Senior living providers are eagerly awaiting a Covid-19 vaccine — but the logistics around inoculating residents and associates are complex.
On Wednesday, the United Kingdom authorized a Covid-19 vaccine from Pfizer for emergency use, increasing hopes that the U.S. Food and Drug Administration will follow suit in short order. While it appears that a vaccine could be available within weeks, senior living providers face uncertainties and complications surround the vaccine supply chain, who should be prioritized to receive the vaccine, and what providers can do about residents or associates who refuse vaccination.
But one thing is certain: most hopes of returning to normal operations in 2021 hinge on the widespread distribution of a safe and effective Covid-19 vaccine. That’s why senior living providers including Juniper Communities, ALG Senior and the Evangelical Lutheran Good Samaritan Society are preparing now to surmount obstacles and ensure a fast and efficient vaccination process, as soon as a vaccine is available. And both are utilizing the help of long-term care pharmacy giant Omnicare and its parent company, CVS Health (NYSE: CVS) as part of the Pharmacy Partnership for Long-Term Care Program.
Having early access to the Covid-19 vaccine is “extremely important” for older adults and the people who assist them, according to Juniper Communities Founder and CEO Lynne Katzmann. Bloomfield, New Jersey-based Juniper operates a portfolio of 22 communities in Colorado, New Jersey and Pennsylvania.
“We have done as much as we can with testing, and we have added to that all the infection prevention measures … but it’s not enough,” Katzmann told Senior Housing News. “The vaccine is going to be another tool, and perhaps our most potent tool, moving forward.”
Three drugmakers — AstraZeneca; Moderna; Pfizer and its partner BioNTech — are seeking regulatory approval from the FDA for three different Covid-19 vaccines. The first doses could be ready to administer as early as later this month.
Between the Pfizer and Moderna vaccines, the CDC expects millions of doses to be available by the end of December — but exactly how much will ultimately arrive by then remains to be seen. Pfizer on Thursday said it expected to be able to ship only half of the vaccines it originally projected due to supply chain issues, according to the Wall Street Journal.
Initially, supplies are expected to be limited, which is why a CDC panel is recommending workers and residents of long-term care facilities, such as assisted living communities and skilled nursing facilities, be among the first to receive a Covid-19 vaccine when it’s available.
‘Influencers’ lead the way
Juniper, ALG and the Good Samaritan Society are strongly encouraging associates to get the vaccine as soon as they can. Community and corporate leaders at all three organizations are preparing to roll up their sleeves and get their shots first as a way to lead by example.
At Juniper, Katzmann, along with the provider’s executive directors and many of its other leaders, are slated to get their shots before anyone else.
“I believe it’s important for my entire team and all of our residents to get it, and I want to show them that I am willing to get it,” Katzmann said. “Influencers making sure that we create a situation where as many people as possible take the vaccine, that is going to be important.”
Randy Bury, president and CEO of the Evangelical Lutheran Good Samaritan Society, shared a similar message.
“I’ve said this to our entire company, if I could get that vaccine today, I’d be the first in line,” he told SHN.
Based in Sioux Falls, South Dakota, the Good Samaritan Society is one of the nation’s largest nonprofit senior living providers, with more than 380 locations across 24 states. Good Sam affiliated with Sanford Health in 2019, so leaders with the senior living provider have been in close contact with acute care providers and other clinical experts, and have reviewed their materials on the vaccine. Based on those conversations and information, Bury said he is “totally comfortable” being vaccinated.
Hickory, North Carolina-based ALG’s portfolio numbers about 140 communities, and leaders at the company will also be among the first to receive the vaccine. This is a practice ALG has utilized during previous flu vaccination campaigns, according to Dr. Kevin O’Neil, chief medical officer at ALG Senior. In past years, O’Neil, ALG CEO Charlie Trefzger, Executive Vice President Rick Grimes and the rest of the senior leadership team have rolled up their sleeves to receive their shots first.
“If we’re going to do the right thing, we’ve got to be good examples ourselves,” O’Neil said. “And the best way to do that is to make sure … our leaders are walking the talk.”
After the first vaccines have been doled out, both providers plan to distribute it with the help of Omnicare and CVS. ALG will first target its communities’ associates, as they are the ones who most frequently leave the community and thus are more likely to spread the virus. All the while, the company will educate residents on the importance of getting a Covid-19 vaccine down the road, O’Neil said.
Juniper hopes to vaccinate all of its residents and associates during the same period of time. If supplies are more limited, the company will first seek to vaccinate its associates, Katzmann said. Juniper also plans to leverage its relationship with Oakland, California-based data analytics firm Dascena in prioritizing the most at-risk residents for vaccination.
Katzmann expects Omnicare and CVS will do much of the heavy lifting in actually vaccinating associates and residents. Reached by SHN Wednesday, Omnicare President Jim Love said the organization is gearing up to work with the more than 25,000 facilities around the country that selected CVS Health and Omnicare as their preferred vaccination partner.
