Nursing homes hit early roadblocks in massive vaccine campaign

Nursing homes and assisted living facilities across the country are facing difficult headwinds as they kick off a mass-vaccination campaign against the coronavirus.

Challenges in obtaining consent could delay vaccinations for millions of residents, and some staff are balking at taking the vaccine, prompting facilities to launch education initiatives in an effort to win them over.

Congregate settings like nursing homes have proved to be the most dangerous areas for COVID-19 transmission, and the elderly are the most likely to face severe complications, including death, if they get the disease.

States have been vaccinating health workers for almost three weeks, but a federal partnership with CVS and Walgreens to inoculate residents and staff of long term care facilities didn’t launch until last week, and in only a dozen states.

Thirty-six more states and the District of Columbia kicked off their programs this week.

Because of the large number of facilities and the logistical challenges, it will take months to reach every U.S. facility.

“This is not rolling out the vaccine for hospital staff, for example. It’s a very different group of workers, and a very different group of residents or patients that are receiving care in nursing homes, and so we definitely need to recognize that difference,” said David Grabowski, a health policy professor at Harvard Medical School.

“This is not like a group of hospital workers that will be done very effectively and efficiently. This is a group that’s going to take more time,” he added.

For nursing home advocates, one of the biggest hurdles facilities will need to overcome is obtaining consent, especially when a patient is suffering from Alzheimer’s or dementia.

If a resident is unable to consent, facilities will need to track down relatives, guardians or attorneys.

Even if a resident is able to consent, he or she may want to first discuss the vaccination with a family member. Those discussions might not be possible in person given the strict limitations on visits due to the pandemic.

“If you have somebody that can’t communicate verbally, and you cannot get a family member to come in, how do you communicate with that person?” said Alison Weingartner, executive director of Massachusetts Advocates for Nursing Home Reform.

The Centers for Disease Control and Prevention, which is overseeing the pharmacy partnership, said verbal consent would be enough, but there is no federal requirement for informed consent about immunizations.

Initially, both CVS and Walgreens indicated that written consent would be required, but later said they will allow verbal confirmation after facilities complained about the burdensome requirements and complicated consent forms.

Mike Dark, a staff attorney with California Advocates for Nursing Home Reform, said consent has never really been an issue in the past, but the politicization of virtually every facet of the COVID-19 pandemic has changed that.

“When you’re dealing with something like the flu, or maybe someone breaking their hip and needing to go to the hospital, that’s not an inherently sort of controversial situation. Certainly not in the way that getting vaccinated from COVID has turned out to be,” Dark said.

CVS expects to vaccinate up to 4 million residents and staff at more than 40,000 long-term care facilities through the program; nearly 3 million residents at 35,000 facilities are partnering with Walgreens.

Under the program, pharmacy teams make three visits to each long-term care facility to ensure residents and staff receive their initial shot and booster. The majority of residents and staff will be fully vaccinated three to four weeks after the first visit, depending on which vaccine they receive.

Long-term care facility operators said they appreciated the switch to verbal consent, and they anticipate it will make the vaccination process go more smoothly.

Verbal consent is “a game changer from having to get an in person signature, which, in these days, would have been virtually impossible and really made it incredibly difficult,” said Katie Smith Sloan, CEO of LeadingAge, an organization of non-profit aging service providers.

The bigger issue, they said, is some nursing home staff are reluctant to get vaccinated, despite data that show both vaccines from Moderna and Pfizer are safe.

“I think in many cases residents and families are eager or certainly willing, but staff is a different story and so we’ve heard numbers all the way from 20 percent or less, to up to 75 percent” who are willing to be vaccinated, which is not enough, said Peter Van Runkle, executive director of the Ohio Health Care Association.

Van Runkle said hesitant staff members aren’t necessarily opposed to the vaccine, they might just want their peers to go first and see what happens.

To that end, he said facilities are launching their own education campaigns, mainly by filming the staff who are first in line, and having them explain why they wanted to be vaccinated.

Van Runkle said he expects to see more staff get vaccinated during the second visit to long-term care facilities.

“It’s probably not going to overcome those people who think that they’re getting in there getting a microchip implanted or something like that,” he said, but once they see that their colleagues who received the first dose are OK, “we expect to see a lot more folks participate.”