No group has suffered more in the COVID-19 pandemic than residents at long-term-care facilities, accounting for more than 60 percent of coronavirus deaths in Massachusetts. And there are ominous signs infections are surging again: Nearly three-quarters of the state’s long-term-care facilities have at least two COVID-19 cases.
But inoculating the tens of thousands of frail elders who live in such facilities and the small army of caregivers who look after them may be the single most challenging phase of the state’s ambitious vaccine program.
Not only are nursing homes full of people whose dementia makes it difficult for them to give informed consent, but many senior care workers express wariness about the vaccines, suggesting sizable numbers may not step forward to get their shots on Monday, when the program is slated to begin.
Adding to the uncertainty, several long-term-care administrators this week said they still hadn’t received definitive information about when their staff and residents will be vaccinated. The pharmacy chains CVS and Walgreens are administering the vaccines with plans to visit each such facility in Massachusetts three times in the coming weeks.
Despite all the complications, some elder care staffers say the vaccinations can’t come soon enough after a year in which one in seven nursing home residents statewide succumbed to COVID-19.
“I have seen so much death in these months, there seems like there hasn’t been a day gone by that someone hasn’t died,” said Kathy Griham, a 54-year-old certified nursing assistant at two nursing homes in Boston.
“I am so ready, I would take [the vaccine] right now,” said Griham who, as a Black woman with diabetes, is at high risk for serious complications from COVID-19.
But many of Griham’s colleagues, as well as legions of other staffers in senior care facilities throughout Massachusetts, have voiced fears about side effects and safety, some feeding off misinformation ricocheting across social media, administrators say. Nursing homes employ many immigrant and Black and Latino American workers who harbor deep-rooted suspicions of a health care system that has often discriminated against them.
“In some nursing homes, I get a sense that it’s just 25 percent [of staff] who will take the vaccine, and some homes up to 60 or 65 percent. But that’s it, unfortunately” said Dr. Asif Merchant,medical director at four nursing homes in the Metro West area and partner of a company that runs medical services for 45 nursing homes in Massachusetts.
Merchant has been leading informational sessions for staff at nursing homes. Before and after each one, he said, he asks participants to raise their hand if they are ready to get a shot. Success, he said, is now measured by one or two more converts at a time.
The union that represents thousands of nursing home workers, 1199SEIUUnited Healthcare Workers East, said an informal survey of its members, which also includes home health and hospital workers, found half expressing hesitation about getting a shot.
“There is some skepticism, but with the right information, delivered by the right person, nursing home workers are willing to do their part,” said Tim Foley, the union’s executive vice president.
On the other hand, nursing home and assisted living administrators say they don’t expect as much wariness among residents.
“Many have lived through the introduction of vaccines for polio,” said Elissa Sherman, president of LeadingAge, which represents nonprofit nursing homes and assisted-living centers. “The polio vaccine was life changing. I don’t think there will be the same level of hesitation.”
Many details remain to be worked out, said Tara Gregorio, president of the Massachusetts Senior Care Association, which represents nearly 400 senior care facilities.
As of Wednesday, a number of facilities had confirmed dates for their first vaccination clinics next week, but others had been given tentative dates and were awaiting confirmation from the pharmacy companies. Nursing homes and other long-term-care centers were also scrambling to obtain vaccine consent forms from residents and from guardians of residents deemed too incapacitated to make an informed decision.
“We’re very focused on a safe and efficient rollout of the vaccines,” Gregorio said.
Senior advocates say hearing and cognitive limitations that are common among residents can make meaningful informed consent challenging, especially in the midst of so many restrictions on visitors due to the pandemic.
“The isolation long-term-care residents have suffered over the last nine months as a result of visitation restrictions makes it difficult for family or others to provide assistance that may be essential,” said Arlene Germain, policy director for Massachusetts Advocates for Nursing Home Reform.
Over the past week, Gregorio said, state and national senior care officials have been working with government leaders and CVS and Walgreens to streamline and simplify the consent forms, making it easier for guardians of residents to give their consent verbally, via e-mail, or through drive-by delivery at some sites. Even so, officials said it was possible that lack of completed consent forms could delay vaccinations.
Mountains of consent forms are needed. Health and Human Services Secretary Marylou Sudders has said roughly 115,000 long-term-care residents and staff statewide need to be vaccinated, all of them requiring consent forms.
While some nursing home operators were confident the vast majority of their staff and residents would be inoculated, questions remained. One common question from staffers — about 90 percent of whom are women — is about the effect of the vaccines if they are pregnant, breast-feeding, or expect to become pregnant. They are being told the vaccines are safe but also to consult with their personal doctors.
Gregorio said some nursing homes may try to work with CVS and Walgreens to extend the number of planned vaccination clinics beyond the three visits per facility set by federal guidelines, but it’s too soon to know whether they’ll be able to do so. Nursing home operators say it will be difficult to vaccinate all their staffs, who work in three shifts, during just three clinics.
With coronavirus cases continuing to climb in long-term-care facilities, state health officials are urging operators to get as many residents and staff vaccinated as possible in the first round of shots. Those receiving injections of the Pfizer vaccine, which is being sent to senior sites, are required to get a second shot 21 days after the first.
Even patients in short-term rehab units that are often connected to skilled nursing homes should get shots, state health officials said. They said clinical studies show people begin to see some protection from the virus within two weeks after their first dose and note that rehab patients discharged after the first shot can return to the home to receive their second shot.
State health officials have a plan in case significant numbers of staffers miss work the day following their shots due to side effects that typically include soreness, fatigue, headaches, and low-grade fever. Rapid response teams are standing by that could go into some facilities to fill in for nurses or aides.
Bill Bogdanovich, chief executive of Broad Reach Healthcare, a nursing home on Cape Cod, said just knowing their CVS vaccination clinic will start some time next week is a hopeful sign that is sorely needed.
“This winter’s [virus] surge is a little more ominous because we know it’s a formidable adversary,” he said. “We can’t wait till we can feel secure.”