The Covid-19 vaccine has arrived in the senior living industry amid a troubled initial rollout nationally. Many are reporting good, albeit early, progress, and they are preparing for obstacles appearing on the horizon.
Providers across the country, including large organizations such as Brookdale Senior Living (NYSE: BKD) and Atria Senior Living, began administering the long-awaited vaccine doses shortly before Christmas. And in the days since, that effort has widened to other senior living providers across the country.
For the senior living industry, the vaccine represents the light at the end of the tunnel of the Covid-19 pandemic. Getting there won’t be easy, both for senior living and for the country as some states fumble their early distribution plans and misinformation regarding the vaccine runs rampant.
Senior living providers have encountered hurdles such as uncertainty regarding vaccine supplies, complicated documentation processes with short submission timelines and prioritization plans that leave some senior living residents waiting for a vaccine. And they are making difficult decisions, including whether to mandate vaccination for team members, and how to encourage residents to receive the vaccine.
Still, many of these same providers have confronted those challenges with careful planning and forethought. They include McLean, Virginia-based Sunrise Senior Living, which is planning vaccine clinics across more than 230 U.S. communities; Bloomfield, New Jersey-based Juniper Communities, which held its first clinics in late December; and Dallas-based Pegasus Senior Living, which held its first clinics Monday. All three providers are working with CVS Health (NYSE: CVS) and its pharmacy subsidiary Omnicare, which along with Walgreens are part of the federal government’s plan for distributing the vaccine in senior housing and long-term care settings.
Other providers, such as Marietta, Georgia-based Sterling Estates; and Milwaukie, Oregon-based Marquis Companies, along with its in-house pharmacy Consonus Pharmacy, have taken a different approach by directly handling the vaccine rollout.
‘Education is key’
For many senior living providers, the vaccination effort began long before any doses arrived at their communities.
For example, Sunrise has focused in recent weeks on providing communities with educational resources on the vaccine from the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). And that education effort is paying off now as Sunrise ramps up its vaccination efforts, according to Chief Clinical Officer Sue Coppola.
“Many of our communities are also hosting town halls where the vaccination process is explained in more detail, concerns are addressed and fact sheets are made available on the vaccine, all of which help ensure that consent forms are fully understood and signed by individuals who want to receive the vaccine,” Coppola told Senior Housing News. “We have also hosted calls that team members can join to ask a nurse vaccine-related questions.”
While Sunrise declined to share exactly how many residents and staff had received their first shot as of Wednesday, Coppola added that “the vast majority of our clinics thus far have been smooth, successful and truly joyful.” The company is taking an “experiential” approach to its vaccine clinics, including by diffusing calming essential oils, playing relaxing music, and having snack and beverage carts available.
“We have every reason to expect that trend to continue, and we will learn and amend processes and approaches as we move forward,” Coppola said.
Meanwhile, Tucson, Arizona-based Watermark Retirement Communities has held overseen the administration of about 500 vaccine doses in seven of its 60 communities across the U.S.
“We anticipate early spring [for] completing the pharmacy clinics for vaccinations, depending on how the allocations continue for senior living,” Watermark National Director of Health Strategy Stephanie Boreale told SHN.
Juniper held its first clinic at its Juniper Village at the Spearly Center community in Denver on Dec. 29. All of the community’s associates and all but three of its 127 residents received their first vaccine dose during the clinic, CEO Lynne Katzmann said.
That high rate of adoption was aided by the fact that Juniper spent considerable time preparing residents and staff for the vaccine. For example, the company held a vaccine information webinar for its associates long before the first doses arrived.
During the webinar, a registered nurse who participated in the Moderna vaccine clinical trial helped answer questions about the vaccine.
“That was remarkably helpful, because she’s a trusted and knowledgeable individual,” Katzmann said. “She also happens to be older, and was able to answer a lot of questions for people.”
Juniper aimed other education efforts at residents and their families. The company shared updates about the vaccine online and in emails and calls, and also held a separate webinar for families and residents starring a medical director from Redwood Health Partners.
“Education is key,” Katzmann said.
Education also paid off for Birmingham, Michigan-based Bloom Senior Living, which owns and operates nine communities in Florida, Indiana, Louisiana, Ohio and South Carolina. The company held its first vaccine clinics at a community in South Carolina on Wednesday, during which 93% of the community’s 50 residents received their first dose.
Like other providers, Bloom held town hall meetings and distributed information among residents and staff to win trust that the vaccine was safe and effective, according to Melissa Campbell, the company’s director of education and development.
“The key to a successful program really is education,” Campbell said. “There tends to be so much false information that gets passed around social media, so getting true, science-based information to the residents and to the associates is so important.”
Although residents participation was high, less than half of the community’s workers had opted to take the vaccine, Campbell said. But this might just be a case of not wanting to go first in a national vaccine rollout.
“I expect in our next round … for there to be an increase in associate participation,” Campbell added.
Juniper made getting a vaccine a requirement for employment, a step that experts consider legally sound, with some exceptions — but one that some other senior living providers have considered too risky to undertake.
One big risk is that some employees will simply quit their job instead of getting the vaccine. Another is that doing so may expose providers to legal risks.
No doubt, Katzmann thinks there will be a small number of Juniper associates who may resign from their duties, or seek medical exemptions from taking the vaccine. But, she also believes that these risks are outweighed by the risks of the pandemic itself.
“Our whole strategy has been based on prevention … and that’s what the vaccine is,” Katzmann said. “So, it was a relatively simple decision to make.”
Katzmann’s advice to other providers going through the vaccination process is to start early, and stay on top of documentation with residents and their families.
