Although some sectors of long-term care are making progress on vaccinating residents, there are ongoing challenges to reach residents of assisted living and other residential care communities, as well as their staff members, according to a panel of experts discussing early lessons from the COVID-19 vaccine rollout at a Thursday webinar held by the Kaiser Family Foundation.

As of Wednesday, just over 1 million vaccine doses had been given in long-term care settings through the federal Pharmacy Partnership for Long-Term Care, according to Tricia Neuman, KFF senior vice president. But that means that less than half of the 2 million residents of assisted living communities and nursing homes have been vaccinated. 

Long-term care settings account for 6% of all COVID-19 cases nationally but 38% of deaths. Priya Chidambaram, a KFF senior policy analyst, said that new cases and deaths in long-term care facilities have been on the rise since September. Such settings reported their highest number of new cases in December, and new KFF data suggest that those numbers will surpass 2020’s record highs, with new peaks in early 2021 in new cases and deaths.

“The patterns in cases and deaths do follow patterns we see nationwide,” Chidambaram said. “It lines up with research connecting community spread to spread of the virus in long-term care facilities.”

Vaccination priorities

Mark Parkinson, president and CEO of the American Health Care Association / National Center for Assisted Living, called COVID-19 the “worst tragedy in the history of long-term care.” Despite working 24/7 to do everything to fight COVID-19, the industry is “losing,” he said. 

But Parkinson said there is an incredible opportunity to change the narrative. Less than 1% of the population — 2 million to 3 million people — live in long-term care facilities, yet, as Chidambaram said, account for almost 40% of COVID-related deaths.

“If we could get our act together and figure out how to get all of these people vaccinated, in a very short period of time, we could cut the death rate dramatically,” Parkinson said. “If we can just figure out how to just vaccinate 2 to 3 million people — we know who they are and where they live — we can have an incredible impact on the death rate from COVID. This provides a way to put this behind us.”

The federal pharmacy program leading the vaccination effort in long-term care facilities, Parkinson said, is “going pretty well.” He said he anticipates that states will meet AHCA / NCAL’s challenge to have all second doses of vaccine administered in long-term care residents by March 1.

Rina Shah, group vice president for Walgreens pharmacy operations and services, said that the company has 240,000 employees working through the federal pharmacy partnership to deliver vaccines to 35,000 long-term care facilities. As of Wednesday, Walgreens administered over 500,000 vaccine doses through 6,000 clinics, with another 6,000 clinics scheduled next week. She said 95% of skilled nursing facility residents will have had their first dose of vaccine by Jan. 25.

Assisted living waits

Nicole Howell, executive director of California-based Ombudsman Services of Contra Costa, Solano and Alameda Counties, which advocates for long-term care residents, said that although vaccination is going well in skilled nursing facilities, residents of assisted living and other residential care settings are “confused and concerned” by misinformation or a lack of information.

“They are at a breaking point,” Howell said. “We’ve been fighting a battle, and we’re exhausted. We’re told help is just the next mountain range, and that the pharmacy partnership has been activated, and yet it’s not getting to us fast enough.”

The increase in vaccination in the assisted living population is thanks to local public health departments and counties, Howell said. Those local health entities are seeing the strain of facility outbreaks on local hospitals, she said, and they are stepping up and taking vaccinations off the top of their allocations and diverting them to long-term care.

“For residents, we are at a place of real desperation and a real decision point as to how we treat those in long-term care,” Howell said, adding that local healthcare entities need to ensure that all long-term care residents have received their first doses by Valentine’s Day.

In assisted living communities and residential care homes, Shah said, barriers to immunization often are the administrative portion of the process and the uneven activation of different parts of the vaccination program in states. 

Howell said the problem is bigger than one organization can take on. She advocated for partnerships with county public health departments and long-term care pharmacies that largely have been “cut out of the process.”

Staff hesitancy

Parkinson estimated that the staff vaccination rate after the first clinics was only approximately 50%, with some buildings reporting staff vaccination rates as low as 20%. He blamed misinformation and the lingering effect of the Tuskegee experiments as reasons for the low numbers.

“We’ve really got to redouble our effort to get uptake of staff better,” Parkinson said.

Matt Yarnell, president of SEIU Healthcare Pennsylvania and national chair of SEIU’s Nursing Home Council, said that close to 1,300 caregivers have lost their lives to COVID-19. Much work needs to be done to build trust in the workforce, he added. 

But mandating COVID-19 vaccination as a condition of employment is a “bad move,” Yarnell said.

“Take a step back and do the hard work and communication work to really meet people where they are,” he said.

Some providers are concerned that vaccination mandates will create larger staffing shortages in an industry that already has chronic staffing problems, Parkinson noted.

“The reality is, it’s hard to find people to work in these buildings,” he said, adding that he advocates for the “carrot” rather than the “stick” approach. “I’ve been encouraging providers to offer incentives and rewards and bonuses to people who get the vaccine as opposed to punishments if they don’t. But one way or another, we have to get this rate much higher than it is now.”