federal program, it cannot use these or any other pharmacists or employees to vaccinate, said Nicole Howell, executive director of Ombudsman Services for Contra Costa, Solano and Alameda counties.
But many nursing homes would like to have the flexibility to do this because they believe it would speed up the process, help build trust and get more people to say yes to the vaccine, she said.
Howell pointed to West Virginia, which relied primarily on independent local pharmacies, rather than the federal program to vaccinate nursing home residents.
The state opted against the partnership in large part because CVS / Walgreens would take weeks to start the injections and Republican Governor Jim Justice wanted them to start immediately, said Marty Wright, CEO of the West Virginia Health Care Association, which represents the long-term state care facilities.
Most of the work is being done by more than 60 pharmacies, giving the state more control over how doses are distributed, Wright said. Walgreens joined pharmacies in the second week, he said, although not as part of the federal partnership.
“We were more interested in local pharmacies than facilities that we could partner with,” said Wright. Preliminary estimates show that more than 80% of residents and 60% of employees in more than 200 homes received their first dose by the end of December, he said.
CVS ‘Goode said his company’s participation in the program is being led by its long-term care division, which has deep experience with nursing homes. He noted that tens of thousands of nursing homes – about 85% nationwide, according to the CDC – found this comforting enough to participate.
“This underscores the confidence that the long-term care community has in CVS and Walgreens,” he said.
Those who receive the vaccine pay nothing out of pocket for injections. The purchase and administration costs are covered by the federal government and health insurance, which means that CVS and Walgreens can make a lot of money: Medicare is reimbursing $ 16.94 for the first injection and $ 28.39 for the second.
Bureaucratic delays
Technically, federal law does not require nursing homes to obtain written consent for vaccination.
But CVS and Walgreens require that they obtain verbal or written consent from residents or family members, which must be documented on forms provided by pharmacies.
Goode said consent has not been an impediment so far, but many people on the ground disagree. The requirements slowed the process, as healthcare facilities collect paper forms and Medicare numbers from residents, said Tracy Greene Mintz, a social worker who owns Senior Care Training, which trains and distributes social workers in more than 100 facilities in California.
In some cases, social workers sent paper consent forms to families and waited to retrieve them, she said.
“The facility is busy trying to keep residents alive,” said Greene Mintz. “If you want to get paid for Medicare, do your own paperwork,” she suggested to CVS and Walgreens.
Scheduling has also been a challenge for some nursing homes, in part because people who are actively sick with Covid should not be vaccinated, advises the CDC.
“If something happens, say, an entire building becomes Covid positive, you don’t want pharmacists to come because no one is going to get the vaccine,” said Taetz of Mariner Health.
Both pharmaceutical companies say they work with facilities to reschedule when necessary. This happened at Windsor Chico Creek Care and Rehabilitation in Chico, California, where a clinic was delayed one day because it was waiting for the results of the Covid test for residents. Melissa Cabrera, who manages the facility’s infection control, described the process as streamlined and professional.
In Illinois, about 12,000 of the state’s nearly 55,000 nursing home residents received their first dose on Sunday, mainly through the CVS / Walgreens partnership, said Matt Hartman, executive director of the Illinois Health Care Association.
While Hartman expects pharmacies to finish administering the first round by the end of the month, he noted that there is a lot of “headache” regarding scheduling clinics, especially when there are home outbreaks.
“Are we happy we didn’t make it through the first round and West Virginia finished?” 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, a service editorially independent of California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.