Crisis-Hit Care Home Faces Covid Vaccine Challenge

But when the Covid-19 vaccine arrives at the care facility this month, Perry, who is also a board member of the National Association of Medical Assistants (NAHCA), says she and many of her colleagues are concerned. Side effects and distrust of the government. She is afraid of having to take unpaid leave with up to six days of paid sick leave a year. Her facility doesn’t tell staff anything about the arrival of the vaccine, she says, and because she fears being forced to take a brand new vaccine that they don’t fully understand, “it’s Put people in panic mode. ”

The arrival of the vaccine is foretold as the beginning of the end of a fierce battle with the care facility Covid, but not all workers and residents roll up their sleeves for a blow. Widespread skepticism about the vaccine between direct care workers and residents, and limited initial administration of the vaccine, can delay or even derail the vaccination of herpes zoster in the long-term care population.

Failure to vaccinate a significant proportion of long-term care residents and workers can result in the loss of many additional lives and the unnecessarily widespread isolation of residents in closed facilities. According to the Covid Tracking Project, more than 110,000 caregivers and staff have died from Covid-19, accounting for about 40% of all US virus deaths. According to the American Health Care Association / National Center for Assisted Living, an industry group, the virus kills about 5,000 people a week in long-term care facilities. “If you fail to deploy a vaccine in long-term care, you miss the opportunity to save tens of thousands of lives,” said Dr. Michael Wasserman, an elderly doctor and former president of the California Long-Term Care Medical Association. .. ..

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Earlier this month, the Centers for Disease Control and Prevention’s Immunization Implementation Advisory Board recommended that healthcare workers and caregivers be at the forefront of the first dose of vaccine. There is room in the state to prioritize different groups, but many follow the recommendations of the Commission. In some states, caregivers and workers can be vaccinated this week, but some workers will need to go to a local hospital. Large-scale vaccine deployments in long-term care facilities will begin later this month, when pharmacies will host their first on-site vaccination clinic for both residents and staff.

It is already clear that initial vaccine shipments are not sufficient in some states. For example, California prioritizes healthcare workers at risk of direct exposure to Covids and caregivers, initially expected to receive 327,000 doses, but 160 workers in direct contact with patients. It goes up to nearly 10,000 people. Kaiser Family Foundation.The state needs to receive an additional 393,000 doses

Pfizer

Next week’s vaccine, Governor Gavin Newsom, said Monday. Deborah Pacyna, a spokeswoman for the California Health Facility Association, which represents the state’s skilled nursing facilities, said, “We’ve asked the state to prioritize,” but hospitals generally give first doses. The county also sets its own priorities.

In other states, caregivers are not a top priority. In Utah, the initial dose of vaccine is sent to the major hospitals with the highest number of Covid patients.

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However, many nursing home workers do not require vaccines. Nearly three in four Certified Nursing Assistants (CNAs) surveyed by NAHCA in early December said they would not take the vaccine because of skepticism about the rapid launch of the vaccine and lack of information on potential risks. I did. The association’s CEO, Lori Porter, says she and her team are answering a 3 am call from the night shift CNA, who is concerned about vaccines. “They have been abandoned by many, so they have no faith or trust,” she says.

It’s a blow to the inhabitants. Penny Shaw, 77, a resident of a nursing home in Braintree, Massachusetts, who joined a national independent committee to assess Covid’s response at a nursing home, probably vaccinated himself because of an autoimmune disease. It states that it cannot be inoculated. She was shocked by their reaction when she started talking to staff at her facility about vaccines last week. “They don’t want to take it,” she says. “Everyone is furious and angry,” he fears being pushed into vaccination.

Some facilities will require workers to be vaccinated. “We are going to make [vaccination] Linkatsman, CEO of the Juniper Community, which operates 22 long-term care facilities in Pennsylvania, New Jersey, and Colorado, said “employment conditions.” That idea doesn’t work for workers like Perry. She says she would consider quitting her job if her own employer needed the vaccine, even if she had worked in the same facility for 25 years. “There were many other places, such as home health care, and I was able to work,” she says. If the facility mandates vaccines, “they will lose a lot of staff.”

