Kimberly Marselas

For the last several months, long-term care’s vaccination efforts have been largely focused on increasing uptake among staff.

But even as news broke Tuesday that fully vaccinated residents could once again dine and socialize — without masks! — in close proximity to one another, there came a nagging reminder that it’s too early to relax.

Jessica Van Fleet-Green, a medical director of a large health system in the Seattle area, says some long-term care facilities in her region have seen vaccination rates plummet to 60% among residents.

Forget the “Drive to 75” campaign promoting a 75% vaccination rate for long-term care staff; if what Van Fleet-Green is seeing is actually a national phenomenon too nascent to be captured in the data, elderly residents will soon enough need their own marketing campaign.

How did we get here? It’s an important question, even if the “we” turns out to be a small sample of nursing homes.

Many providers have done the hard work of arranging large-scale clinics in cooperation with federal partners, helping the majority of residents and some staff recognize the value in inoculations both as a means of self-protection and a way to protect those they live and work with.

But a key factor in the falling rates is that the people many nursing home residents call neighbor or caregiver change way too often. Van Fleet-Green acknowledged as much in her comments to LeadingAge members, saying much of her state’s problem is connected to new admits who have no direct access to vaccines either in the facility or during a prior hospital stay.

How can this be, when providers warned against this from the outset?

In many states, Washington included, officials have left ongoing vaccination efforts up to SNFs to iron out with their pharmacy reps. But because of cold storage issues, some long-term care pharmacies are requiring a certain number of needed Pfizer or Moderna doses before scheduling delivery. 

While that was initially attributed to efforts to reduce dose wasting, it may be time to reconsider the strategy. Some regions are reporting a glut of vaccines, and the vaccination slide in Washington shows speedy vaccination administration is becoming more important than getting the last drop out of each and every vial. 

It’s clearly not a Washington state-specific problem either. Last week, the Associated Press noted long-term care facilities were leading Colorado in new infections, with 52 outbreaks since April 1.

“Nursing home residents were among the first to be offered vaccines, but not everyone took the shot. Some unvaccinated residents may have also moved in since vaccination efforts began,” the wire service reported.

May have? Even with census down almost universally, you can bet that nearly every skilled nursing provider has taken in at least a few unvaccinated residents since December.

If state officials are being even a smidge as blasé about the implications of those move-ins, it’s easy to see why some residents now find themselves worried once again about COVID’s ability to threaten both their quality of life and their actual lives.

If you’re a provider, you’ve got to get out there and push for faster, more routine access. Tell your state officials you need more consistent delivery. And if you’re a state official who thinks providers and pharmacists can navigate alone, consider this advice from David Gifford, chief medical officer of the American Health Care association:

“There is this notion among some that vaccines were administered in long-term care, so we’re done, and that would be a perilous mistake,” he said in a statement earlier this month. “We need federal and state public health officials to continue to prioritize long-term care for vaccine allocations and other support for the foreseeable future and until this virus is eradicated.”