Community carrying large vaccination syringe
(Credit: Malte Mueller / Getty Images)

Changing insurance coverage and reimbursement, improving communication by government and public health agencies with long-term care settings, identifying “immunization champions” and gaining long-term care and geriatric representation on the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices could help improve all types of vaccination of senior living and other long-term care residents.

That’s according to a recently released white paper detailing recommendations emerging from a January roundtable of 45 stakeholders convened by the Alliance for Aging Research and the American Society of Consultant Pharmacists. LeadingAge, Argentum and AMDA–The Society for Post-Acute and Long-Term Care Medicine were among the participants, which included long-term care providers, national health professional societies, public health associations, patient advocacy organizations, industry and the federal government.

In addition to vaccine update, the paper lays out recommendations to improve vaccine confidence and stress the importance of collaboration and coordination.

“We must act now to ensure that the public health crisis of the past three years and the lessons we have learned can be converted into a proactive playbook for public health, prevention, preparedness and care,” the paper authors said. “Acting on the recommendations outlined in this white paper will put us on a path to ensuring that the nation’s most vulnerable and at-risk — older individuals, immunocompromised people, and residents of long-term care facilities and other congregate care settings — can have easier, regular access to the vaccines recommended” by the Centers for Disease Control and Prevention.

Long-term care pharmacies ‘vital’

The group also recommended formally incorporating long-term care pharmacies into the nation’s medical and public health infrastructures. 

Such pharmacies remain “vital” to all immunization efforts, they authors said, but accomplishing this goal would necessitate changes to public and private health plan payment policies, federal Medicare statute and other public policies.

“The model of using a long-term care pharmacy as the foundation for vaccination of long-term care residents is incredibly flexible, and its nimbleness allows it to meet the needs of every resident at every long-term care facility,” the paper reads. “This system must be maintained as it will allow for ongoing vaccination against COVID-19, as well as vaccination against influenza, pneumococcal disease, and all diseases that currently have — or will have — ACIP recommendations for adults.” 

Unlike skilled nursing facilities, assisted living communities typically do not have the “qualified personnel” and authorization to administer vaccines, the report noted. “As such, assisted living settings therefore typically also lack the personnel who are qualified to administer vaccines, requiring them to either bring in authorized individuals from the outside or transporting residents to get vaccinated,” the authors said.

Meeting in advance of the expiration of the federal public health emergency, the group identified waivers and flexibilities that warranted extension or permanence, including public-private partnerships and other regulatory flexibility that allowed pharmacists to play an integral role in vaccinating long-term care residents and staff. Between December 2020 and April 2021, the federal Pharmacy Partnership for Long-Term Care program administered approximately 8.1 million COVID-19 vaccine doses within assisted living communities and nursing homes.

The roundtable also developed recommendations for federal government actions, specifically highlighting actions needed from the White House, the Department of Health and Human Services, the CDC, the Centers for Medicare & Medicaid Services, the Food and Drug Administration and Congress. Additional recommendations were highlighted for vaccine manufacturers and third-party stakeholders, including clinician associations and patient advocacy groups.