COVID-19 vaccines arriving at (some) nursing homes. Here's what families need to know

Dec. 27—The nation's unprecedented COVID-19 vaccination program wades into the very heart of the pandemic beginning Monday as shot-givers fan out to skilled nursing homes, where coronavirus deaths have hit in disproportionate numbers among California's most elderly and infirm.

Officials at the homes, which were forced to shut down most family visitations in March, say they are eager for the moment. But they are uncertain how it will play out.

"Nobody's done this before. This is new territory," said Deborah Pacyna of the California Association of Health Facilities. "There are going to be some hiccups."

It will take a month or more for the inoculation program to finish up at 1,200 California skilled nursing facilities, officials say. Even then, the virus may not be tamped down sufficiently in surrounding communities for family members to be allowed to resume face-to-face visits with loved ones at the facilities.

It's about time, though, that the shots started, said Aaron Bloom, a nursing facility administrator in the Sacramento region. He's frustrated by what he considers mixed messages and delays in getting the vaccines to hard-hit facilities where infection clusters continue to pop up and where some staffers are exhausted from dealing with illness and death.

"We are still in the fight against this virus," Bloom said. "It is the moment for our industry. We need to do this now."

The first phase of COVID-19 vaccinations in the United States began more than a week ago, and initially was expected to be conducted in both skilled nursing homes and hospitals. But government contracts with pharmacies slightly delayed the launch of the skilled nursing facility inoculations.

Instead, hospitals went first. That process is well underway at dozens of Sacramento-region hospitals and appears to be going smoothly.

The challenges will be greater in nursing facilities. For one, skilled nursing homes report some residents and staff are expressing concerns or at least questions about the efficacy and safety of the new vaccines. A certain number of them are likely to decline to take the shots, officials say.

The two available vaccines — one from Pfizer, the other from Moderna — have been tested since mid-summer and determined by the federal Food and Drug Administration to be highly effective and safe for most people.

Not all congregate care facilities in California are included in the roll out.

"The state has not activated the program for assisted living facilities or affordable senior housing yet, from my most current information," said Eric Dowdy, government affairs officer for LeadingAge, an umbrella organization for those facilities. "We hear that the supply isn't there yet to get down to those lower tiers yet. Once more doses are delivered we will see it reach the less acute settings."

Death rates high in nursing homes

Congregate care facilities have been at the epicenter of the pandemic. A Sacramento Bee analysis found a statewide death rate of 5 residents per 100 nursing home beds.

In the four-county Sacramento region, nursing home residents represent far less than 1% of the population, but about 25% of the deaths, state data show.

That includes 20 deaths in the Alderson Convalescent Hospital in Woodland. In Carmichael, the Whitney Oaks Care Center has seen 19 deaths. Fifteen people have died in the Stollwood Convalescent Hospital in Woodland, 14 in the Eskaton Care Center Fair Oaks and 13 so far at the Roseville Care Center.

Opinion polling nationally shows more than 70% of the public intends to take the vaccine, a number that has been on the rise. Nursing home residents and employees are not required to take the vaccine — inoculations are voluntary.

"We are going through the process of education, but there will be people who will refuse," said Bloom, who oversees the Valley West Care Center in Colusa County.

His facility in the town of Williams has suffered six deaths and 65 infections among residents and staff during the pandemic. Nevertheless, about half of the 88 residents there have expressed concerns and questions about the vaccination during discussions with staff, Bloom said.

A Valley West Care Center employee began reaching out last week to families to update them on the plans, and on the need for either the resident or a family member with legal medical decision-making authority to give formal consent to the shots.

The shots at most facilities will be administered by staffers from CVS and Walgreens pharmacies under federal and state agreements.

There appears to be last-minute confusion about the complicated consent process.

State health officials told skilled nursing facilities last week that residents or family members in charge of a residents' health decisions can give consent verbally or in an email, said Pacyna of the health facilities group.

CVS, in an online statement, said it prefers written consent, either on paper in triplicate, or in electronic form, from which three copies must be made.

The pharmacy said, however, it will accept oral consent from responsible parties "for patients who do not have physical or cognitive ability to consent." However, "if patients or their responsible party are able to provide written consent, that process should be used."

"If consent is collected verbally by the facility, a facility representative signature is required" confirming that the facility has documented that consent in the facility's medical record for the resident.

CVS and Walgreens will give shots

At the 99-bed Folsom Care Center, where residents are in their 80s and 90s, almost all residents and their families have indicated interest in getting the shots, administrator Calvin Callaway said.

Callaway said his facility has been contacted by Walgreens, which will be administering the shots, that they are on the list now for a series of visits from Walgreens' innoculators, but have not yet been given any dates.

"I'm relieved," Callaway said. The facility has had some deaths and "our share" of infections. "You never know when the next wave (of infections) is going to come."

In a press statement last week, CVS said shots have already started at long-term care facilities in some states, and will begin this week in California and some other states.

"Today's roll out is the culmination of months of internal planning and demonstrates how the private sector can use its expertise to help solve some of our most critical challenges," said Larry J. Merlo, President and Chief Executive Officer, CVS Health.

Pharmacy teams will make three visits to each long-term care facility to offer the double does of shots required for the Pfizer and Moderna vaccines.

"The majority of residents and staff will be fully vaccinated three to four weeks after the first visit, depending on which vaccine they receive," the company said in a news release. "CVS Health expects to complete its long-term care facility vaccination effort in approximately 12 weeks.

At this point, it is unclear which facilities in Sacramento and California will be up first, and which will have to wait. Pacyna said on Monday her group had so far gotten confirmation from only six facilities that inoculation teams from either CVS or Walgreens will be arriving on Monday.

In Sacramento County, health officer Dr. Olivia Kasirye said the prioritization process belongs to the state, not to local officials. But, she said, it makes sense to focus the limited initial vaccine supplies mainly on front-line caregivers in hospitals before branching out. The same will be the case for long-term care facilities.

Health officials will want to assure they have done the job well among those high-risk groups before moving on to the next tranche of the public, she said. "We want to make sure the majority of that group are covered before we go on to the next group."

Question about side-effects

The planned roll out has prompted some concerns about large numbers of patients, residents and staffers dealing with side effects at the same time as each other. Clinical trials found that a percentage of people getting the shots will be deal with short-term side effects, mainly fatigue, headache, fever and soreness at the shot site in the upper arm.

The symptoms are a sign that the body is reacting appropriately to the vaccine, and is building up its defense system against the actual virus, health officials say.

But it means some nursing homes may have to deal with a high number of under-the-weather patients for a day or two, at the same time that some staff members who get the vaccine may be feeling unwell.

The typical treatment for the side effects is minimal — over-the-counter ibuprofen or acetaminophen is recommended.

Pacyna of the statewide health facilities association said her group expects it to be months, at least, before families can visit without major restrictions. Even if most people in a particular care facility have been vaccinated, state and county shutdowns likely will remain in place if the virus is not yet under control in the surrounding county.

"We're going to have to wait until the county positivity rates drop below 5%," she said, and even perhaps a while after that.

___

(c)2020 The Sacramento Bee (Sacramento, Calif.)

Visit The Sacramento Bee (Sacramento, Calif.) at www.sacbee.com

Distributed by Tribune Content Agency, LLC.