Las Vegas Review-Journal (Sunday)
Adult day cares face long path to ‘normal’
Securing vaccine for clients, employees a major challenge
Aida Grasman stopped bringing her 39-year-old son to his adult day care center a year ago when the COVID-19 pandemic began to take off in Southern Nevada, fearing for his safety in the group facility. Now she’s excited about his impending return to a setting where he can interact with friends.
A crucial piece to making that happen was getting him vaccinated against the coronavirus.
Her son, Alexander Hammerstein, has a rare genetic condition called Coffin-Lowry syndrome, which the National Institute of Neurological Disorders and Stroke says typically includes “craniofacial (head and facial) and skeletal abnormalities” and “delayed intellectual development.”
He received his second dose of the vaccine on March 17 — St. Patrick’s Day — at the Nevada Adult Day Healthcare Center on Eastern Avenue in Las Vegas.
The setting was an on-site clinic run by Albertsons pharmacy personnel for center employees as well as clients.
It’s a familiar place for him, so he’s comfortable. It’s a blessing that he got it here.
Aida Grasman, mother of Alexander Hammerstein
Grasman, 71, said her son was happy to see his friends and staff for the first time in a year while getting his shots.
“It’s a familiar place for him, so he’s comfortable,” she said. “It’s a blessing that he got it here.”
Adult day care plays a critical role for families with seniors, disabled younger adults or those suffering from Alzheimer’s disease and other forms of dementia, allowing them time for work or other activities.
But despite serving many highrisk clients and being allowed to stay open during the pandemic, Las Vegas-area adult day care centers have faced challenges in getting access to COVID-19 vaccine for their clients and employees.
‘Everyone was scrambling’
“Of course, everyone was scrambling and trying to position themselves to get the vaccine,” said Christopher Vito, president and CEO of Nevada Adult Day Healthcare Centers, referring to the period after it became clear that the adult day cares were not included in a federal pharmacy partnership aimed at providing vaccine to longterm care facilities that began in mid-December.
He contacted Southern Nevada Health District for help, and while he was awaiting a response Albertsons reached out about scheduling on-site vaccination clinics at each of the company’s three Las Vegas Valley facilities.
“It’s a huge help for us,” he said. Vito said he’s not faulting anyone, but he didn’t hear from the health district until a week after Albertsons provided the first clinic in February. That was about 1½ months after he requested help, he said.
Jeffrey Klein, president and CEO of Nevada Senior Services, a nonprofit that runs two Las Vegas-area adult day care centers, said he initially thought the organization would qualify for the federal program, even though they aren’t technically long-term care facilities.
His reasoning: They are congregate settings similar to nursing homes, but “where people go home at night,” Klein said. He soon learned that they were not included in the program.
Adult day care centers weren’t the only state-regulated facilities ineligible to participate in the program managed by the Centers for Disease Control and Prevention.
Of about 1,500 licensed care facilities or agencies in Nevada, more than 1,000 weren’t eligible for the federal pharmacy partnership, according to state Department of Health and Human Services (DHHS) data obtained by the Review-Journal through a public records request. They include home health care providers, hospice care facilities and alcohol or drug abuse treatment facilities.
There are nearly 40 centers licensed in Nevada as facilities “for the care of adults during the day,” according to the state, with some entities operating multiple facilities.
The state’s plan to get vaccine to the facilities that didn’t qualify called for them to “be reached through (a) pharmacy or locally coordinated clinical strike teams,” DHHS spokeswoman Shannon Litz said in an email to the Review-Journal. The Nevada State Board of Pharmacy has worked to coordinate on-site clinics, she said.
But Southern Nevada Health District spokeswoman Jennifer Sizemore said in an email last week that district officials were told the state and Board of Pharmacy “partnered with pharmacies to provide vaccines to these groups” and thus didn’t muster strike teams to visit such facilities.
How the grocer got involved
Both the Nevada Adult Day Healthcare Centers and Nevada Senior Services, which between them operate five adult day cares in Southern Nevada, ultimately were able to hold vaccination clinics in February or early this month with the help of pharmacy staff from the Albertsons grocery chain.
The State Board of Pharmacy reached out to Albertsons to seek assistance in providing the on-site COVID-19 vaccinations for some facilities that didn’t qualify for the federal program, said Mike Halle, pharmacy district manager for Albertsons and Vons in Southern Nevada.
Albertsons receives vaccine through the federal pharmacy program — which is used for in-store immunizations — and from the county, which is being used at care facilities that didn’t qualify.
So while neither Nevada Senior Services not Nevada Adult Day Healthcare Centers immediately heard back from the government, doses from the health district’s vaccine allotment were fueling the clinics at their facilities.
As of Friday, Albertsons has provided 64 clinics and administered more than 3,500 doses at care facilities in Southern Nevada, including adult day care centers and senior living facilities.
Halle said clinics and care facilities are being added every week, with some facilities reaching out directly to Albertsons and the grocer seeking state permission to give vaccine when it hears hears of a facility in need.
Meanwhile, hundreds of Nevada long-term care facilities have received on-site COVID-19 shots provided by CVS Health, Walgreens or Consonus Pharmacy through the federal program.
