Nurse applying vaccine on patient's arm wearing face mask

Early this month, AMFM Nursing & Rehabilitation Centers celebrated the completion of second-round COVID-19 vaccinations at all 19 of its buildings — before many had even offered a first round and nearly two months ahead of the target a national provider organization has set for all U.S. facilities to finish both rounds.

The chain dubbed Jan. 8 “V-Day,” acknowledging the hope that the vaccinations brought for victory over the pandemic.

AMFM’s vaccine campaign — like those of most providers in West Virginia — has not relied on the federal vaccination partnership with CVS and Walgreens.

Instead, the state allowed nursing homes to lean on long-term care pharmacies that have long been partners in daily care, flu vaccination efforts and COVID-19 testing.

Soon, those partners will play a larger role in vaccinating long-term care residents nationwide. As the federal SNF program — widely criticized for its slow rollout — winds down after February, states will have more say about who gets vaccine and how it is distributed.

“It’s going to be messy because you’re going to have 50 different jurisdictions making decisions … and they won’t all necessarily be the same,” Chad Worz, PharmD, Executive Director and CEO of the American Society of Consultant Pharmacists, told McKnight’s Long-Term Care News.

Those already in the trenches say establishing local or long-term care pharmacy partnerships now will ensure nursing homes have continued access to and help administering COVID-19 vaccines.

Federal guidance

The American Health Care Association has called on all first-round vaccination efforts to be completed by March 1. But even after an initial series of clinics get existing personnel fully vaccinated, nursing homes will still need doses for new staff and newly admitted residents.

According to guidance posted by the Centers for Disease Control and Prevention, facilities can keep working with original partner pharmacies. CVS told McKnight’s on Wednesday that it could continue to provide smaller amounts of vaccine after initial clinics, “but future visits outside of the federal program would be determined on a case-by-case basis.” Walgreens also said it would be flexible with the three-clinic “model.”

Neither major pharmacy would say definitively whether it would provide anyone a first dose of the vaccine at a scheduled third clinic, when there might not yet be a follow-up plan.

But nursing homes can opt to work with other pharmacy providers, and choices are growing.

“There will be a broader list coming,” said Neil Marshall, president of Consonus Pharmacy, one of seven affiliated with Managed Health Care Associates that was included in the initial federal partnership.  “There are several hundred (pharmacies) Managed Health Care Associates is working with for the next stage.”

In Oregon, Consonus served 200 skilled nursing and assisted living facilities, nearly all of the pharmacy’s client base. The company planned for months to prove it could meet requirements for ultracold storage and data reporting.

Marshall said long-term care pharmacies are uniquely positioned to address ongoing vaccine needs. Often, they already have logistics, delivery schedules and patient information in place.

In many cases, Consonus pharmacists worked alongside a building’s clinical staff to speed up vaccinations. Marshall admits asking already overworked staff to take on another commitment is a “heavy lift,” but said his company also tried to connect facilities with additional resources.

In some buildings, having the product provided by a trusted facility partner, by people who were routinely in the building pre-COVID, also helped increase staff acceptance, Marshall said. Consonus is on track to wrap up second shots by Jan. 31 with 90% acceptance among residents and 60% to 70% among staff, both figures on the high end among average rates reported thus far.

In some places, local pharmacies are so far ahead of the big two retail chains that skilled nursing operators are trying to switch midstream. Consonus and others can accommodate some of those requests through a “clear pathway” used by public health officials.

A success story

Because AMFM’s partner, Lifetree Pharmacy, knew its facilities, President Todd Jones said distributing 4,489 doses went smoothly, with dining rooms used as socially distanced inoculation sites and carts taken to non-mobile residents.

Now, the goal is to calculate how many doses to reserve for use by Lifetree’s clients in coming weeks, such as doses needed for staff who missed first-round shots because they had COVID-19.

Packaging will continue to limit availability. Instead of vaccinating new residents as they arrive, Marshall said pharmacists will likely set a threshold at which they can justify opening a multi-dose vial.

Facilities will need to emphasize communication with residents and families about vaccination opportunities, he said, and they must continue to encourage and confirm staff vaccinations, especially as more are given outside the workplace.