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As COVID Infections Rise, Nursing Homes Are Still Waiting For Vaccines
"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."
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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.
"We're not going to just say, 'OK, everyone get vaccinated,' and then forget about it," she said.
Avalon's homes have used modest financial incentives to encourage staff members to get vaccinated. Some have organized contests among different units, with the winner getting prizes like a pizza party or a drawing for a gift certificate from a department store, and those efforts will resume this year.
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."
Sheena Bumpas, a nursing assistant in Duncan, Oklahoma, and vice chair of the National Association of Health Care Assistants, planned to get this season's shot but said some of her colleagues would not.
"Now that the public health emergency has ended, I think people are done with it," she said.
Edenwald Senior Living, a nursing home within a retirement community in Towson, Maryland, is requiring its workers be vaccinated unless they can justify an exemption for medical or religious reasons.
As of Sept. 10, about three-fourths of the home's workers were up to date with their previous COVID vaccines, triple the national rate for nursing home employees, according to federal records.
Edenwald is relying on the Giant supermarket pharmacy to administer the shots in the auditorium of its independent living section. Sign-up sheets have already been distributed for clinics later this month. The home is billing workers' insurance for the shots, but managers at the home said it would pay for employees without health coverage.
"This is our seventh clinic for COVID," said Meghan Curtis, Edenwald's director of care management. "We've kind of got it down pat."
Swati Gaur, the medical director of three nursing homes affiliated with Northeast Georgia Health System, said some homes might offer recalcitrant employees the Novavax vaccine. It relies on more traditional virus-blocking technology than the Moderna or Pfizer shots, which use messenger RNA.
"We are basically saying, 'Why are you not taking the vaccine? Have you thought about Novavax? It's manufactured like the flu vaccine,'" Gaur said.
For the first time, nursing home residents will be offered a vaccine for RSV. The virus causes the hospitalizations of as many as 160,000 people older than 65 each year, killing up to 10,000. Most nursing homes are coupling the flu vaccine with either the COVID vaccine or the RSV vaccine but are not attempting to give all three simultaneously.
Gaur said that the novelty of the vaccine and people's relative unfamiliarity with RSV meant that clinicians would need to spend more time explaining the reason for the shots.
Spurgeon Manor, the nursing home where Wityk lives, is partnering with the pharmacy at a nearby Hy-Vee grocery store to provide the COVID shot, most likely in early October, to 85 residents of the home and an adjoining assisted living center, as well as employees.
Alana Marean, its assistant director of nursing, said that workers would be encouraged to receive the shots, but she guessed that not even half would do so. "There's a lot of stigma out there about it," she said.
Lee Giese, 95, a retired truck driver who lives at the home, said he was looking forward to the latest shot after coming down with COVID last winter. He said he believed his earlier vaccinations helped protect him from more serious symptoms.
He said he expected most residents of his facility would get the shots, but a few would refuse. "Some people have a death wish," he said.
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Jordan Rau and Tony Leys are reporters for KFF Health News, a nonprofit news organization. For this story, Leys reported from Dallas Center, Iowa, and Rau reported from Washington, D.C.
c.2023 The New York Times Company
Supply Shortages, Insurance Hiccups Complicate Vaccine Rollout
The Boston Globe
A CVS pharmacist administered vaccinations for COVID-19 and the seasonal flu. Joe Burbank / AP updated on September 27, 20233:48 PM Mary Chitty, a 73-year-old Somerville resident, had hoped to get a triple-whammy COVID booster, flu shot, and RSV vaccine on Monday but settled for less because her local CVS ran out of COVID boosters.
When she asked to schedule a new COVID vaccination appointment, Chitty was told the next available appointment wasn't until next week at the earliest.
Chitty is one of many Americans seeking new and updated vaccines this fall and facing delays, canceled appointments, and headaches with insurance coverage. She had hoped to receive a vaccination before traveling to New Hampshire this weekend but was out of luck.
"I'm just trying to do the responsible thing," she said. "I'm sure I can get [a COVID booster] eventually, but it's a little frustrating."
Her main complaint is not the lack of boosters, but the lack of communication and clarity throughout the process — one that's reminiscent of the original COVID vaccine rollouts, she said.
"It seems like they haven't learned anything," Chitty said. "It's reminding me of the difficulty of getting vaccines three years ago."
Millions of the newly formulated COVID vaccines have shipped out since the Centers for Disease Control and Prevention signed off on them earlier this month for ages 6 months and up. Cases started rising again in late summer, and experts hope the new shots will help protect people during the fall's respiratory virus season.
But this is the first time the federal government is leaving purchasing to the private market since the pandemic began, according to CDC Director Dr. Mandy K. Cohen, who acknowledged the distribution problems.
"It's important to know that there is vaccine available," Cohen said in a video posted on social media last week. "You will be able to get one. And it should be free for you — whether or not you have insurance."
"It's great that people are excited to get the vaccine," Cohen added. "If you've had a problem finding the vaccine, stick with it. More vaccine is on the way."
Ann Shannon, 61, of Ipswich, was told by a pharmacist technician at a CVS in Newburyport that they did not have any boosters left in stock when she showed up to her scheduled appointment on Sept. 16.
Worse, the pharmacy wanted to charge her "a couple hundred dollars" for the RSV vaccine she had scheduled at the same time, Shannon said. She declined the shot and called her insurer, Tufts Health Plan, which attributed her experience to "coding issues on their end," Shannon said.
