A panel of healthcare experts Tuesday afternoon urged long-term care facilities to get all eligible residents and staff a booster shot by year’s end to help protect against COVID-19’s omicron variant.

Though long-term care has seen an uptick in COVID-19 cases, early access to boosters has provided some protection and limited hospitalizations and deaths, especially relative to 2020. But providers and public health experts remain concerned about the now-dominant omicron variant’s possible impact on seniors and an already overburdened healthcare system.

“What we are seeing now is an urgent need to get those booster shots, and we need to support the goal of getting all those eligible to get their booster shots by the end of this year. That’s 10 days,” Admiral Rachel Levine, M.D., Assistant U.S. Secretary for Health, said during a Tuesday town hall hosted by LeadingAge, AARP and the American Health Care Association. “Getting the boosters must happen in the next couple weeks… We really have one, two, three weeks until, everywhere, the surge is here and hospitals are potentially overwhelmed.”

Levine and David Gifford, M.D. chief medical officer for AHCA, emphasized that full vaccination offers about 35% protection against the omicron variant, while individuals who have received a booster shot are 75% protected — meaning their risk of a serious case requiring hospitalization is reduced by more than half.

That makes additional shots of extra importance to seniors and the chronically ill – essentially the entire nursing home population – because their chances of developing severe cases are higher to begin with. Levine noted that access to hospitals could be limited should the number of even moderate cases skyrocket.

Without a federal distribution system, however, booster shot efforts in nursing homes are dragging. Data updated by the Centers for Disease Control and Prevention this week revealed 54.7% of nursing home residents have received a booster, while just 23.5% of staff members there have.

Earlier Tuesday, AHCA President and CEO Mark Parkinson, told CNN his organization was on “high alert, adding that achieving a 90% booster rate among residents is the group’s top priority.

“We need to do better, and we will,” Parkinson said. “We certainly don’t know if (omicron) is milder among our residents. The average age of a nursing home resident is 83. Our residents have a lot of frailties, so we’re extremely concerned.”

Lack of federal support for NH boosters

Gifford said during the town hall that AHCA is working with members and long-term care pharmacies to move schedules up and get a mass of shots into arms between now and New Year’s Day.

But Brendan Williams, president and CEO of the New Hampshire Health Care Association, told McKnight’s Long-Term Care News Tuesday that the lagging distribution of boosters to facilities showed “feigned federal concern for nursing home care” had “dissipated into indifference.” 

“The same federal government that seeks to require vaccination is not, even as the omicron variant makes headlines, prioritizing nursing homes for vaccine booster shots,” he said in an email. “Instead of being at the front of the line, care facilities now share that line with everyone else, and pharmacies have their own workforce issues in administering vaccines to a growing list of eligible recipients.”

Williams noted, however, that elderly residents continue to be safer inside heavily vaccinated nursing homes than outside them because of the ongoing emphasis on vaccinations by most providers.

Even as omicron passed delta to become the nation’s prominent variant, making up 73% of cases as of Tuesday, nursing home cases in many states stayed at levels below last year’s peaks (while community cases began to exceed previous counts).

In Pennsylvania, an infectious disease specialist at UPMC said the system’s hospitals were seeing very few nursing home residents — about 1% — among their COVID-19 patients.

Will open visit policy hasten spread?

Still, given the lack of easy access to boosters and lingering questions about omicron’s virility, providers are also increasingly troubled by federal regulators’ expectations that facilities continue allowing visitors with few if any exceptions. 

Gifford joined leaders from LeadingAge and AMDA last week in asking the Centers for Medicare & Medicaid Services to revisit its visitation guidance issued in November and consider giving providers “more flexibility to temporarily limit, restrict, or prohibit visitors from entering the facility.” 

“We are concerned that the absolute, unconditional language may pose a risk to nursing homes and their residents, placing skilled nursing facilities in precarious situations when outbreaks occur,” they wrote. “It seems counterintuitive and potentially dangerous to limit facilities’ ability to temporarily restrict access to the building when a deadly and highly transmissible illness like COVID-19, especially with omicron expected to surge, is already rampant inside the facility, in the surrounding community, or when hospitals in the area are experiencing a surge. Additionally, during an outbreak situation, staffing shortages may lead to the inability to ensure that safe visiting policies are being followed.”

Barring a response from CMS, the Pennsylvania Health Care Association Monday urged visitors to follow all infection control guidance and stay home if sick or potentially exposed.

“Unfortunately, CMS made an abrupt decision rather than taking a more considerate, gradual approach, especially as providers are still trying to increase booster rates,” said Zach Shamberg, president of the Pennsylvania Health Care Association. “With expected increased foot traffic at long-term care facilities during the holiday season, and as COVID-19 cases in the community continue to rise with no federal restriction on visitation, we continue to ask the public to be mindful of heightened infection control guidelines when planning to visit a loved one in a long-term care facility.”

While nursing homes cannot prohibit visitors based on vaccination status, PHCA called on CMS to institute a testing measure to screen guests for symptomatic and asymptomatic cases. Such a measure could require visitors to receive a COVID-19 test 24-48 hours in advance of a visit or pay to have a provider conduct a test when the visitor arrives at the long-term care facility, leaders suggested.