Efforts to vaccinate some of the country’s most vulnerable residents against Covid-19 have been slowed by a federal program sending retail pharmacists to nursing homes – accompanied by bureaucracy and logistical snafus.
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As of Thursday, more than 4.7 million doses of the Pfizer BioNTech and Moderna Covid vaccines had been given to the federal pharmacy partnership, which has hired pharmacy teams from Walgreens and CVS to vaccinate nursing home residents and workers. However, since the program began in some states on Dec. 21, they have given about a quarter of the doses, according to the Centers for Disease Control and Prevention.
Across the country, some nursing home directors and health officials say the partnership is actually hindering the vaccination process by imposing paperwork and awkward company policies on facilities that are sparsely staffed and affected by the devastating effects of the coronavirus. They argue that nursing homes are unique medical facilities that could be better served by medical professionals who already understand how they work.
Mississippi State Health Commissioner Dr. Thomas Dobbs said the partnership was “a fiasco”.
The state allocated 90,000 doses of vaccine to the effort, but pharmacies had only administered 5% of those shots by Thursday, Dobbs said. Pharmacy officials told him they were having trouble finding enough people to fill the program.
Dobbs pointed out neighboring Alabama and Louisiana, which he says vaccinates long-term care residents at four times the rate of Mississippi.
“We get a lot of angry people because it goes so slowly and we are unhappy too,” he said.
Many of the nursing homes that have successfully vaccinated willing residents and employees do so without federal aid.
For example, the Jewish home in Los Angeles, with around 1,650 employees and 1,100 residents in four locations, began vaccinating on December 30th. By January 11, the home medical staff had given their 1,640th dose. Even the facility’s chief physician, Noah Marco, helped with the vaccination.
The house is in Los Angeles County, which refused to participate in the CVS / Walgreens program. Instead, it has hired nursing homes to self-administer vaccines and only uses Moderna’s easy-to-use product, which doesn’t need to be stored in ultra-cold temperatures like Pfizer’s vaccine. (Both vaccines require two doses to provide full protection 21 to 28 days apart.)
In contrast, Mariner Health Central, which operates 20 nursing homes in California, relies on the federal partnership for its homes outside of LA County. One of them won’t get his first doses until next week.
“It was so much worse than expected,” said the chain’s chief medical officer, Dr. Karl Steinberg. “The light at the end of the tunnel is dim.”
Nursing homes have seen some of the worst outbreaks in the pandemic. Although they house less than 1% of the country’s population, nursing homes have caused 37% of deaths, according to the COVID Tracking Project.
Facilities participating in the federal partnership usually plan three vaccination clinics over a period of nine to 12 weeks. Ideally, those eligible and wanting a vaccine will receive the first dose in the first clinic and the second dose three to four weeks later. The third clinic is considered a makeup day for everyone who missed the others. Before administering the vaccines, pharmacies require nursing homes to obtain consent from residents and staff.
Despite complaints of a slow rollout, CVS and Walgreens said they are on track to deliver the first doses as promised by January 25th.
“Everything went as planned, except for a few cases where we were challenged or had difficulty contacting long-term care facilities to plan clinics,” said Joe Goode, a spokesman for CVS Health.
Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, admitted some delays from the partnership but said it was to be expected as this type of effort has never been attempted before.
“There is a feeling that they are going to get used to it and it will be helpful as the health departments are quite overwhelmed,” said Plescia.
But any delay puts lives at risk, said Dr. Michael Wasserman, the immediate past president of the California Association of Long Term Care Medicine.
“I’m going to be nuclear,” he said. “There should never be an excuse for people not to be vaccinated. There is no excuse for delay. “
Nursing homes are equipped with resources that could have supported vaccination efforts – but are often not used.
Most already work with specialist pharmacists who understand the needs of nursing homes and provide medication and annual vaccinations. These pharmacists know the patients, their medical histories and are familiar with nursing home equipment, said Linda Taetz, chief compliance officer of Mariner Health Central.
“It’s not that they aren’t capable,” Taetz said of the retail pharmacists. “They are just not embedded in our buildings.”
If a facility participates in the federal program, it cannot use that or any other pharmacist or employee to vaccinate, said Nicole Howell, executive director of Ombudsman Services for Contra Costa, Solano and Alameda counties.
But many nursing homes want the flexibility because they believe it would speed the process, build trust, and get more people to say yes to the vaccine, she said.
Howell pointed out West Virginia, which relied primarily on local, independent pharmacies rather than the federal program to vaccinate its nursing home residents.
The state largely opted against the partnership because it took CVS / Walgreens weeks to begin the recordings and Republican Governor Jim Justice wanted them to begin immediately, Marty Wright, CEO of the West Virginia Health Care Association, said the long-term position of the state represents care institutions.
Most of the work is done by more than 60 pharmacies, which gives the state greater control over the distribution of the doses, Wright said. The pharmacies were joined by Walgreens in the second week, but not as part of the federal partnership.
“We were more interested in local pharmacies than facilities we could work with,” Wright said. Preliminary estimates show that more than 80% of residents and 60% of employees in more than 200 households had received an initial dose by the end of December, he said.
CVS’s Goode said his company’s participation in the program is led by its long-term care division, which has extensive nursing home experience. He found that tens of thousands of nursing homes – about 85% nationally according to the CDC – found this reassuring enough to attend.
“This underscores the long-term care trust in CVS and Walgreens,” he said.
Vaccine recipients pay nothing out of pocket for the recordings. The cost of buying and managing it is covered by the federal government and health insurance, which means CVS and Walgreens make big bucks: Medicare reimburses $ 16.94 for the first shot and $ 28.39 for the second.
Technically, federal law does not require nursing homes to obtain written approval for vaccinations.
However, CVS and Walgreens require oral or written consent from local residents or family members, which must be documented on the forms provided by the pharmacies.
Goode said consent hasn’t been a barrier so far, but many local people disagree. The requirements have slowed the process as nursing homes collect paper forms and Medicare numbers from residents, said Tracy Greene Mintz, a social worker who has senior care training and trains and employs social workers in more than 100 California facilities.
In some cases, social workers have been sending paper informed consent forms to families waiting to get them back, she said.
“The facilities are busy keeping the residents alive,” said Greene Mintz. “If you want Medicare paid, do your own records,” she suggested to CVS and Walgreens.
Planning was also a challenge for some nursing homes, also because people who are actively suffering from Covid should not be vaccinated, advises the CDC.
“If something comes up – let’s say an entire building goes positive – you don’t want the pharmacists to come because nobody gets the vaccine,” said Taetz of Mariner Health.
Both pharmacy companies say they are working with institutions to make a new appointment if necessary. This happened at Windsor Chico Creek Care and Rehabilitation in Chico, California, where a clinic was pushed back a day as the facility waited for covid test results for residents. Melissa Cabrera, who manages the facility’s infection control, described the process as streamlined and professional.
In Illinois, about 12,000 of the roughly 55,000 nursing home residents had received their first dose by Sunday, primarily through the CVS / Walgreens partnership, said Matt Hartman, executive director of the Illinois Health Care Association.
While Hartman hopes pharmacies will complete the first round administration by the end of the month, he noted that planning the clinics is a lot of “headache”, especially when home outbreaks occur.
“Are we glad we didn’t make it through the first round and West Virginia is done?” he asked. “Absolutely not.”
KHN correspondent Rachana Pradhan contributed to this report.
This story was produced by KHN publishing the California Healthline, an editorially independent service of the California Health Care Foundation.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
This story can be republished for free (details).