This fall is the first time that seniors are being offered the vaccine for RSV, which the Food and Drug Administration approved in May and the CDC recommends for adults 60 and older.
Under the Affordable Care Act, private health insurers must cover the cost of preventive care, including vaccines recommended by the CDC's Advisory Committee on Immunization Practices.
On Tuesday, Tufts reported still receiving complaints about RSV vaccine coverage through its call centers. "We are actively reaching out to the pharmacies, as the coding was resolved on Friday," said Kathleen Makela, director of public relations at Point32Health, Tufts' parent organization.
Tufts said its members on Medicare plans should call the member services phone number on their health plan identification cards to receive reimbursement. Tufts Health Plan members who have Medicaid plans will not have coverage for the RSV vaccine until Oct. 2, said Hemant Hora, senior medical director at Tufts Health Plan.
CVS has been receiving the updated vaccine on a "rolling basis," said corporate spokesperson Matt Blanchette. He said although the majority of its retail pharmacies have been able to honor scheduled appointments, delivery delays to select stores have forced the company to reschedule appointments. "We'll continue to offer additional appointments at those locations as supply is received," he told the Globe in an email.
Walgreens temporarily paused online appointment scheduling over the weekend and apologized for the inconvenience that canceled appointments had caused customers.
Ann Scales, a spokesperson from the Massachusetts Department of Public Health, said DPH can only track COVID vaccines that are ordered through federal contracts for the state vaccine program. DPH has no visibility into commercially purchased COVID vaccines, Scales said.
To avoid any insurance-related headaches, Cohen of the CDC advised those getting vaccinated at their local retail pharmacy to confirm their details before heading to an appointment, including whether their pharmacy is "in network" with their insurance plan.
Moderna and Pfizer representatives said they have enough supply. Spokespeople said that Pfizer isn't experiencing any shortages, that it has "shipped and delivered several million doses of its 2023-2024 COVID-19 vaccine" and that "100% of orders are being shipped within days of an order being placed."
Globe reporters visited a handful of CVS and Walgreens pharmacies in downtown Boston on Tuesday and found that three out of four had no boosters in stock. The fourth, a Walgreens, had a limited supply.
"I was surprised initially that there was a shortage of the COVID vaccine because there were so many announcements around it, saying that it would be available," Shannon said. "It appeared to be an easy process and then it really wasn't."
Alexa Gagosz of the Globe staff contributed reporting. Material from the Associated Press was used in this report.
Updated COVID-19 Vaccines Are Now Available In San Diego: Where To Find Them
SAN DIEGO — Updated vaccines to combat new strains of COVID-19 are starting to become available for residents across San Diego County.
The new monovalent boosters, which were designed to more closely target the XBB lineage of the Omicron variant, were approved for distribution earlier this month. The shots replace the former bivalent booster shot that was in circulation over the last year.
This comes as COVID cases remain elevated above lows seen during the summer months. In San Diego, as many as 3,234 confirmed positive cases were reported since the beginning of September, according to data from the county.
Free at-home COVID tests are back: Here's how to get yours
"This new vaccine is a welcome resource to our ongoing COVID-19 prevention efforts, especially as we enter the fall and winter seasons when cases traditionally increase," said San Diego County public health officer Dr. Wilma Wooten. "As virus remains prevalent in our community, I encourage everyone eligible to get the updated vaccine."
Health officials recommended people get up to date on COVID shots. For those ages five and up, that means receiving one of the updated doses. Children from 6 months to 4 years old are also encouraged to get all recommended doses, including one updated shot.
According to the Centers for Disease Control and Prevention, the new vaccine will provide renewed protection against severe illness, hospitalization and death for those who contract COVID. It will also help minimize symptoms for people who become infected with the virus.
Here are some of the ways to find one of the updated vaccines near you:— Contact your healthcare provider to make an appointment for the updated COVID vaccine.
— State's MyTurn website: Visit MyTurn.Ca.Gov, to schedule an appointment for the updated vaccine, as well as the flu and Mpox immunizations. MyTurn can also be used to find walk-in clinics in your area.
— County Public Health Centers: Visit one of the six San Diego County Public Health Center locations for a no-charge immunization (available only for those who are uninsured)
— CVS Pharmacies: San Diego CVS locations still are offering free COVID vaccines and booster shots. To schedule either of the immunizations, you can visit the CVS website.
— Rite Aid Pharmacies: Schedule an appointment at a Rite Aid near you for a free COVID-19 vaccines and booster shots. Information is available on the Rite Aid website.
— San Diego County residents who are homebound and would like to get their shot at home can call 2-1-1 for more information about how to receive the updated COVID booster or flu vaccine.
More information on the updated COVID vaccine in San Diego County can be found here.
Facemasks remain optional at Tijuana schools as COVID-19 cases climb in Baja
Along with the vaccine, health officials encourage people to take a number of personal actions to protect themselves and limit the spread of COVID. These include:
Stay home if sick.
Seek treatment from your doctor immediately after testing positive. Paxlovid and other treatments are very effective and work best if started promptly.
Consider wearing a mask in public places, especially in crowded or poorly ventilated spaces.
Wash your hands and practice good hygiene.
Cover your cough or sneeze.
For the latest news, weather, sports, and streaming video, head to FOX 5 San Diego.
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