By Jordan Rau and Tony Leys
“COVID is not pretty in a nursing home,” said Deb Wityk, a 70-year-old retired massage therapist who lives in one called Spurgeon Manor, in rural Iowa. She has contracted the disease twice and is eager to get the newly approved vaccine because she has chronic leukemia, which weakens her immune system.
The Centers for Disease Control and Prevention approved the latest vaccine two weeks ago, and the new shots became available to the general public within the last week or so. But many nursing homes will not begin inoculations until well into October or even November, though infections among this vulnerable population are rising, to nearly 1%, or 9.7 per 1,000 residents in mid-September from a low of 2.2 per 1,000 residents in mid-June.
“The distribution of the new COVID-19 vaccine is not going well,” said Chad Worz, the CEO of the American Society of Consultant Pharmacists. “Older adults in those settings are certainly the most vulnerable and should have been prioritized.”
With the end of the formal public health emergency in May, the federal government stopped purchasing and distributing COVID vaccines. That has added new complications for operators of nursing homes, who have encountered resistance throughout the pandemic in persuading people, especially employees, to receive yet another round of shots.
The coronavirus decimated nursing homes during the first two years of the pandemic, killing more than 200,000 residents and staff members. Elizabeth Sobczyk, the project director of Moving Needles, a CDC-funded initiative to improve adult immunization rates in long-term care facilities, said that without a government agreement to purchase the shots, vaccine manufacturers would only make large quantities once CDC experts recommended approval.
“Then they need to be FDA-inspected — we want safe vaccines — then there is contracting and rollout,” Sobczyk said. “So I completely understand the frustration, but also why the availability wasn’t immediate.”
Even once the shots are available, nursing homes face continuing resistance to the vaccines among nurses and aides. Without state mandates for workers to be vaccinated, most nursing homes are relying on persuasion, and that is often proving difficult.
“People want COVID-19 to be in the rearview mirror,” said Leslie Eber, medical director of Orchard Park Health Care Center in Centennial, Colorado. “We’re going to have to remind people more this year that COVID-19 is not benign. Maybe it’s a cold for some people, but it’s not going to be a cold for the folks I care for.”
Only 62% of nursing home residents are up to date on their vaccines, meaning they have received the last booster available before this month’s new shot, according to federal data from mid-September. That’s an improvement over the 38% rate at the start of October 2022.
But only 25% of nursing home employees are up to date, which is close to last October’s rate.
In a written statement, the Department of Health and Human Services said that it would be identifying long-term care facilities with low vaccination rates and reaching out to ensure “proven infection prevention and control measures are being implemented to protect seniors.”
This year, more nurses and aides will have to obtain shots at drugstores or health centers on their personal time, rather than at work. Many homes are running clinics, with their long-term care pharmacies supplying the vaccine as they did before, but they face extra bureaucratic hassles in billing insurers for the vaccine for both residents and employees.
On top of that, homes are rolling out a new vaccine for another dangerous virus — respiratory syncytial virus, or RSV — which will be a third shot for many residents, along with vaccines for COVID and the flu.
The trio of vaccines will create more administrative complexity for nursing homes because now they must bill Medicare to be reimbursed for the shots. The COVID vaccine is charged to Medicare Part B, which covers outpatient and physicians’ services, but the RSV vaccine must be billed to Medicare Part D, the prescription drug benefit.
“The United States has been phenomenal in screwing up vaccinations,” said David Nace, chief medical officer of UPMC Senior Communities in Pittsburgh. “This idea that some are under Part B and some are under Part D and some can be billed by a pharmacy — who in God’s name came up with this?”
While Medicare will pay for vaccines for most nursing home residents, employees may face private insurance red tape and, for a small group, potential out-of-pocket costs.
Leslie Frane, an executive vice president of Service Employees International Union, which represents more than 134,000 workers in 1,465 nursing homes, said that many homes had stopped running clinics in their facilities and had told workers to go to the drugstore to get vaccinated. She said this would lead to more workers skipping their shots.
“There’s very little time, given how many nursing home workers work multiple jobs,” she said.
The CDC has arranged for 25 million to 30 million people who lack health insurance or whose insurance doesn’t cover the complete cost of the vaccine to get free COVID shots at select pharmacies, health centers and medical offices listed on www.vaccines.gov. Frane said the program was not well-known among workers, and Worz said distribution was favoring the large pharmacy chains, slowing access in rural communities. Of the nation’s 19,400 independent pharmacies, federal officials said 627, many in rural areas, were enrolled in the program and 100 more were being added.
A big obstacle, though, continues to be resistance to vaccination among nurses and aides. Like many facility owners, Avalon Health Care Group, which owns or operates more than a dozen nursing homes in western states, is not mandating staff be vaccinated. Dr. Sabine von Preyss-Friedman, Avalon’s chief medical officer, said she tries to address the reasons with each worker and won’t abandon the push.
Jim Wright, the medical director of Our Lady of Hope Health Center and two other nursing homes in Richmond, Virginia, said that rewards and respectful persuasion were not enough to sway his homes’ employees. They tend to be in their 20s and 30s, he said, and are not worried about catching COVID, which many have already weathered.
“They most likely will not do it to protect the residents or protect themselves,” he said. “I don’t know what the answer is.”