COVID-19 vaccine can't come too soon for nursing homes, but many questions remain
Lynne Katzmann, whose company runs 22 long-term care facilities in Colorado, New Jersey, and Pennsylvania, knows what she will do as soon as a new COVID-19 vaccine becomes available to her staff and residents.
She'll roll up her sleeve.
"I am going to get the vaccine myself. They can take as many pictures as they want," she said. "I will be the equivalent of the queen's taster."
Katzmann, founder and CEO of Juniper Communities, knows that one of the things mostly likely to convince people to take a new vaccine is seeing someone they know and respect get it.
"I want to be an influencer," said Katzmann, who is 64 and has high blood pressure, a risk factor for more severe COVID-19. "I want to encourage people to do it."
Richard Feifer, executive vice president and chief medical officer of Kennett Square-based Genesis HealthCare, the nation's largest nursing home group, said he and other top executives plan to take similar steps to encourage their staff members to get the shot.
"The sooner we vaccinate everyone in society the better, the sooner we can get back to normal," said Feifer, who is an internist.
Once a COVID-19 vaccine arrives, there will be a new challenge: Convincing people it's safe A committee that advises the U.S. Centers for Disease Control and Prevention last week recommended that health-care workers in all settings along with residents of nursing homes and assisted living facilities receive the first, limited doses of coronavirus vaccines.
But whether facility staff and residents will embrace these vaccines is just one of many questions facing long-term care providers as they prepare for what may be an exceptionally fast rollout. A federal advisory committee to the Food and Drug Administration will meet Thursday to discuss details on the first coronavirus vaccine, made by Pfizer, and, possibly, recommend that it receive an emergency use authorization. The vaccine, which must be stored at ultracold temperatures and is shipped in large lots, could be available by the end of the month.
In a matter of days, facilities will have to gather signed consent forms from residents or their official decision makers, make copies of staff insurance cards and set up staff appointments. They will also have to be prepared to keep track of any side effects that residents experience.
Resistance to COVID-19 vaccines is expected. In a new Pew Research Center poll, 39% of Americans said they definitely or probably would not get the vaccine. Black Americans, who hold crucial frontline jobs in many care homes, were considerably less enthusiastic than other racial groups.
Sidney Greenberger, chief executive of AristaCare Health Services, which owns six nursing homes in New Jersey and one in Pennsylvania, said only 40% of his staff and residents said they wanted the new shot when he asked two weeks ago. Like other industry leaders, he'd like them all to get shots.
The vaccine requires two shots taken 21 days apart. At this point, facilities don't know how many doses will be available or which buildings will get vaccine first.
"There's a lot of uncertainty," Feifer said. "There's a lot that needs to be figured out very quickly."
COVID-19 has had a 20% mortality rate among infected nursing home residents, killing almost 100,000 so far, said Mark Parkinson, president and CEO of American Health Care Association (AHCA), which represents long-term care providers. Case numbers and deaths are rising again now as the disease resurges. More than 1,000 staff members have also died.
AHCA Monday said states should pledge to give nursing home residents and employees both doses of vaccine by March 1. Early vaccination of this group, Parkinson said, could save "tens of thousands of lives."
Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, said staffing is the biggest business challenge for nursing homes now, either because workers are sick or fear infecting family members. While some are concerned about vaccine unknowns, others "can't get this vaccine quickly enough."
The federal government has contracted through the new Pharmacy Partnership for Long-Term Care Program with drugstore giants CVS and Walgreens to give the shots in long-term care settings. Feifer said thinks the current emergency calls for a consistent, national approach. "The more variation we have, the more lives are going to be lost," he said.
Details on how the program will work are slim. CVS and Walgreens, which are expected to provide consent forms, have agreed to make three visits to facilities, a number that some officials say is too low to cover three shifts and deal with absenteeism if workers have significant reactions to the shots. Nursing homes, Feifer said, "cannot afford to have a significant portion of their staff call out sick on the same day."
Katzmann said that a company representative told her that CVS is planning for the first vaccines to be given on Dec. 21. Vaccinators may go room to room to vaccinate nursing residents, but have asked for a 10-by-10 room with a table and two chairs for others. "They've actually sent us diagrams of what the room should look like," she said.
While the new products were tested in a wide range of Americans, clinical trials did not include nursing home residents. The lone dissenting vote on the advisory committee recommendations stemmed from this issue.
Greenberger plans to offer incentives, in the form of raffles, for staff to get the shots.
"We want everybody to [get the vaccine] in a perfect world, but everybody's got to make that decision for themselves," Greenberger said.
Genesis and Juniper have not surveyed staff or residents. Instead, they're focusing on education and hoping that people already accustomed to taking flu shots will accept COVID-19 shots as well. "We know that there is skepticism," Feifer said. "A lot of it's based on misinformation and lack of information."
Some expect that people who have witnessed coronavirus deaths up close will be more inclined than other Americans to choose vaccination.
Feifer said vaccinating staff is "absolutely critical" because they are the ones most likely to transmit the virus to residents. When community spread is high, workers often become infected outside work.
While people over age 65 were in the Pfizer and Moderna trials, those who live in nursing homes tend to be older and sicker than trial participants. Most treatments are not studied in this population, Feifer said. Doctors have to make informed choices about what to use. While Genesis will look carefully at details released this week, he said the company likely will be "strongly advocating for vaccination."
Stuart Shapiro, a physician and interim CEO of the Health Care Association of New Jersey, said he's listening to scientists. "Everything that is coming out of the mouths of real experts is that the benefit of these vaccines in all adult populations, including the elderly, outweighs the risks," he said.
The AHCA's Parkinson said he hopes large numbers of staff members get vaccines voluntarily. If they don't, organizations may investigate whether they can legally require coronavirus vaccines. Some already mandate flu shots.
Katzmann said Juniper may consider a mandate. "While I love my individual liberties," she said, "this is a time when community means more."
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