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Hope, uncertainty abounds ahead of COVID-19 vaccine arriving in Kansas nursing homes

Andrew Bahl
Topeka Capital-Journal
Long-term care facilities, such as Aldersgate Village Life Plan Community in Topeka, are hoping the COVID-19 vaccine will arrive in the coming weeks.

The COVID-19 pandemic has left no stone unturned in spreading its tentacles across the state — and rural Phillips County is no exception.

The northwest Kansas county, which straddles the Nebraska border, has had one of the higher rates of COVID-19 cases per capita in the state.

As of now, that has not impacted Phillips County Retirement Center in Phillipsburg — Nate Glendening, the facility's administrator, said they have been able to avoid an outbreak and are looking to keep it that way.

A surefire means of keeping the facility's 50 residents and 65 staff members safe is the COVID-19 vaccine, which is expected to begin rolling out to long-term care facilities across the state as early as next week. 

Long-term care is one of the areas that will be prioritized in the initial vaccine rollout, with good reason.

Since the pandemic began, these facilities have been linked to 503 outbreaks, accounting for over 9,400 cases and 963 deaths.

But Glendening said it is not clear when his facility will get its immunizations, even as the local hospital got the first shipment of 50 doses on Thursday.

"Here we are, serving the most vulnerable population, and we are still sitting here and waiting," he said. "We've got high hopes it is coming, hopefully by the end of the year. To see that it is being distributed to other organizations, not that they don't need it, as well ... but it can get a bit frustrating."

Glendening said that Phillips County Retirement Center had to lean on a staffing agency for the first time in its history, with workers forced to quarantine even as facilities required an increasingly demanding workload in order to keep the virus at bay.

That's why the arrival of a COVID-19 vaccine is good news and a way of reversing the negative trendlines — if nursing homes and their advocates are able to get a handle on how the immunizations will be doled out to residents.

"Everybody is feeling a sense of hope and relief that none of us have felt for months," said Mitzi McFatrich, who is the executive director for the nonprofit Kansas Advocates for Better Care. "But I also think people are feeling like 'Oh there is a fix coming' and maybe they don't have to keep at ... all of the things we need to be really focused on. We aren't to the vaccine yet, we aren't to the herd immunity, we're not to protection yet. I think there are a lot of challenges."

Vaccination effort to rely on pharmacies

Vaccination in nursing homes will look different than it has for the thousands of health care workers who were the first to get the shots last week.

The Centers for Disease Control and Prevention has tapped CVS and Walgreens, the largest pharmacies in the United States, to handle vaccinations in long-term care facilities.

Most, though not all, facilities in the state have elected to partner with one of those two providers to get their vaccine.

Vaccination of nursing home residents and staff began Friday in a handful of states, with more set to follow suit over the weekend and into the early days of next week.

Gov. Laura Kelly said at a news conference Wednesday that Kansas will join them in the coming days, when the second batch of Pfizer vaccine doses arrives in the state.

Those 17,000 or so doses will go directly to CVS and Walgreens locations across the state. CVS has said that they will begin vaccinations in Kansas on Dec. 28. It is unclear when Walgreens will start giving out their shot

Those providers are working one-on-one with nursing homes and other facilities to figure out what the vaccine's administration will look like in each individual facility.

Most of the facilities belonging to Presbyterian Manors of Mid-America will be getting the vaccine in the last week of December, according to Karen Harriman, the network's chief marketing officer.

Harriman said pharmacies were planning on making repeated visits to a facility over a three- to four-week period, with residents and staff needing to get a second dose.

In Phillips County, for instance, half of all interested residents and staff will get the vaccine at a first appointment. When the Walgreens representatives return to administer the second dose, those who remain unvaccinated will get their first shot.

That provides ample opportunity for individuals who may be on the fence about getting the vaccine to opt-in.

"There is a lot of dialogue about the vaccine itself," Harriman said. "Is it safe? Do we want to wait for the other (vaccine)? What happens if we wait for the other one?"

It isn't clear how facilities are prioritized for getting the vaccine. Lee Norman, secretary of health and environment, has said that the doses will get pushed out across Kansas and will not be concentrated in the state's urban areas.

Debra Zehr, executive director of LeadingAge Kansas, an organization of more than 160 nonprofit facilities across the state, said that would be true for long-term care, as well, as bigger facilities will not necessarily gain priority.

