Assisted living and skilled nursing providers greeted news of a vaccine against the SARS-CoV-2 virus with hope and enthusiasm in December. COVID-19 cases in long-term care total 6% — and 38% of deaths — nationally.  

In January, however, there is confusion, concern and disappointment at the lagging rates of vaccination for older adults, particularly those who live in assisted living and other residential care communities. Many of these residents have yet to receive — or be scheduled for — their first vaccine, even as the federal government announced an expansion of the vaccination rollout.

Progress is being made — as of Jan. 15, the Centers for Disease Control and Prevention reported that almost 1 million doses had been administered across long-term care settings, representing more than 46% of the 3 million older adults in assisted living communities, skilled nursing facilities and other congregate settings.  

“This shows a marked improvement over prior weeks and even days, and we expect the rate of administration to continue to rise,” John Schulte, Argentum vice president of quality improvement, told McKnight’s Senior Living. He added it’s “imperative”’ that residents and employees in senior congregate living settings — regardless of care level — continue to be prioritized to maximize vaccine effectiveness. 

Even as vaccines are rolling out, the coming months could be “the deadliest of the pandemic” for people living and working in long-term care, according to projections.

Among the challenges the federal program faces are vaccine hesitancy by long-term care workers; spikes in cases in some facilities, necessitating the rescheduling of vaccine clinics;  and delays in activating assisted living and other long-term care communities as priority populations.

Mark Parkinson, president and CEO of the American Health Care Association / National Center for Assisted Living, has said he knew the rollout would take time. Vaccine hesitancy is a primary focus.

“We remain hopeful that uptake for the vaccine will improve as this pharmacy partnership program continues to unfold in the coming weeks and months in the subsequent clinics,” he said. 

State plans

Some states and cities are taking matters into their own hands

In Seattle, the fire department is being used to vaccinate residents and staff at adult family homes. Florida hired an emergency services company to vaccinate residents at 1,900 assisted living communities. West Virginia, which opted out of the federal pharmacy partnership, was the first state to finish initial vaccination of all long-term care facility residents by Dec. 30. Colorado requires providers to administer vaccine doses within 72 hours or lose them.

Wisconsin officially activated Part B of the Pharmacy Partnership for Long-Term Care Program to provide vaccinations at assisted living communities last week, indicating that once nursing homes vaccinations are completed, assisted living vaccinations can begin.

Arizona Gov. Doug Ducey (R) issued an executive order enabling the state to reallocate vaccine doses to provide statewide coverage for rapid distribution and administration. Washington Gov. Jay Inslee (D) on Monday announced a public-private partnership between the state health department and companies to boost the state’s COVID-19 vaccinations, aiming to vaccinate 45,000 Washingtonians per day.

Frustration

Officials in other states have expressed frustration at the slow rollout of vaccination in their aging populations.

In California, news reports revealed that about 83% of long-term care facilities partnering with CVS Health and Walgreens through the federal pharmacy partnership have yet to receive clinic dates — especially assisted living communities. According to the Sacramento Bee, California ranks third worst among states in the country in percentage of vaccine doses administered. Only Alabama and Georgia had lower rates.

LeadingAge PA President and CEO Adam Marles told McKnight’s Senior Living that Pennsylvania is “extremely far behind other states” in vaccinating residents in assisted living and personal care homes. Meanwhile, he said, the state announced Tuesday that it was expanding Phase 1a to include individuals aged more than 65 years and those aged 16 to 64 who have high-risk conditions, while also raising concerns about vaccine availability.

“The conflicting messaging and ineffective rollout are frustrating to providers, residents and families alike,” Marles told McKnight’s Senior Living. He added that he is “fearful” that this will make a “devastatingly slow process for vaccinating the individuals living in these settings worse.”

Marles also cautioned that the Keystone State has no plan for people living in independent living communities or affordable senior housing.

“We have been doing our best to educate the state on why these individuals need to be prioritized, too, particularly those who live on the same campuses with nursing homes and personal care homes / assisted living residences,” Marles said. “Providers have spent 10 months keeping older adults safe on campuses, and the best the state sees to offer is that now they should leave that safe environment to find a clinic elsewhere.”

Pennsylvania activated Phase B of the federal Pharmacy Partnership for Long-Term Care Program — for long-term care facilities other than skilled nursing — last week, expanding vaccinations to personal care and assisted living communities. The state health department also asked the federal government to launch the Retail Pharmacy Partnership to expand access to vaccinate healthcare personnel and, eventually, other phases of the state’s vaccine plan. 

There are approximately 1,200 personal care homes and assisted living facilities in Pennsylvania, as well as 700 skilled nursing facilities, that have a total of 250,000 to 270,000 residents and staff members.

Pennsylvania Health Care Association President and CEO Zach Shamberg said that a month into the vaccine rollout, Pennsylvania has only just scratched the surface of the need in assisted living and personal care homes.

“As the numbers rolled out last week, we learned that only 17% of vaccine allocation was directed to long-term care. That’s a problem,” he said. “We are living within the federal pharmacy partnership program, only utilizing CVS and Walgreens. That’s a problem.”

Shamberg said he looks at neighboring states, including West Virginia, Ohio and Florida, and sees the process working.

“With every day that goes by, potentially, lives are at stake,” he said. “As we look at neighboring states, we are seeing progress. There’s a lot of frustration, a lot of anger here in Pennsylvania from providers, workers, residents and even family members of those residents as they see others begin vaccinated.”

Although the scheduling of vaccination in assisted living communities and personal care homes in the state has begun, he said he is “certainly concerned as we head into February, we are not going to have the vast majority of assisted living and personal care residents and workers vaccinated.” Shamberg also said he is concerned whether the state will have the bandwidth and the manpower to vaccinate assisted living and personal care residents and employees, because the second round of vaccinations also will be occurring in nursing homes.

On Wednesday, the Pennsylvania Human Services and Health departments announced a partnership with Rite Aid to begin administering COVID-19 vaccinations on Jan. 27 to staff members and residents of long-term care facilities and other congregate care settings that were not included in the federal pharmacy partnership program. That includes assisted living communities and personal care homes that were not enrolled in the federal pharmacy partnership, as well as group homes for people with disabilities, residential treatment facilities and private psychiatric hospitals.

The state estimated that 6,000 facilities will be covered by this effort, which will be based on vaccine supply available to the state.