‘ANAMERICANDUTY’
Nursing homes ready formajor endeavor of vaccinating residents
Amy Buehrer wanted to be sure her dad understood the choice he was making.
It has been a tumultuous year at his new nursing home in Houston, where visits for months were prohibited because of the coronavirus pandemic. He hadn’t had a say in the lockdown. But she wanted 86year-old Ollie Moffitt to be able to decide whether to receive the vaccine that could begin restoring his freedom. The answer was unequivocal.
To him, “this is an American duty,” Buehrer said.
Next week, pharmacy teams will begin fanning out across Texas for one of the most cumbersome and critical phases of the COVID-19 vaccination campaign: inoculating staff and residents at the thousands
of long-term care facilities that span the state.
Nursing homes and state-run living facilities have been especially hard hit by the pandemic, accounting for more than a quarter of the state’s 25,855 COVID-19 deaths. Getting vaccines to their residents, many of whom are older, have underlying health conditions and can’t advocate for themselves, will be a huge endeavor.
With details still emerging, families and care providers are facing a number of uncertainties, including which facilities will get the vaccines first, whether they can pick which vaccine they get and how soon unrestricted visitations can resume. Resident advocates also worry that some providers won’t take the necessary steps to ensure that residents participate voluntarily.
“The nursing homes are anxious to get to the finish line, and I think there’s the potential for them to run roughshod over patient’s rights about informed consent in order to get there,” said Brian Lee, a patient advocate at Families for Better Care. “Families need to be aware of this.”
More than two-thirds of the state’s 3,100 long-term care facilities have already signed up to receive vaccines through a federal partnership with CVS Health and Walgreens. In some areas, providers will be able to partner with HE-B and independent pharmacies, according to state health officials.
The process will take several weeks, at least, with the first doses being administered next Monday. Many providers began reaching out to families earlier this month about the vaccines. Two have now received emergency use authorization from the Food and Drug Administration, one from Pfizer and BioNTech and the other from Moderna.
Both vaccines had more than 90 percent effective rates in clinical trials, including in adults over 65.
Carmel Dyer, a geriatrician and the director of the UTHealth Consortium on Aging, emphasized that the development process was fast but did not cut corners. She said long-term care residents should strongly consider taking it; she’s scheduled this month to receive the first of two doses herself.
“This could truly be life-saving formany people,” Dyer said. “The risk-benefit ratio is clearly in the patient or long-term care residents’ favor.”
Residents at all long-term care facilities, including assisted living centers, are eligible to receive the first waves of the vaccine. There are 240,000 nursing home staff and residents in the state, and an estimated 64,000 assisted living residents, not including staff.
Though nursing homes have seen far more deadly outbreaks, staff often overlap or work in close proximity to assisted living centers, according to Carmen Tilton, vice president of public policy at the Texas Assisted Living Association.
Kevin Warren, president and CEO of the Texas Health Care Association, which advocates on behalf of long-term care providers, said they are still working through a host of logistics and weren’t sure where vaccines would be sent first. A spokeswoman for the Department of State Health Services, which is helping coordinate the distribution, did not respond to a question about the order.
CVS and Walgreens have agreed to make three visits for each participating facility, meaning residents will have two chances to receive both doses of the vaccine. Consent will need to be given in advance, so the pharmacies know how many doses of the vaccine to bring. It’s unclear what will happen for those who miss the window.
The effort will likely be complicated by resistance among some staff, who may worry about being the first to receive the vaccine, or about potential side effects that could keep them home from work for a day. Some clinical trial participants experienced mild to moderate side effects, such as fever, headache and fatigue.
Several providers have already begun reaching out to families and staff with information about the vaccines and requests for consent. One was considering prize money for the first staff members vaccinated, picked through a lottery system. Another, Focused Post Care Acute Partners, instructed nursing home directors to meet one on one with staff to explain vaccine protocols.
Park Manor facilities were distributing FAQs to keep people informed and talking with staff as they got their weekly test, spokesperson Leticia Caballero said.
“We’re going to be ready,” she said.
Advocates urged residents and their families to reach out to their primary care providers if they have specific concerns about receiving the vaccine.
Steve Hengst, a bike shop manager whose 85-year-old mother lives in a nursing home in northwest Houston, said he’s still trying to learn about each of the vaccines and hopes he has a choice in which one she gets.
Bernard Gerber, a physician, already gave verbal consent for his relative in an assisted living facility to get the vaccine. He trusted the data and what experts have said about the safety and efficacy.
For him, the chance for vulnerable people to get protection felt like a miracle — and gave him hope.
“There’s just no question inmy mind that it’s the right thing to do,” he said.