State says nursing homes should be ready to give COVID-19 booster shots next week

Pfizer-BioNTech COVID-19 vaccines at a senior living facility in Worcester, Pennsylvania, on Aug. 25, 2021.Hannah Beier/Bloomberg

The Massachusetts Department of Public Health told nursing home administrators Thursday they should be ready to start administering COVID-19 booster shots to residents and staff as early as next week.

Nursing homes were hit especially hard early in the pandemic, and account for nearly one-third of the state’s COVID deaths. Though residents and staff were among the earliest to be vaccinated, some research suggests that protection from infection and severe illness with the Pfizer vaccine, which was widely used in nursing homes, wanes after six months. And the rise of the contagious Delta variant has senior care leaders on edge.

“We are grateful that the federal government has made COVID-19 booster shots available for our vulnerable residents, which ... will further help to keep our residents safe from breakthrough COVID-19 infections,” said Tara Gregorio, president of the Massachusetts Senior Care Association, which represents nearly 400 senior care facilities.

There are roughly 38,000 nursing home residents in Massachusetts. The state’s latest data indicates 300 COVID infections in facilities over two weeks in mid-September, with 116 among residents and 184 among staff. Most were breakthrough cases in people who had already been vaccinated, the state said.

The state’s health department declined to comment further Thursday about its plan for booster clinics in nursing homes.

The department’s booster shot directive comes as longterm care facilities are facing historic staffing shortages. Some administrators say the vaccinations, while welcome news for thousands of vulnerable nursing home residents, will be a challenging process for pandemic-weary staff already stretched thin.

“The directors of nursing are burnt out,” 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.

On Wednesday, the Food and Drug Administration authorized booster shots of the Pfizer vaccine for people 65 and older who received their second shot at least six months earlier.

The FDA also authorized Pfizer booster shots for adults who are at high risk of complications from COVID because of frequent exposure to the coronavirus at their jobs, such as nursing home workers.

On Thursday, an advisory panel to the Centers for Disease Control and Prevention recommended the extra doses for people 65 and older, nursing home residents, and people 50 to 64 with underlying medical conditions. It also said boosters can be offered to people 18 to 49 with underlying conditions.

Nursing homes received a big assist earlier this year from the federal government, which sent teams of pharmacy workers into facilities to administer first and second-rounds of COVID shots.

But this time, that federal cavalry isn’t coming, and nursing home administrators in Massachusetts are being directed by the state health department to work it out on their own, with the help of the pharmacies they usually use for other medications. The department said in its Thursday telephone briefing that it would help facilities that need assistance and said further guidance would be coming shortly.

CVS, one of two national pharmacy companies used in the federal nursing home COVID vaccination program earlier this year, said in a statement that it is “fully prepared to play a leading role in providing booster shots this fall.” But it warned that nursing homes may have to compete for assistance from their local pharmacies because millions of adults who are not in nursing homes will also be seeking the shots.

“Due to the expected demand for booster shots in our pharmacies, the availability of on-site vaccination clinics at facilities will be determined by local resources,” said Mike DeAngelis, a CVS spokesman.

But nursing home resources are also thin. There are approximately 6,000, or 1 in 5, unfilled nursing and direct care positions in Massachusetts nursing facilities, according to Mass Senior Care.

Dr. Larissa Lucas, who serves as medical director for six nursing homes through North Shore Physicians Group, is optimistic that her facilities’ will be able to handle booster shot clinics, despite severe staffing shortages.

“Every year, we roll out flu vaccines to all our residents without a problem,” she said. “But it’s a lot of administrative work getting consent forms signed.”

As nursing homes juggle booster shot plans, as well as upcoming flu vaccination clinics, they also are scrambling to meet an Oct. 10 state deadline to have all of their staff vaccinated with at least their first rounds of shots, or face penalties and staff dismissals.

Vaccine hesitancy among workers has been a pressing issue for the facilities. Some administrators have said the state’s vaccine mandate for nursing home workers might drive off reluctant staff. Yet the mandate appears to have helped nudge quite a few people; the latest federal data show Massachusetts nursing homes with among the highest staff vaccination rates nationally with 83 percent of workers fully vaccinated.

Gregorio, of the Massachusetts Senior Care Association, said the group projects about 3 percent of total staff statewide will refuse to be vaccinated or have a valid medical or religious exemption.

Gregorio said in a statement that the group is working to educate and persuade workers to get vaccinated.

“As nursing facilities face the worst workforce crisis in history...” she said, “we cannot afford to lose a single staff member.”