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By Hannah Critchfield
UPDATE: Barbara Fischer, who was featured in this article, died of her COVID-19 infection on Jan. 23, three days before she was scheduled to get vaccinated. Our thoughts are with her family.
Even as North Carolina enters the second phase of its vaccine plan, some long-term care residents are still waiting for the COVID-19 vaccine.
For Barbara Fischer, an 83-year-old dementia patient at Brookdale Meadowmont, it could be coming too late.
When the state announced that people in long-term care facilities would be among the first to receive vaccination and that initial doses would arrive by mid-December, Ester Amy Fischer thought her mother’s group home would be offered the vaccine within weeks.
The Chapel Hill facility had been dealing with a COVID-19 outbreak since late November, and though the memory unit where her mother resided remained free of infection, that stability seemed more fragile with each passing day.
“I was just anxiously waiting for her to get the vaccine,” Fischer’s daughter Ester said.
The first vaccine, made by Pfizer, was released to states on Dec. 14. The second vaccine, manufactured by Moderna, was approved over the weekend of Dec. 22.
“And then on Dec. 31, her facility emailed me.”
Fischer learned Brookdale Meadowmont would not receive the vaccine until Jan. 26, much later than she hoped.
By early January, her mother had tested positive for the novel coronavirus.
“It’s the thing I feared would happen the most, starting way back in November,” Fischer said. “I was livid.”
North Carolina is beginning to offer the vaccine to anyone over 65, having first offered doses to first-responder health care workers.
Vaccination of people who live and work in long-term care facilities, the other first-priority group for inoculation, is different. It’s handled by the federal government in partnership with CVS and Walgreens, two private companies that are administering the doses.
Some families and staff say the pace of the rollout is too slow for high-risk loved ones living in these congregate settings, where viral outbreaks can spread like wildfire once inside.
“Honestly, when I first heard about the CVS-Walgreens program, I thought it was a good idea,” said Fischer. “But I think the problem is there just was not enough oversight on the state or county level – so when they weren’t getting the vaccine out fast enough, there was no way for states or counties to intervene.”
A federally run/privately run rollout
Residents and staff in long-term care facilities account for about 40 percent of all COVID-19 deaths nationwide.
In mid-December of last year, the federal government seemed optimistic about the vaccine rollout in these homes, with Secretary of Health and Human Services Alex Azar declaring that all nursing home residents could be vaccinated by Christmas.
But approval for the vaccines only came in mid-December. Then, there have been differing speeds for vaccine rollout on the ground, with wide variation by state.
Brookdale Meadowmont, an assisted living facility in Orange County that provides care for Alzheimer’s and dementia patients, is receiving the vaccine through CVS Health, according to Heather Hunter, spokesperson at Brookdale Senior Living, the company that oversees the home.
CVS Health has administered the vaccine to 630 long-term care facilities in North Carolina since beginning the effort in late December, according to Joseph Goode, CVS spokesperson.
Two-hundred and sixty-nine facilities that chose the company as its vaccine partner are still waiting.
The Brookdale Meadowmont facility is one of them — the long-term care facility is slated to receive the vaccine on Jan. 26, Hunter confirmed.
“As part of Phase 1 distribution, vaccinations are already underway at Brookdale Senior Living communities across the state and country,” she said. She also confirmed that the facility is still experiencing a coronavirus outbreak.
Walgreens, the other vaccine partner for long-term care, declined multiple requests for comment on the number of group homes that have already been offered doses under their contract.
For elderly residents like Barbara Fischer, the delay had dire consequences.
She tested positive for COVID-19 on Jan. 4, according to Fischer’s daughter Ester, and is still battling the illness weeks later.
“Her oxygen is normal, but she won’t wake up. I spoke to her doctor over the weekend, and she’s really not doing well,” Fischer said. “I really think the facility did the best they could do [to contain the spread] — but they need the vaccine.”
A staff member within the memory care unit, who requested to speak without being named by North Carolina Health News for fear of losing employment, confirmed that this was the date the outbreak struck the ward.
“People at a memory care unit cannot social distance,” the worker said. “You know, they want to hold hands with each other; it’s things that they do that they don’t know that they’re doing.
“It’s hard to try to keep them apart because six feet to them means absolutely nothing. So they should be at the top of the list, because they’re more susceptible to get it, just like the doctor in the ER.”
The worker also tested positive for COVID-19 two weeks ago, around the same time as resident Barbara Fischer. Infection also comes with high risk for the worker, who lives with elderly family members.
States help set priority
Though the federal government is coordinating these vaccinations to long-term care residents and staff, a CVS spokesperson said the company is still prioritizing which group homes should come first based on each state’s guidance.
“Some states have chosen to activate the program for certain residents of long-term care facilities (e.g., those in skilled nursing facilities) before others,” said Goode in an emailed statement. “We schedule clinics by geography and based on available weekly allocation, facility readiness and staffing to send out to LTCs in that community.”
Skilled nursing facilities are for people who require significant medical care, and are considered medical facilities. Because they’re regulated by federal authorities, who made the decision to contract with the pharmacy companies to administer the vaccinations.
Assisted living facilities like Brookdale Meadowmont, which tend to have fewer on-site medical staff than nursing homes, nevertheless are often home to people at-risk for the worst outcomes of the virus, including those with developmental disabilities and dementia.
“Although older adults who reside in assisted living communities have many of the same risk factors as the older adults who live in nursing homes, in general, they’re less medically impaired,” said Sheryl Zimmerman, co-director of the Program on Aging, Disability and Long-Term Care at the University of North Carolina School of Social Work. “We certainly can’t forget them, and in fact, of all COVID-19 deaths that occur in long-term care settings, those in assisted living account for about 30 percent of the deaths.”
There tend to be more private rooms in assisted living facilities, Zimmerman noted, as well as fewer staff. Both decrease the risk of COVID-19 spread, which may help explain why some states are prioritizing skilled nursing homes first.
North Carolina prioritized skilled nursing facilities for scheduling “when possible,” according to Catie Armstrong, DHHS spokesperson.
“To me, if you wait to vaccinate people in memory care, you really don’t give them a fighting chance,” said the Brookdale Meadowmont staffer. “All elderly people, especially those with underlying issues, should get vaccinated.
“However, if you are capable of simple instructions such as social distance and washing your hands, you should be bumped down that list, and the person that can’t do those things needs to be bumped up.”
‘Too late for my mom’
For now, Fischer tries to keep in touch with her mom virtually.
“I FaceTime her once or twice a day and just talk to her, even though she’s asleep,” Fischer said.
She doesn’t know if her mother will recover.
“I’ve kept fighting [for faster vaccinations], even though it’s too late for my mom,” she said. “I care a great deal about the other residents and the staff who work there — I’ve kept writing to the governor, DHHS and my county health department. I was trying to see if somebody could do anything.
“I understand it’s a federal program,” she added. “But it’s like they’re not even sure what’s going on.”
The staffer who spoke to NC Health News is no longer waiting for the vaccine.
“I’ll be getting my first dose next week,” the worker said. “Orange County is offering it.”