Roy Afflerbach, public policy adviser to the National Adult Day Services Association, said he wasn’t surprised that adult day care centers weren’t included, given that attention was focused on the large
Christopher Vito, president and CEO of Nevada Adult Day Healthcare Centers, said he’s not faulting anyone, but he didn’t hear from the Southern Nevada Health District until a week after Albertsons provided a first vaccination clinic in February. That was about 11/2 months after he requested help, he said.
number of deaths in residential facilities.
As a result, centers have had to aggressively seek out partners — such as local pharmacies or health departments — to provide COVID-19 vaccinations, he said, adding that there’s still a lot of work to do.
States have generally been cooperative, but some ordered adult day cares to close more than a year ago and have not yet given them permission to reopen, he said. There’s now movement to do so as more people get vaccinated, he noted.
In Nevada, adult day cares were omitted from Sisolak’s emergency order on March 20 that shut socalled nonessential businesses and placed in the same category as day care centers for children. The order did require them to observe social distancing and other restrictions to minimize the spread of the disease.
But some closed of their own accord out of safety concerns or the financial impact to their operations as the COVID-19 caseload grew.
Figuring out a Plan B
Nevada Senior Services, which closed only briefly on a few occasions, overcame a number of hurdles to hold its first on-site vaccination clinic on March 10 at its Las Vegas center.
“We realized very early on that vaccine access was going to be a major problem here in Nevada — particularly, for vulnerable seniors,” Klein said, adding that the nonprofit has been “very aggressive” in pursuing a solution.
So Nevada Senior Services started the process months ago to get the necessary approvals to hold its own vaccination clinics rather than rely on an outside entity.
In do that, it had to gain certification on the Nevada WebIZ vaccine tracking system, requiring a day of training provided by the state and several weeks for certification.
The effort paid off when the nonprofit hosted a clinic March 10 and provided first doses of the COVID-19 vaccine to 91 clients, their family caregivers and center employees.
Nevada Senior Services’ nursing staff, assisted by physician assistant students from Touro University Nevada, administered first doses after receiving the Moderna vaccine and supplies from the health district.
Then, Nevada Senior Services held another clinic March 17 for more than 50 vulnerable clients — mostly, those younger than 65 — and their family caregivers. That clinic was run by Albertsons.
Now, approximately 90 percent of organization’s employees and clients, and about 80 percent of family caregivers it serves, have received at least one dose of the vaccine.
‘We’re effectively imprisoning those people’
Some local agencies have conducted strike team events to give COVID-19 shots, Klein said, but noted he’s hearing from agencies that it’s far more efficient to have a mass vaccination than it is to target certain neighborhoods or go door to door.
In the meantime, though, seniors who are “very much at risk” are essentially locked down at home if they haven’t been vaccinated, he said, adding, “In effect, we’re effectively imprisoning those people.”
Operational, fiscal impacts
While navigating the vaccination rollout, many Las Vegas-area adult day care centers also have faced operational and economic challenges.
For an unknown number of centers, the financial blow was fatal.
“Some centers closed, and some closed and will never reopen,” Klein said.
Those that survived say that enrollment remains far below pre-pandemic levels.
At Nevada Senior Services’ adult day care centers in Las Vegas and Henderson, the number of clients has “dropped very substantially,” Klein said.
The Las Vegas center, which is licensed to have up to 80 people on site, was nearly at that cap preCOVID-19, while the Henderson center is licensed for up to 70 and was accommodating about 50 people. Early this month, attendance was averaging below 40 a day at the Las Vegas center and fewer than 30 in Henderson, he said.
In mid-March 2020, Nevada Adult Day Healthcare Centers’ locations voluntarily closed for 2½ months due to safety concerns and mandated social distancing requirements, before reopening in June.
The centers, which opened in 2003, had about 100 clients in early March compared to about 260 clients before COVID-19, Vito said.
Adult day care in Nevada is “very under resourced in terms of quantity,” said Klein, with Nevada Senior Services. “That’s been historically true and part of that, frankly, is the very low reimbursement rates in the state for the portion of the population covered by Medicaid.”
And clients who require a lot of care are more expensive to take care of, he said. “If you’re in the business of adult day care and need to make a profit, taking on expensive clients is not what you want to do.”
Focus on ‘medically complex’ patients
The nonprofit’s focus is on serving the most vulnerable seniors, including those with complex medical conditions, Klein said, and they typically attend every day. And like many other adult day care centers, it also serves younger adults.
“We tend to get people who are medically complex,” he said.
But the loss of income from a diminished clientele has affected operations and had a trickle-down effect on families.
Pre-COVID-19, the Las Vegas center was open seven days a week and the Henderson center was open six days a week; they historically have been the only centers in the Las Vegas Valley open on weekends, Klein said. Now, they’re each open one fewer day a week.
The decision was made primarily based on revenue loss due to the decline in attendance, higher operating costs during the pandemic and a 6 percent reduction to the Nevada Medicaid reimbursement rate that was part of state budget cuts forced by the pandemic.
And while more clients are beginning to return with the wider availability of COVID-19 vaccine, there is still a long way to go before the industry can be considered recovered.
“We are running at a fraction of where we were 14 months ago,” Klein said.
While navigating the vaccination rollout, many Las Vegas-area adult day care centers also have faced operational and economic challenges. For an unknown number of centers, the financial blow was fatal. “Some centers closed, and some closed and will never reopen,” Jeffrey Klein, president and CEO of Nevada Senior Services, said.