So far, there has been little communication about vaccine deployment plans directly targeted to nursing home staff, according to long-term care professionals. “There was no educational campaign for nursing home staff,” says Dr. Kathleen Unlaw, an associate professor at Indiana University School of Medicine and a nursing home doctor. In a November survey of nursing home staff in Indiana, Unroe found that only 45% of vaccines would be vaccinated as soon as they became available. She says both staff and residents are afraid that they are designated as “guinea pigs.”

In the days leading up to the deployment of the vaccine, the turmoil over vaccine consent requirements has confused the already overwhelmed long-term care industry. Pharmacy chain CVS, which has partnered with the CDC to provide Covid vaccinations at more than 40,000 care facilities nationwide, said it would mail the facility three paper consent forms and asked them to fill out before the vaccination clinic. It was. It will start on December 21st at the earliest.

Walgreens,

Another pharmacy giant participating in the federal partnership program also said it would collect consent forms from the facility on the day of vaccination. According to industry groups, filling out these forms on time and collecting signatures from official representatives of residents who are incapable of making their own medical decisions poses some major logistical challenges. Probably.

But recently, some requirements have changed. According to the industry group AHCA / NCAL, after discussing the paperwork burden and its impact on vaccination rates with the industry, major pharmacies withdrew the signed consent requirement and documented oral or email consent. And came to accept electronic consent. signature. CVS began talking to the facility about additional options on Monday, says spokesman Michael De Angelis. When the institution collects verbal consent, they still have to fill out and sign the consent form, he says. A spokeswoman for Walgreens said the Walgreens agreement included industry opinion and would be offered to the facility “a few days before the on-site clinic.”

Other challenges remain, such as vaccination of workers who are not full-time employees of the facility. Some care providers may only occasionally visit their buildings for vaccine distribution, such as temporary staffing workers, hospice workers, but such workers are not always prioritized. It states that it is not limited. Paul Ruderman, CEO of staffing agency All American Healthcare Services, spoke with dozens of long-term care clients about vaccine distribution, saying “they intend to prioritize residents and dedicated nursing staff.” Agency workers may need to visit a local hospital to get their shots, he says.

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Residents and workers who missed the first vaccination opportunity may have to find another way to get their shots or wait a few months for another opportunity. In general, pharmacies schedule up to three vaccination clinics at each facility, and for those who do not receive two vaccinations within that schedule, “the next step in the process is not planned. “Hmm,” says Peter Van Runkle. , Secretary General of the Ohio Healthcare Association.

Given the shortened schedule, strong vaccination among nursing home staff may present unique challenges to the facility. As many facilities prefer, there is not much flexibility in shifting staff and resident vaccinations. Vaccination of all workers on the same day is a “disaster recipe” because many nursing homes are already understaffed and many can get sick due to the side effects of the vaccine. It could be, “says Van Rankle. As of late November, only about two-thirds of nursing homes reported lack of staff, according to data from the Centers for Medicare and Medicaid Services.

“That’s a concern for Genesis HealthCare, one of the largest nursing home operators,” said Dr. Richard Pfeiffer, the company’s chief healthcare officer. Genesis is considering moving staff between facilities and attracting agency workers, he says. “When our residents need the most care, we can’t afford to be understaffed.” However, given the fierce competition for frontline workers, some facilities have agency staff. I am having a hard time securing it. “The body is just not there,” says Patzina.

The burden of managing the vaccination process and coping with side effects occurs in addition to other Covid-related requirements, such as twice-weekly compulsory testing at some facilities and additional resident care associated with a surge in cases. To do. For direct care workers, that all leads to extreme uncertainty. Given the tight immunization schedule, “the entire building will get sick,” says Sheena Bumpas, director of NAHCA at CNA in Duncan, Oklahoma. “This is unknown and scary.”

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