Northwest Arkansas Democrat-Gazette
Nursing home vaccinations going slowly
About 10% of long-term care facility residents, staff vaccinated
LITTLE ROCK — Almost two weeks after Arkansas started to receive its first 68,800 doses of the Moderna coronavirus vaccine, only about 10% of the roughly 50,000 residents and employees in some 300 longterm care facilities had been vaccinated as of Thursday morning, according to the Arkansas Department of Health.
Gov. Asa Hutchinson said earlier this week he was”not satisfied” with the slow pace of the vaccine rollout to such facilities, such as nursing homes and assisted living facilities, which have been the epicenter of tens of thousands of fatal cases of the coronavirus across the United States.
In Arkansas alone, nearly half of covid-19 deaths have been residents and employees of such facilities, according to data from the Arkansas Department of Health.
The administration of vaccinations in those facilities is being handled by pharmacies — two major chains plus locally owned businesses.
As of Thursday morning, Walgreens and CVS administered 178 vaccines while independent pharmacies administered 4,539, according to the Arkansas Department of Health.
“I am asking our large retail pharmacies and all of our pharmacies to really understand what’s at stake here to help us get the vaccine administered as quickly as possible because lives are at stake,” Hutchinson said Tuesday’ at his weekly news conference on the pandemic. “It is critical we accelerate the deployment of this vaccine.”
Hutchinson said he “hopes and expects” all longterm care residents and staff to be vaccinated by the end of January.
Long-term care facilities are presenting new challenges for the state’s vaccination blueprint, which places residents and employees of such facilities as a top priority behind frontline workers in hospitals who began receiving the Pfizer vaccine in mid-December.
The Moderna vaccine has been designated almost exclusively for long-term care.
VACCINATIONS BY PHARMACIES
Long-term care facilities had the option of partnering with the national pharmacy chains CVS and Walgreens, which inked deals with the U. S. Centers for Disease Control to offer on-site vaccination services to nursing homes and other assisted living facilities.
CVS is administering vaccines to 40,000 long-term care facilities nationwide, according to the company.
More than 35,000 facilities across the country selected Walgreens, that chain said.
About half of the state’s long-term care facilities partnered with CVS or Walgreens, according to the Arkansas Pharmacists Association, a statewide professional organization that is assisting with the effort.
Facilities also had the option of partnering with Arkansas-based pharmacies, some of which have retail locations and others that work almost exclusively with long-term care operations.
Walgreens began vaccinations in Arkansas this week, according to Kelli Teno, spokeswoman for the company. The pharmacy chain wouldn’t release details on where it had given vaccinations nor how many doses it had administered.
Forty-five long-term care facilities in Arkansas selected CVS to administer vaccinations to a total of 8,300 staff and residents, Abby Major, company spokeswoman, said.
Vaccinations began Monday and should be completed in 12 weeks, Major said. CVS wouldn’t identify the facilities.
“Our effort to administer a covid-19 vaccine to Arkansas’ long-term care community has been going according to plan, and in close coordination with the state,” Major said.
Walgreens and CVS didn’t respond to requests for further comment on whether they plan to speed up vaccine administration or whether they are facing any challenges or other delays.
The state Health Department doesn’t know how many doses of the Moderna vaccine these pharmacies received because shipping and delivery “is handled on the federal side,” Gavin Lesnick, a department spokesman, said.
Walgreens and CVS were allotted more than half of the state’s vaccine ration, Lesnick said.
COORDINATION
Rachel Bunch, executive director of the Arkansas Healthcare Association, the state’s largest organization of licensed long-term care centers, said she hasn’t received information from Walgreens or CVS on how many vaccination clinics the pharmacies have organized so far.
The Arkansas Healthcare Association is working with the Health Department and the Arkansas Pharmacists Association to coordinate vaccine distribution.
“I have been trying to get some updates on that,” Bunch said. “I don’t know how many clinics they have done.”
There are concerns because of the volume of vaccines the two chains are administering, the nursing homes that partnered with them may experience delays.
“Just by the sheer number of homes they have to provide services to, it will take a while for them to get into every one of those homes and vaccinate all of those residents and staff,” John Vinson, chief executive officer of the Arkansas Pharmacists Association, said.
“The homes will eventually get the vaccine, but it may take a little longer and not be as timely as those who selected local pharmacies that they are used to working with,” Vinson said.
“Whenever you are working with 70 homes as opposed to two or three homes, the logistics are more challenging,” he said. “If a facility has selected a partner that is not local, it will take longer to get the vaccine delivered and get a team of individuals to that nursing home to administer that vaccine.”
SMALLER SCALE
Independent pharmacies also face obstacles.
There are about 30 pharmacies working to administer vaccines to thousands of residents and staff across the state, Vinson said.
Some pharmacies, such as City Pharmacy in Little Rock, only have a handful of employees, who have been working extended hours to coordinate with the facilities, distribute information about the vaccines, file required paperwork and train employees.
“This is a huge monumental task,” Dr. Andy Hart, owner of City Pharmacy, said. “The logistics have been a real nightmare.”
“It is like a flu [shot] clinic on steroids,” Hart said.
The pharmacies aren’t only tasked with coordinating onsite vaccine clinics but they also must collect consent forms from employees and residents, usually ahead of time, to make sure they know the number of doses to allocate for a particular location. This is also essential to try to prevent wasted doses.
CONSENT PROBLEMS
Obtaining consent has been cumbersome.
Many residents in longterm care facilities have illnesses, such as dementia, which means another family member or legal guardian must be contacted to OK on the injection. Sometimes the guardians live out of state or are otherwise hard to reach, causing further delays.
“Sometimes it takes more than one phone call and attempt to reach them [a guardian] and explain or answer questions to get consent,” Bunch said. “That process takes time.”
Workers have also been reticent, Vinson said, adding a handful of long-term care homes are requiring employees get vaccinated.
“Especially in certain parts of our state, there is a lot of reluctance,” Vinson said. “There is vaccine hesitancy, and not 100% of the residents or the staff will accept the vaccine. That will take some education.”
It might also take multiple pharmacy visits to one facility to continue to vaccinate employees and residents as more people want a shot.
Already pharmacies are struggling to schedule on-site clinics as soon as they can, with some long-term care facilities reporting their first inoculation dates set in February, even March.
“Some facilities have even received multiple clinic dates,” Bunch said. “Some of them initially were scheduled really far out.”
“We have been working to clean that up,” she said.
This has resulted in some residential facilities opting to change pharmacies to schedule clinics sooner. Often, that means the consent process will have to start again as the new pharmacy will have to collect new consent forms, Bunch said.
“There is just so much,” she said. “The whole situation is incredibly complex, and there are lots of moving parts.”
Some long-term care facilities have “fallen through the cracks” or didn’t enroll at all, Bunch said.
“We had some facilities that thought they had signed up with a particular partner or filled out the enrollment information online but have not been contacted by a pharmacy,” she said. “We have been working hard to get those added to the list.”
Long-term care facilities also have high turnover of staff and residents, which makes planning more difficult. They also have peripheral providers, such as physical therapists or dentists, who work with residents at multiple facilities, adding even more complexity.
Vinson, of the Arkansas Pharmacists Association, said the numbers of residents vaccinated is likely higher than state data indicate due to a backlog of overwhelmed pharmacies still logging numbers with the state’s reporting system.
He also said some pharmacies didn’t receive their first shipments of the Moderna vaccine until Monday of this week.
“The data versus what has happened in the field may not be the same,” Vinson said.
“We are willing to work to find whatever solutions are necessary to save lives,” he said. “We are doing the best we can to react and to solve challenges when the challenges arise.”