CVS and Walgreens under fire for slow vaccination in retirement homes

Dobbs pointed to neighbors in Alabama and Louisiana, which he says immunize long-term care residents at four times the rate of Mississippi.

“We make a lot of people angry because it’s going so slowly, and we’re unhappy too,” he says.

Many of the nursing homes that have successfully vaccinated consenting residents and staff do so without federal government assistance.

For example, Los Angeles Jewish Home, with approximately 1,650 staff and 1,100 residents on four campuses, began immunizing on December 30. On January 11, medical staff at the home administered her 1,640th dose. Even the facility’s chief medical director, Noah Marco, helped with the vaccination.

The house is located in Los Angeles County, which refused to participate in the CVS / Walgreens program. Instead, he’s tasked nursing homes with administering the vaccines themselves and only uses Moderna’s easier-to-handle product, which doesn’t need to be stored in ultra-cold temperatures. , such as the Pfizer vaccine. (Both vaccines require two doses to provide full protection, spaced 21 to 28 days apart.)

In contrast, Mariner Health Central, which operates 20 nursing homes in California, relies on the federal partnership for its homes outside of LA County. One of them will not receive his first doses until next week.

“It was much worse than expected,” said channel chief medical officer Dr Karl Steinberg. “This light at the end of the tunnel is dim.”

Institutions participating in the federal partnership typically schedule three immunization clinics over a nine to 12 week period. Ideally, those who are eligible and want a vaccine will receive the first dose at the first clinic and the second dose three to four weeks later. The third clinic is considered a make-up day for anyone who missed out on others. Before administering vaccines, pharmacies require nursing homes to obtain consent from residents and staff.

Despite complaints of a slow rollout, CVS and Walgreens said they were on track to complete delivery of the first doses by January 25, as promised.

“Everything went as planned, except for a few instances where we were challenged or had difficulty reaching out to long-term care facilities to schedule clinics,” Joe Goode said. , a spokesperson for CVS Health.

Dr Marcus Plescia, chief medical officer of the Association of State and Territory Health Officials, acknowledged some delays in the partnership, but said it was predictable because this kind of effort never had been tried before.

“There is a feeling that they are going to find out and it will be useful, as the health services are quite overloaded,” Plescia said.

But any delay puts lives at risk, said Dr. Michael Wasserman, outgoing president of the California Association of Long Term Care Medicine.

“I am on the verge of going nuclear,” he said. “There should never be an excuse for people who don’t get the vaccine. There is no excuse for delays.”

Bring in vaccinators

Nursing homes are equipped with resources that could have helped the immunization effort – but they are often not used.

Most already work with specialist pharmacists who understand the needs of nursing homes and administer medications and annual vaccinations. These pharmacists know the patients and their medical histories, and are familiar with the nursing home device, said Linda Taetz, compliance manager at Mariner Health Central.

“It’s not that they aren’t capable,” Taetz said of retail pharmacists. “They are just not integrated into our buildings.”

If a facility participates in the federal program, it cannot use these pharmacists or other staff to immunize, said Nicole Howell, general manager of ombudsman services for Contra Costa, Solano and Alameda counties.

But many nursing homes would like the flexibility to do so, as they believe it would speed up the process, help build confidence and get more people to say yes to the vaccine, she said.

Howell pointed to West Virginia, which relied primarily on independent local pharmacies instead of the federal program to vaccinate its nursing home residents.

The state opted against the partnership largely because CVS / Walgreens would have taken weeks to start the shooting and Republican Gov. Jim Justice wanted them to start immediately, said Marty Wright, CEO of West Virginia Health Care. Association, which represents the long term of the State. care facilities.

The bulk of the work is done by more than 60 pharmacies, giving the state greater control over how the doses are distributed, Wright said. The pharmacies were joined by Walgreens in the second week, he said, but not as part of the federal partnership.

“We had more interest from local pharmacies than from establishments that we could partner with,” Wright said. Preliminary estimates show that more than 80% of residents and 60% of staff in more than 200 homes received a first dose at the end of December, he said.

CVS’s Goode said his company’s participation in the program was led by its long-term care division, which has extensive experience with nursing homes. He noted that tens of thousands of nursing homes – about 85% nationally, according to the CDC – found this reassuring enough to participate.

“This underscores the long-term care community’s confidence in CVS and Walgreens,” he said.

Vaccine recipients pay nothing out of pocket for vaccines. The costs of purchasing and managing are covered by the federal government and health insurance, which means CVS and Walgreens should make a lot of money: Medicare reimburses $ 16.94 for the first shot and $ 28.39 for the second.

Bureaucratic delays

Technically, federal law does not require nursing homes to obtain written consent for vaccinations.

But CVS and Walgreens require them to obtain verbal or written consent from residents or their families, which must be documented on forms provided by pharmacies.

Goode said consent hasn’t been a barrier so far, but many on the ground disagree. The demands have slowed the process down as nursing homes collect paper forms and health insurance numbers from residents, said Tracy Greene Mintz, a social worker who owns Senior Care Training, which trains and deploys workers. social services at over 100 locations in California.

In some cases, social workers sent paper consent forms to families and waited to collect them, she said.

“The facilities are busy trying to keep the residents alive,” Greene Mintz said. “If you want to get paid by Medicare, do your own paperwork,” she suggested to CVS and Walgreens.

Planning has also been a challenge for some nursing homes, in part because people who are actively infected with Covid should not be vaccinated, advises the CDC.

“If something happens, for example, an entire building becomes positive for Covid, you don’t want pharmacists to come in because no one will get the vaccine,” said Taetz of Mariner Health.

Both drug companies say they are working with establishments to reprogram if necessary. This happened at Windsor Chico Creek Care and Rehabilitation in Chico, Calif., Where a clinic was pushed back a day because the facility was waiting for Covid test results for residents. Melissa Cabrera, who manages the facility’s infection control, described the process as streamlined and professional.

In Illinois, about 12,000 of the state’s roughly 55,000 nursing home residents received their first dose on Sunday, mainly through the CVS / Walgreens partnership, said Matt Hartman, executive director of the Illinois Health Care Association.

While Hartman is hoping pharmacies will finish administering the first round by the end of the month, he noted that there are a lot of “headaches” around planning clinics, especially when homes have gone. epidemics.

“Are we happy that we didn’t complete the first round and West Virginia is over?” He asked. “Absolutely not.”