But because the process is carried out by a third-party entity, facilities are expecting a certain amount of variance in terms of what the vaccine rollout looks like at different nursing homes or assisted-living centers.

Some facilities, for instance, may have their staff get vaccinated in a common area on site. Others may have them go off-site, likely to a brick-and-mortar Walgreens or CVS pharmacy.

And a small minority of facilities have elected to get their vaccines directly from the state, owing to their remote location.

It is also not clear what will happen for residents who move facilities in between doses or for those new arrivals who enter a home after the vaccine has been administered.

All this adds up to guidelines that often change by the hour.

"It is evolving rapidly, we are getting information almost hour-by-hour and some of it is not definitive," Zehr said.

How many will want a vaccine?

In Phillips County, the "vast majority" of staff and residents are intent on getting vaccinated, Glendening said.

Phillipsburg at large is more divided, with Glendening saying there was a 50-50 split between those who want the vaccine and those who remain skeptical.

But just because someone doesn't want to get the vaccine, that doesn't mean they are opposed to their loved one getting it, he noted.

"The family feedback that we've gotten has been overwhelmingly excited," Glendening said. "I think that thing a lot of those folks are looking at is, regardless of their belief, the fact that the vaccine is a leaping point to starting to connect with their loved one."

Residents at long-term care facilities like Aldersgate Village Life Plan Community are making decisions about whether to get the COVID-19 vaccine.

There is some concern that a good chunk of residents and staff will opt not to get the vaccine. Meanwhile, homes are mobilizing on the fly in an effort to get information to residents and loved ones.

Kris Erickson, CEO of Bethany Home in Lindsborg, said the facility had begun outreach to residents and families in recent days about the vaccine's availability.

Glendening said he would be personally meeting with residents in his assisted-living unit Friday afternoon to talk through the procedure.

And Harriman said that some family members have been asking questions about the vaccine for months already.

"We got calls a few months ago from people saying 'I want my mom to get it first,' " she said.

But not everyone has made up their mind.

There is concern that the breakneck speed with which the immunizations are likely to be deployed could make it difficult for families to have conversations with their loved ones about what getting the shot might mean, especially with lots of misleading information floating around.

"There are multiple layers to the onion of trying to get information out," Zehr said.

A facility usually spends weeks, if not months, preparing to give out flu vaccines, said Barbara Hickert, the state's long-term care ombudsman.

But staff are already overwhelmed, she noted, and might not be able to devote the time needed to support a full-throated information campaign.

"How much time will they have to do a really good job in explaining it to people who might be hesitant or concerned," Hickert said. "If I'm concerned, you're probably not going to convince me by saying 'Here, read this from the CDC.'"

And then there is the issue of consent.

There is no federal requirement that individuals sign off on being vaccinated even though it is common practice for other immunizations, such as flu shots. 

But some residents, such as those with dementia, are not able to give consent themselves. A family member is generally designated as a legal guardian to make those decisions.

Many homes have already started passing along the consent forms provided by Walgreens or CVS with an eye toward getting a jump on the process.

Still, there is conflicting guidance as to whether consent via email or over the phone is enough.

Pharmacy providers have told other states that consent forms must be signed in writing by the day of the vaccination. Some officials in Kansas, however, have said they were led to believe electronic or oral consent would be allowed.

Either way, McFatrich was adamant that residents and families should be having discussions about the vaccine now — because it could be at their facility before they know it.

"Now is the time to make that choice," she said.

Hope at vaccine's arrival remains

The road for nursing homes is not likely to get easier, even as the vaccine arrives in the state.

Accessing testing supplies and personal protective equipment remains difficult for most facilities, and many are staring down the barrel of financial challenges and ballooning insurance premiums in the months ahead.

And even once the shots are doled out, the questions from family members and residents are likely to keep coming.

Glendening says he's expecting to be pressed by family members who want to visit and residents who want the facility's normal slate of group programming to resume.

But the fact that such questions are being raised is a relief, he said, and a sign that long-term care will once again be associated with vitality and vibrance, rather than fear.

"If we can start opening up our doors, hopefully, to get some people back in to see what life is like and that we are still providing great care and doing good things for the people we serve," Glendening said. "I think that would help lighten the mood and get people that don't see the full picture from our perspective to have a different viewpoint and see these are still great places."

For the first time in nine months, those passionate about long-term care say hope abides.

"(Vaccine distribution) is going to evolve and all will be revealed — probably after it is done," Zehr said. "We are just happy the time has come to seriously think about it.