Vaccines go mobile to keep seniors from slipping through the cracks
ANTIOCH, Calif. — A mobile “strike team” is bringing vaccines to some of Northern California’s most vulnerable residents along with a message: This is how you avoid dying from COVID-19.
So far, that message has been met with both nervous acceptance and outbursts of joy from a population that has been ravaged by the disease.
One 68-year-old pastor, who lives in a racially diverse, lowincome senior housing complex, rolled down his sleeve after his shot and said he wants to live to see 70 — just to spite the government.
The team of county nurses and nonprofit workers is targeting Contra Costa County residents who are eligible for COVID vaccines but have been left out: residents of small assisted-living facilities that haven’t yet been visited by CVS or Walgreens, and occasionally people who live in low-income senior housing. The retail pharmacy giants have a federal government contract to administer vaccines in most long-term care facilities.
Launched a few weeks ago, the strike team moves through each vaccination clinic with practiced choreography. At a small group home in Antioch recently, a nurse filled syringes while another person readied vaccine cards and laid them on a table. An administrative assistant — hired specifically for these clinics — checked everyone’s paperwork and screened them for symptoms and allergies before their shots, logging them into the state’s database afterward. After the shots, a strike team member told each person when their 15 minutes of observation was up.
In a little over an hour, 14 people had a shot in their arm, a card in their hand and their data in the system. Nurses wiped down the chairs and tables and packed up supplies.
As the state vaccination plan moves past long-term care facilities and on to the next group, deploying mobile units will help prevent eligible people in small facilities from being left behind, said Dr. Mike Wasserman, past president of the California Association of Long Term Care Medicine.
“The assisted living side has been our greatest tragedy,” Wasserman said. “It’s February. We’re vaccinating others already and we haven’t finished vaccinating those who need it most.”
California is in the midst of transferring primary control of vaccine distribution from local public health departments to Blue Shield of California.
The agreement between the state and the insurance company includes incentives for vaccinating underserved and minority populations, and like Contra Costa, Los Angeles, Kern and other counties are creating mobile clinics to reach vulnerable residents.
But as efficiently as these clinics can run, it’s still slow going to vaccinate a few people at a time in a state that has lost more than 44,500 people to COVID.
Small long-term care facilities, usually with no more than six beds, are the strike team’s main target. These “six-beds” are a major source of residential care for older Californians, as well as others who need care and supervision but don’t want to live in nursing homes. Of almost 310,000 long-term care beds in California, about one-third are in nursing homes, according to Nicole Howell, executive director for Ombudsman Services of Contra Costa,
Solano and Alameda counties. Two-thirds are in some form of assisted living, mostly six-beds.
These homes are typically in residential areas, with little to distinguish them from other houses on a suburban block. They’re small businesses, often owned by families, that offer a “social” model of care, not a medical one. There is no doctor or director of nursing on staff.
Long-term care residents were in line to be vaccinated right after front-line health workers, starting in nursing homes. Theoretically, residents of small facilities like six-beds should get their shots from the same federal program vaccinating most nursing homes, which is administered through CVS and Walgreens.
But it’s difficult to coordinate with these homes because there are so many, Howell explained, and they often have fewer resources and minimal IT infrastructure. Because these aren’t large corporate chains or 500-bed facilities with everyone’s medical records on hand, it takes time and local knowledge to reach them all, she said.
CVS and Walgreens said they have administered first and second doses to nearly all nursing home residents in the state and have started on assisted living communities. They said they do not have breakdowns of which kinds of assisted living facilities they have visited, but CVS Health spokesperson Joe Goode noted that the pharmacy has completed the first round of doses at nearly 80% of participating assisted living facilities, with hundreds more clinics scheduled.
The state has largely left it up to facilities to call the pharmacies to schedule clinics, though many did not know it was their responsibility until late January, according to Mike Dark, a lawyer with California Advocates for Nursing Home Reform. He had been fielding calls for weeks from families who were told that, if they wanted to get their loved ones in six-bed homes vaccinated, they needed to figure it out themselves, he said.
“Smaller assisted living facilities, the ones least equipped to deal with this virus, still house people with significant impairment and needs,” Dark said. “It’s been a scandal, really, how poorly this process has been going.”
The residents at Above All
Care, a six-bed in Orange County, finally got their first shots on Feb. 4, according to owner Nicolas Oudinot. But that came after weeks of confusion and silence.
“From November to midJanuary, I had no information,” Oudinot said. “I went from nothing to getting a call every day. They tried to schedule the same facility two or three times.”
In late December, when it became clear that many longterm care facilities wouldn’t get clinics scheduled for months, Contra Costa County decided the federal program needed to be supplemented with local resources, said Dr. Chris Farnitano, the county health officer.
“This is where we’re seeing the most dying happening,” Farnitano said. “These are the most vulnerable people. We’ve got to protect them sooner.”