“Once a vaccine is approved and available in the U.S., my team within Omnicare, along with our colleagues throughout CVS Health, will work quickly to make vaccinations available to staff and residents at those facilities free of charge through a series of vaccination clinics, where appropriate personnel will administer the vaccines on-site,” Love told SHN. “Depending on which vaccine is approved, two doses may be required, in which case we will schedule a follow-up visit as well within the recommended timeframe.”
Still, Juniper is readying a backup plan to have its staff help distribute the vaccine. And there are some hurdles in doing so.
One is the shot itself, which is administered in two doses spaced apart by days or weeks in all three vaccines seeking FDA approval. To stay on top of scheduling the vaccines and reporting to state and federal officials, Juniper is working with its electronic health record (EHR) vendor, PointClickCare, on its documentation process.
“[We’re seeing] whether there’s a simple way of documenting that, or whether we can help construct one that others can use in addition to ourselves to make the documentation as simple as possible,” Katzmann said.
The vaccine may also come with some side effects, such as muscle or injection site pain, fatigue, chills and fever, depending on the administered vaccine. Although one challenge is the discomfort of the vaccine itself, a bigger one is the fact that many of the side effects mimic Covid-19 symptoms. To that end, Juniper is working on a system to track vaccine-related side effects in residents, should they arise.
While acknowledging that the vaccine could lead to uncomfortable side effects, Good Sam’s Bury urged a larger perspective.
“You have some fatigue for a few days and a sore arm — you look at what Covid is doing to a large segment of this population, the number of deaths, the number of serious health consequences, I don’t think it’s even close,” he said.
Another hurdle is the temperature at which the vaccine doses are stored. The Pfizer vaccine in particular requires storage at subzero temperatures of minus-70 degrees Celsius — well below the capability of most senior living providers. Although Pfizer plans to ship its vaccines inside of a specially made “cool box”, both ALG and Juniper still have questions about the vaccine supply chain.
“That’s going to be a challenge in some cases,” O’Neil said.
Refusing the vaccine
Senior living providers also must face the possibility that some will decline the vaccine. Senior living associates and residents alike are facing a wall of misinformation regarding the vaccine, and recent polling shows that the public still has concerns regarding the vaccine’s safety.
Mandating vaccines for health care workers is legally complicated in many states, though many employers already require workers to get their annual flu shots. But Sabra Health Care REIT (NYSE: SBRA) CEO Rick Matros has some questions about the process.
“While employers may legally be allowed to mandate, can they do it practically? Should the government mandate and take the burden off employers?” Matros told SHN. “If some percentage of employees don’t want to be first in line, what then? Will they not be allowed to come to work? There are shortages already, so that doesn’t seem practical.”
All questions aside, Matros believes that if even half of all health care workers get a Covid-19 vaccine when it’s available, that would go a long way in normalizing the process.
“I would think that once others start seeing that those folks are fine, then more will take it,” Matros said.
Sabra’s portfolio consists of 425 leased and managed senior housing and skilled nursing communities, and the real estate investment trust is currently communicating with all of its operators regarding their vaccine planning. And all have either reached agreements or are in the process of reaching agreements with CVS and Walgreens for access and distribution, Matros said.
Meanwhile, both ALG and Juniper will strongly encourage employees and residents to get their shots, with plans for people who do not.
ALG is readying a declination form that associates can sign if they refuse to take the vaccine — something it has already done in past flu vaccine clinics. The provider also has urged associates to take a “hero’s pledge” that they understand the threat of Covid-19 and will uphold the company’s infection control protocols at all times.
“After understanding the benefits and the risks, if they decide against it, they’ll sign a declination form,” O’Neil said. “Hopefully that will be a disincentive to refuse the vaccine.”
For associates who decline the vaccine, ALG would likely relieve that worker of frontline resident duties.
“We’re not going to let you work directly with a resident if there’s any chance you haven’t been immunized,” O’Neil said.
At Juniper, Katzmann hopes that the incentives of getting vaccinated will outweigh any concerns.
“I hate to even have that conversation,” Katzmann said. “Because I believe that most people will want the vaccine, particularly if it’s proven to be safe.”
Residents, on the other hand, are a different story. While providers can’t force them to get vaccinated, they can educate them on the benefits of doing so. For residents who decline the vaccine, Juniper plans to ask them to continue all of their Covid-19 safety precautions through the end of the pandemic, such as social distancing, regular testing and the use of personal protective equipment (PPE).
In the end, a vaccine in limited quantities is not a panacea, Katzmann said, and it will take many months for the U.S. as a whole to reach some semblance of widespread immunity and halt the spread of the virus. But she is hopeful that the vaccine represents the light at the end of the tunnel for the senior living industry.
“Essentially, it’s going to take 60% to 70% of the people being vaccinated in this country to achieve enough immunity from the virus,” Katzmannn said. “And that isn’t going to happen until the second or third quarter.”