Relief and confusion as COVID-19 vaccines reach nursing homes
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More than a third of all the COVID-related deaths in the country have been residents or staff at nursing homes and assisted living facilities. That’s 110,000 people.
So it makes sense that the vaccination campaign has started there. But it will be a heavy lift for many homes that have been dealing with outbreaks, equipment shortages and labor challenges.
For Michael Hicks, CEO of Sundale Nursing Home in Morgantown, West Virginia, it comes as a relief. Sundale is about 80 miles south of Pittsburgh. He remembers getting a call on March 22. “We had the first case of community spread coronavirus in West Virginia,” he said. “That was a devastating time for us.”
According to Hicks, Sundale has had 94 cases and five deaths since then. Hicks had to find gowns, gloves and masks, but couldn’t get everything he needed from his usual medical supplier. “A lot of the N95 masks have been coming from the National Guard,” he said. “So they’ve been a tremendous support for facilities in West Virginia.”
A recent study by the U.S. Public Interest Research Group found nursing homes across the country have struggled to find enough personal protective equipment and shortages actually worsened by the fall.
About two-thirds of nursing homes are currently operating at a loss, according to the National Center for Assisted Living, a trade group. Executive Director Scott Tittle said staffing has been the top COVID-related cost for the battered industry. “So we were faced with a labor shortage even before the pandemic hit,” he said. “And if you can imagine the sheer stress, the long hours, the intensity level of what our frontline staff, really heroes, have gone through in the last nine or so months, it’s just incredible. And so we know that labor will be a significant challenge in the future.”
Tittle said 90% of nursing homes have hired additional staff or paid overtime.
The vaccines could be a ray of hope. Lisa Gaudet is the vice president of business development and marketing for Berkshire Healthcare Systems in Massachusetts. “It’s like Christmas morning to a certain extent. There is a tremendous amount of relief, excitement,” she said.
Vaccinations will start soon at Berkshire’s network of 20 facilities. Fifty-five residents died after outbreaks at two of its nursing homes. “We are at the beginning of the end of what has been a nightmarish experience,” Gaudet said.
But the logistics are complicated. The vaccine will be given to residents and staff by workers from pharmacy chains, like CVS. But Michael Barnett from the Harvard School of Public Health said one major issue is: “How can you get consent for a vaccine from nursing home residents who aren’t able to offer informed consent on their own because they have dementia or they have some kind of cognitive impairment that prevents them from doing that?”
That’s something Sundale, in West Virginia, has already experienced. The Pfizer vaccine has to be used within five days. “It was shipped into West Virginia last Monday, and those vaccines had to be used on Friday,” Hicks said. The home wasn’t able to get consent in time for about a dozen of its residents. So they missed the window for that shipment.
Ultimately, Hicks said, he scrambled and was able to find doses at another pharmacy and get the remaining residents vaccinated, except two who flat-out refused.
And that is another hurdle in the effort: residents and staff who don’t want to get vaccinated. “Nursing home workers tend to be disproportionately minorities,” Barnett said. “And they are in a group that has a high rate of concern about the vaccine. I’m really worried about how does a nursing home manage it exactly [when] a lot of workers don’t want to take it and they only have a couple of chances for these pharmacists to come and deliver the vaccine?”
Experts say the history of medical abuse suffered by Black and Latinx communities will pose an additional challenge for public health officials. The Equal Employment Opportunity Commission has said employers can bar unvaccinated employees from the workplace, but Hicks said he is not worried about having to do that.
Gaudet at Berkshire said that for now, they are working with staff members who are hesitant. “There’s a certain percentage that I think they’re just not comfortable, they’re skeptical. We are actively working with them to educate them, give them resources, you know, try to make sure we’re answering all their questions,” she said.
Lana Hoover, a retired teacher outside of Fort Worth, Texas, placed her parents in a nursing home in March. She wasn’t able to see them in person for seven months, though by the time her father died in November, she was able to be by his side. She’s eager to get her mom vaccinated, but said a lot of the damage done by the pandemic won’t be solved by a vaccine.
“What I hear from most friends who have parents in a facility or a community like that,” she said, “is they are seeing them all go downhill much more rapidly, as did my parents. And I truly think that’s from loneliness. I’m much more concerned about loneliness than COVID.”
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