A “nuanced approach with attention to details” is necessary for senior living communities to navigate the uncertainties, hesitancies and logistical issues of COVID-19 vaccination, according to Patricia Davidson, Ph.D., dean of the Johns Hopkins Bloomberg School of Nursing.

Davidson made the observation during a COVID-19 vaccination virtual town hall Wednesday for senior living and affordable seniors housing administrators, managers and staff members. A panel of experts from the Johns Hopkins Schools of Nursing and Public Health, LeadingAge and the Baltimore City Health Department addressed the science behind vaccines, vaccine distribution, messaging strategies, infection prevention vigilance, and other pandemic challenges in senior living communities.

Vaccine uptake

Morgan Katz, M.D., a Johns Hopkins University assistant professor of infectious disease, said assisted living communities and nursing homes are “looking to an end to this.” That end, she said, will depend on vaccine uptake.

“We want things to change like a switch,” Katz said. “We are on the path. We can expect slowly, slowly to continue to see changes as more and more people get vaccinated. It’s so important for all of us to do our part, in terms of spreading this education and making people aware of the benefits of the vaccine, not just for yourselves, but for the community and the world.”

She predicted another couple of months of a “slog,” “but after what we’ve been through, we can do it.”

While vaccination is rolling out at senior living communities, she said, it’s important to stick with core infection prevention practices. Until community prevalence decreases in the general population, policies related to testing, limited visitation practices and infection control measures cannot be changed, Katz added.

“I think even after staff are vaccinated, even after residents are vaccinated, it depends on vaccine uptake in the community,” she said. “If you’re only vaccinating 50% of the community, it makes it harder to get to a point where you can stop the testing. You’re still vulnerable at that point.”

Attitudes

Thomas Cudjoe, M.D., a Johns Hopkins University assistant professor, cares for older adults through the university’s home-based medicine program. He said he has encountered both excitement and hesitancy among his patients concerning the vaccine.

Cudjoe said it’s important to acknowledge varying interest in the vaccine in older adults. He is focusing conversations on motivations for how to get through the current experience — balancing unknowns against the known threat of COVID-19. 

“Acknowledge vaccines are part of a broader strategy in our effort to mitigate the effects of the coronavirus,” Cudjoe said. 

Education

William Moss, M.D., executive director of the Johns Hopkins International Vaccine Access Center, said one of the biggest struggles for senior living providers is combating myths and misinformation about the COVID-19 vaccines.

The 95% efficacy shown by both the Pfizer and Moderna vaccines, he said, is “astonishing.” Equally remarkable, he said, is that protective efficacy was just as high in older adults. 

Juliana Bilowich, LeadingAge director of housing operations and policy, said that the education component on the vaccine cannot be understated. 

“The education effort is not just limited to vaccine clinics,” she said. “It’s an ongoing effort to improve outcomes at these communities.”

Getting on the radar

Providers are in a great position to help improve resident health outcomes, she said. Communities that did not enroll in the Centers for Disease Control and Prevention’s Pharmacy Partnership for Long-Term Care, which is facilitating on-site vaccination of residents and staff at enrolled assisted living communities and skilled nursing facilities, should “try everything you can to get on the radar of your state and health departments to be part of expanded strategies for vaccine distribution.”

CDC epidemiologist Ruth Link-Gelles, Ph.D., said most vaccinations in skilled nursing facilities through the federal pharmacy partnership have been completed, with assisted living communities and other long-term care facilities scheduling or starting vaccination clinics this week. 

It’s too late for communities to sign up for the federal program, but Link-Gelles echoed Bilowich’s comments on working with state and local health departments to vaccinate residents.

Heang Tan, deputy commissioner of aging and care services for the Baltimore City Health Department, went a step further and asked senior living providers to consider potential policies requiring staff members to take the vaccine if they can. 

Atria Senior Living and Juniper Communities are among senior living operators moving to make a COVID-19 vaccination a condition of employment to more quickly mitigate the effects of the virus in their communities. The U.S. Equal Employment Opportunity Commission in December released guidance stating that employers can require proof of COVID-19 vaccination from employees, with some exceptions.

COVID strategy courses

The town hall was a supplement to the recently launched Johns Hopkins Bloomberg School of Public Health free COVID-19 training courses in strategies for assisted living and senior housing communities during COVID-19.