“You have to figure out who’s going to be signing the consent form for each individual that will be vaccinated … so, doing that ahead of time is really helpful,” she explained.
Another piece of advice: check privacy screen supplies, as senior living communities with private rooms don’t always have them. And it might not hurt for those getting their shots to take an Advil or Tylenol and stay hydrated to ward off vaccine-related side effects, Katzmann said.
Preparation was also a key to success for Pegasus. While the company held its first vaccine clinic at its flagship community in Austin, Texas, on Tuesday, it had prepared for the process already, according to Dr. Sandra Petersen, who is leading the provider’s Covid-19 efforts.
In preparation for the vaccines, the company developed an “all-hands-on-deck” plan that thought through every facet of operations, from aiding residents at the vaccine clinics to planning for meals.
“We thought through every aspect of it,” Petersen said. “Both in our day-to-day operations and how it would impact that, as well as how we could have a co-occurring clinic and still meet the needs of our residents.”
Like Juniper, Pegasus also worked to get residents’ consent forms in order before the first doses arrived at their communities.
“Letting people know early and getting all the paperwork in place, getting insurance ready to go … the more pre-work you can do, the better,” Petersen said.
Leading the rollout
While many senior living providers chose to work with pharmacy providers Walgreens or CVS under the Pharmacy Partnership for Long-Term Care Program, others chose to spearhead the effort themselves.
One example of that is Marquis, which put Consonus in charge of vaccine administration at its 23 senior care facilities across the country. In addition to servicing Marquis’ communities, the company also provides services to hundreds of skilled nursing and senior living communities in eight states.
Marquis had planned for the rollout weeks ahead of time by building an electronic system to collect, analyze and export vaccine-related data.
Consonus first began administering the Covid-19 vaccine to residents and associates last month. The initial rollout involved a fleet of 15 motorhomes staffed to oversee vaccine administration and paperwork. To help ensure a smooth process, Marquis and Consonus are deputizing community nurses to serve as vaccine administrators for the clinics, according to Marquis CEO Phil Fogg, Jr.
“We’ll manage the logistics of the vaccine, we’ll get it to your facility, we will reconstitute it … but you bring the nurses to go in and actually administer the vaccine in the facilities,” Fogg said. “Not having to hire thousands of vaccine administrators or nurses is what enabled us, I think, to be able to get into those buildings faster and to do more.”
So far, the long-term care pharmacy has held clinics at 194 facilities and delivered shots to more than 8,000 staff and residents. The company is on track to complete all of its first vaccination clinics — including those at communities outside the Marquis umbrella — by Sunday, with round two beginning the next day.
“We get it done, fast,” Fogg said. “And it enables us to have a larger capacity or bandwidth because of the ability to get it done quickly.”
Handling the vaccine effort in-house was also a boon for Sterling Estates, a senior living provider with three properties in Georgia. The company opted to self-distribute the vaccines and worked with Transitional Care Physicians of America and Guardian Pharmacy to administer the first vaccinations in its communities on Christmas Eve.
The process was “like becoming your own CVS,” according to Sterling Estates Vice President of Operations and Partner Nathan Madigan. If all goes according to plan, Sterling Estates will begin holding its second round of vaccination clinics in a matter of weeks.
“We all kind of put our heads together and worked as a team to get those clinics up and running,” Madigan told SHN. “It is a testament to that partnership that you’re getting a vaccine, and in less than 24 hours we were spinning up our immunization clinics.”
Despite the early success in holding vaccination clinics, many senior living providers also see challenges ahead to overcome.
One is whether there will be enough vaccines to meet the demand of the industry. At Pegasus, Petersen said she’s heard that there may be shortages in the future, though she has yet to see whether that holds true.
So far, the process appears to be going as planned, according to the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which represents more than 14,000 nursing homes and assisted living communities across the U.S.
“As of right now, we are not aware of widespread issues or delays with this vaccine rollout, and if there were, we would be among the first to sound the alarm,” said Mark Parkinson, president and CEO of AHCA/NCAL, in a press release Wednesday. “We continue to assist a minority of member providers who come to us looking for assistance or clarity, but the majority of providers tell us that their clinics have been scheduled or have already occurred and that overall, the program is running smoothly.”
State policies themselves are also somewhat of a challenge for senior living providers. Because each state controls the vaccine allocations, they potentially operate under different rules.
“This is a real problem, because not every state is defining the order for vaccination in the same way that the CDC committee recommended,” Katzmann said.
Meanwhile, some senior living communities are still waiting to hear back from their pharmacy providers regarding scheduling their first clinic. Watermark is still waiting to schedule clinics in the state of Arizona for assisted living and independent living residents. Sunrise, too, is waiting for some states to add senior living residents to the prioritization list.
“In many states, skilled nursing has been prioritized, and this represents a relatively small segment of our resident population,” Coppola said. “We’re now seeing some states include assisted living and memory care communities as well. We continue to work with CVS Health regarding dates for clinics at each of our communities.”
In Texas, where Pegasus is headquartered, health officials chose to open up the second vaccination phase to people 65 and older or with certain medical conditions, not just those living in senior living communities. Other states have taken similar steps.
“If there had been a focus on senior care … before opening it up to people at-large, that would have maybe been a little better as far as the distribution and supply-and-demand goes,” Petersen said.
Still, while there are sure to be challenges in the vaccination effort, they are all manageable given the circumstances, according to Katzmann.
“When you’re down to this point, and you’re going to get a vaccine that keeps people alive, none of that seems really to be so awful,” Katzmann said. “It’s hard, but you do it.”