Nursing Homes Navigate an Uncertain Vaccine Future as Federal Program Wraps Up

Skilled nursing facilities were given clear vaccine opportunities through the federal Pharmacy Partnership for Long-Term Care program, which provided three on-site clinics at facilities across the country — with the goal of providing the two-dose inoculations to as many residents and staff as possible.

Now that the third vaccination clinics are wrapping up in most states, the onus to secure shots for new residents admitted after the program began — as well as stubbornly reluctant staffers — is largely up to SNFs themselves

The Centers for Disease Control and Prevention (CDC) is advising SNFs to use their existing long-term care pharmacy to continue vaccinations. But between logistics and finding partners outside of the federal program that has gotten the sector this far, that could prove tricky.

“The idea here is in the next couple of weeks, as supply increases a little bit and the LTC program winds down, we’ll be providing an allocation of vaccine to some of these groups that sit over long-term care pharmacies, and those pharmacies will be able to order down on that vaccine as needed to keep vaccinating residents and staff in facilities,” CDC epidemiologist Ruth Link-Gelles said during a recent call with trade group LeadingAge. “And that vaccine can go to both facilities that were part of the original program, as well as facilities that didn’t participate in the original program.”

More than 95% of nursing facilities nationwide have completed their second on-site clinics as of February 25, according to the American Health Care Association, with about half done with all three.

The drive to keep up the pace of long-term care vaccinations comes as preliminary data shows clear results from the first clinics: Weekly COVID-19 deaths in nursing homes fell by 66% from the start of the federal program at the end of December to early February, a Kaiser Family Foundation analysis found, even as the nationwide death count jumped 61%.

That said, the industry continues to grapple with widespread hesitancy among workers, only 37.5% of whom opted to roll up their sleeves during the first round of clinics, according to the CDC. There is evidence that uptake among staff increases during subsequent clinics, after skeptical workers are able to see their peers suffering no ill effects — making ongoing availability of shots imperative to drive vaccination rates higher.

Swati Gaur — medical director for New Horizons, a pair of transitional care facilities in Georgia operated by the Northeast Georgia Health System — said that many SNFs in the state went with the federal program and now have significant concerns. Facilities that are part of a health system, like New Horizons, were able to choose to get their vaccinate allotment sent to the health system; that’s exactly what New Horizons did, Gaur said. But setting up the distribution and administration was much more complicated than she initially thought it would be.

“We don’t have it always available, because you’re always concerned about opening that vial,” Gaur said. “Typically, you get Moderna, and once you have a vial open, then you have to give all those 10 shots and possibly 11 shots in a short timeframe. We have to have those 11 people lined up between residents and staff.”

With the responsibility on nursing homes to move forward, Gaur worries that SNFs that were relying on the federal partnership won’t know the steps, or who exactly to call, to get residents and staff vaccinated.

“Knowing who to call is a challenge, and I think that challenge can be overcome if departments of public health could give accessible phone numbers, accessible e-mails, or create a step-by-step system, even electronically, to be able to reach out and create a workflow,” Gaur said.

Beth Husted, director of retail services at long-term care pharmacy provider Absolute Pharmacy in Ohio, said the company recently finished up the third clinics as part of the federal program.

“From a vaccine provider standpoint, had we not given flu shots and pneumonia vaccines in a clinic form, I think there would have been a much bigger learning curve for us to implement these clinics and and get things up to par on our side,” Husted said. “So I think facilities will definitely, from participating in the program to being a leader in the program, they’ll have a learning curve as well.”

There are also concerns about whether residents and staff can get a first vaccination during the third clinic. Gaur said she’s heard from several SNF colleagues that pharmacies that are part of the federal program will not administer a first dose during the third clinic.

“What we are hearing is that some of the federal pharmacy programs are basically saying, ‘Well, we can’t give you the second dose, so we’re not going to give you the first dose,’ which is a little bit of a backward approach — especially because we have so much data that shows that prevention of outbreak starts with that first,” Gaur said.

The CDC advises that a first dose can be given at any time, as do recommendations from the Society for Post-Acute and Long-Term Care Medicine. Christopher Laxton, the executive director at the society, said that withholding a vaccine is unethical.

“If you have to wait a month or two months, there is science to show that’s an acceptable process,” Laxton said. “And of course, there’s also the monoclonal antibodies, which are a therapeutic intervention that can also prevent hospitalizations and sort of slow the progression of the disease. There are a number of modalities that nursing homes can deploy to keep their residents safe while we’re waiting.”

Brian Ellsworth, the vice president of public policy and payment transformation at Health Dimensions Group, said his team is in the process of taking an inventory of plans in all seven states where the firm runs SNFs and assisted living facilities.

“Unfortunately, there has not been a lot of direction provided yet on what to do with staff or residents that get their first shot at the third clinic and new staff or residents that arrive after the third clinic,” Ellsworth said. “The federal government has indicated that the states are making the decisions on how this will be handled.”

A spokesman for Walgreens, which along with CVS formed the bulk of the federal vaccination push, wrote in an e-mail to SNN that all patients who elect to receive vaccines will be accommodated.

“If needed, our vaccine leads will work with facilities to administer dose one during clinic three and/or coordinate to have patients vaccinated at local store locations,” the spokesman wrote.

CDC public affairs coordinator Kate Grusich told SNN that facilities have both federal and local options for solving the first-dose, third-clinic problem.

“LTCF staff members who receive their first dose of COVID-19 vaccine at a third clinic can contact CVS, Walgreens, or any other pharmacy locations providing the same vaccine product in their community to schedule an appointment to get their second dose,” Grusich said. “Staff can also contact their local health department for this information. This applies to LTCF residents who are later discharged, too.”

For instance, the state of Wisconsin has said residents and staff can get a first shot during the third clinic, but it’s the responsibility of the SNF to figure out a second dose strategy, according to Ellsworth at Health Dimensions Group.

“In terms of planning for post-LTC Partnership vaccination, WI DPH suggests working with a local pharmacy partner or becoming a vaccinator,” Ellsworth said in an e-mail. “DPH pointed out that some facilities are working with their LTC pharmacy partner or another pharmacy for weekly or bi-weekly visits to vaccinate staff or residents.”