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Vaccinating long-term care residents, staff for COVID-19 comes with challenges

Although healthcare workers and nursing home residents are at the top of the list for COVID-19 vaccinations, there are still many steps needed to guarantee a smooth rollout.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practice recommended that the two groups should be in the first phase of COVID-19 vaccination, but the decision will lie with state officials.

“I wish it were as simple as saying we’re going to vaccinate residents and staff,” said David Grabowski, a professor of healthcare policy at Harvard Medical School. Instead, he predicts some challenges on adoption and education.

Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, which represents more than 14,000 nursing homes and assisted living facilities across the U.S, said the industry is calling on governors from every state to prioritize long-term staff and residents in vaccine distribution “to save as many lives as possible.”

“Given the asymptomatic and pre-symptomatic spread of this virus combined with the explosion of community spread across the U.S., we are extremely hopeful this vaccine will literally be a lifesaver for thousands of residents and expedite the reopening of our facilities to family members and loved ones,” Parkinson said in a statement. “Now it is up to the governors and state health agencies to implement these recommendations and ensure our long-term care residents and staff are prioritized in the actual rollout of the vaccine to provide this protection as soon as possible.”

Katie Smith Sloan, president and CEO of LeadingAge, an association of not-for-profit aging services providers, said the ACIP recommendation is “an important step in the right direction, if it’s acted on.”

“States must follow suit by ensuring that long-term care residents and staff are among the first to receive a COVID-19 vaccine,” Smith Sloan said in a prepared statement.

Beyond prioritization, a challenge will be in ensuring that staff and residents are willing to accept the vaccine, Grabowski said.

“Here we have some individuals unwilling to get this and lots of other individuals clamoring to get in line to get the vaccine. It’s really important that we not take it as a given that we all want the vaccine and we all understand the benefits and the risks,” he said. “This isn’t about forcing anyone to take the vaccine. It’s really about making sure they are educated.”

There’s a level of distrust of management among nursing home workers, Grabowski said, and “it’s unclear you’re going to a get a high share of the staff willing to vaccinate.”

“This is a very vulnerable workforce, and I think, in many regards, they’ve been asked to do a lot, especially during COVID, in terms of working long hours and working short-handed on many shifts. I very much believe that there’s a lot of dissatisfaction with management at nursing homes,” Grabowski said.

It’s still unclear whether long-term care facilities can or would mandate workers get vaccinated.

“Providers are exploring how to work with those people who are fearful or skeptical or distrustful, particularly among groups most likely to be concerned or resistant. They are working within their organizations and with local and state partners on the delicate question of whether vaccine mandates can or should be considered,” said Janine Finck-Boyle, vice president of regulatory affairs for LeadingAge.

AHCA/NCAL hopes that healthcare workers will be willing to get the vaccine.

“Given that our residents are most at-risk for the virus and that prolonged isolation is bad for their health and being, we remain optimistic that most staff members will choose to take it,” AHCA/NCAL said in an emailed response.

Grabowski said CMS should provide long-term care facilities with information on how the vaccine was developed and its efficacy before distribution even begins to lay the groundwork for adoption, Grabowski said.

“It’s just been frustrating during COVID, but even pre-pandemic, there’s this idea that if we build it, they will come, they’ll use it,” he said, pointing to the federal government’s distribution of point-of-care testing devices to nursing homes. Many nursing homes are using the more accurate PCR tests instead of the government’s antigen tests because, among other reasons, state and local regulations require them.

“Testing is the perfect example,” he said, noting that the federal government didn’t really work with facilities to make it work. “It’s not enough to just send the test.”

The Society for Post-Acute and Long-Term Care Medicine, which represents practitioners in post-acute and long-term care, is developing a tool kit for staff and residents and already has released a FAQ document about the vaccine, as has LeadingAge.

Finck-Boyle said she expects CVS and Walgreens, the two pharmacy chains approved to administer the vaccine in nursing homes and assisted living facilities, to issue vaccine distribution plans soon.


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