The Centers for Medicare & Medicaid Services has released new guidance reminding nursing facilities and other congregate care providers to actively offer updated COVID-19 vaccinations and to provide timely treatment to prevent severe outcomes.
In a Quality, Safety & Oversight (QSO) memo, the agency stressed the importance of testing for COVID-19 and monitoring individual risk to keep mild symptoms from escalating. The guidance specifically encouraged the use of approved monoclonal antibodies and oral antiviral drugs.
Special vigilance should be provided for patients with multiple preexisting comorbidities, before their condition deteriorates, the memo stated. These include residents of nursing homes and participants in programs such as the Program of All-Inclusive Care for the Elderly (PACE), CMS said.
“Every patient who tests positive for COVID-19 should be evaluated to determine whether the use of an available therapeutic is appropriate,” CMS added. Nursing homes in particular should “review and reinforce their infection control protocols,” for COVID-19 and flu, it said.
No boosters yet?
CMS also expressed chagrin that only 44% of nursing home residents have received an updated bivalent COVID-19 booster shot. Some facilities appear not to have complied with the CMS requirement to educate their residents about COVID-19 vaccinations or to offer recently updated shots.
“The agency is particularly disappointed that some facilities are reporting that zero residents have received the updated bivalent vaccine, and we will be looking closely at these facilities,” it stated. The agency cautioned outliers to get back on track, emphasizing that it will continue to track facility outbreak status and poor outcomes.
Vaccination clinics for facilities
The CMS memo was released the same day that the White House announced the start of a six-week campaign to encourage all eligible Americans to get COVID booster vaccinations.
The Biden administration has been promoting vaccinations for influenza and COVID for months in an attempt to get ahead of an expected “tripledemic” of those diseases and respiratory syncytial virus. As part of the effort, $125 million will go toward getting more older Americans and people with disabilities vaccinated through outreach, education and other methods, it stated in a fact sheet.
For its part, CMS said it plans to meet with its Quality Improvement Organizations this month to support their outreach and to help set up more vaccination clinics at nursing homes nationwide.
So far, ‘remarkable’
That 44% of residents have gotten the updated bivalent shots is remarkable when compared to a “dismal” 11% of the general population, said AHCA/NCAL President and CEO Mark Parkinson, and LeadingAge President and CEO Katie Smith Sloan in response to the government’s announcements. But more can be done, they added.
The two largest long-term care associations on Tuesday voiced their approval of an “all hands on deck” approach to getting the number of COVID-19 booster vaccinations up.
“We believe we can continue to increase that booster rate and to do so requires a shared commitment from the government and other healthcare providers,” they said in a joint statement. For example, among the 90% of residents admitted to nursing homes from hospitals, very few are current on their vaccines upon admission. That statistic can be improved through collaboration with hospitals, they said.
For a refresher on COVID-19 treatments, CMS referred providers to the following webpages:
Guidance on the antiviral molnupiravir (lagevrio): https://aspr.hhs.gov/COVID19/Therapeutics/Products/Lagevrio/Pages/default.aspx
Guidance on the antiviral Paxlovid: https://www.fda.gov/drugs/news-events-human-drugs/fda-updates-paxlovid-health-care-providers
Guidance on monoclonal antibodies: https://www.cms.gov/monoclonal