Jessica Van Fleet-Green, M.D.

After seeing COVID-19 vaccination rates of long-term care residents average in the 75% to 85% range this winter, healthcare leaders in one state are warning about an alarming spring slide.

In Washington State, the original ground zero for the U.S. coronavirus pandemic, some nursing homes are now reporting resident vaccination rates of just 60%.

Jessica Van Fleet-Green, M.D.

“We’re going to get ourselves back to where we were last year,” warned Jessica Van Fleet-Green, M.D., medical director of care continuum for Washington-based MultiCare Health System.

Some counties in Washington are reporting a fourth wave of the virus, with an uptick in cases in nursing centers, Van Fleet-Green said. That follows previous reports of fresh skilled nursing outbreaks in Colorado, Maine and elsewhere.

“We hear similar concerns from some states, but access to additional doses in long-term care settings varies tremendously state by state, by county, and sometimes by provider organization,” Ruth Katz, senior vice president for policy at LeadingAge told McKnight’s Tuesday. “It is worrisome. We don’t want to lose the progress of the federal pharmacy partnership; it vaccinated the majority of nursing home residents. But nursing home populations are not static; residents leave and new ones are admitted regularly; new staff are hired into the organization.”

Van Fleet-Green said cases in Washington have spiked among younger populations, and they are beginning to mount again among residents of nursing homes and adult family homes. Though there have been some breakthrough COVID-19 cases among long-term care residents, Van Fleet-Green said most appear to involve unvaccinated individuals.

Lax succession plan a setback

Increasingly, more buildings have newer residents who have yet to receive COVID-19 shots. Providers have questioned for months how they would be able to ensure ongoing availability to keep up with resident and staff turnover, and some now find themselves facing the consequences of a lag in the system.

“It’s a blow,” Van Fleet-Green said during a LeadingAge COVID-19 webinar Monday. “There hasn’t been a great succession plan.”

Since the federal vaccine partnership ended  —  officially last week, but earlier in many places — Van Fleet-Green and others have said states haven’t made enough vaccines available to long-term care providers or put in place clear processes for keeping them flowing. In Washington, a two-page document issued by the state Department of Health March 30 essentially tells providers to rely on an “existing relationship” with a long-term care pharmacy to coordinate vaccine planning. 

One major weakness is how to ensure hospitalized patients get vaccinated before being referred to skilled nursing facilities. Administering either of the two-dose vaccines in a hospital has been especially problematic, with some acute providers refusing to give them unless a patient schedules a follow-up.

For some long-term care providers, that might involve transporting a vulnerable or frail resident to a retail pharmacy or back to the acute-care setting.

“That’s a logistical nightmare,” Van Fleet-Green said.

She said states need to develop better workflows and be able to track where patients have received their shots and plan how to get them the second dose if needed. Earlier this week, The NY Times reported some 8% of shot recipients nationwide had not received second doses. It’s unclear how many of those recipients might have been long-term care residents.

Van Fleet-Green said a better defined way forward is critical, especially as staff hesitancy remains an issue. The combination of unvaccinated staff, who face fewer and fewer social distancing rules outside of work, and high-risk patients has already proven deadly, according to the CDC. Last week, the agency blamed a variant-fueled outbreak at a Kentucky nursing home on an unvaccinated worker. Three residents, two of them unvaccinated, died.

That the outbreaks continue as some parts of the U.S. now have a glut of vaccines make the continued threat all the more frustrating for providers.

“It’s not a supply chain problem anymore,” Van Fleet-Green said. “This is the hardest part: getting it from the syringe to the patients’ arms.”

Katz concurred. 

“Certainly states could collaborate with health departments or with hospitals, for instance, to ensure that as many people as possible are vaccinated before discharge to a nursing home. Or towns or counties could develop mobile clinics to deliver vaccines to nursing homes as needed, when doses are available,” she said. “Devising solutions requires collaboration; we need the federal government to stay on this and work with us.”