Aging

shows the back of a wheelchair, with an old and wizened hand on the arm of the chair

Project ECHO resounds throughout WNC

January 29, 2021 by Melba Newsome

Project ECHO resounds throughout WNC - North Carolina Health News

Long-term care facilities use a “guided practice” model to mitigate the coronavirus.

By Melba Newsome

Each Monday at noon, Janice Somers closes her office door at Westwood Hills Nursing and Rehabilitation and puts her phone on Do Not Disturb. For the next 90 minutes, the nurse administrator and four team members join hundreds of employees from over a hundred North and South Carolina facilities for the Nursing Home COVID-19 Action Network, a four-month online course designed to establish common guidelines for infection control in nursing homes.

The training is a way to share best practices and other practical information. But Somers says the camaraderie is important, too.

“I want to know what other people are doing,” says Somers. “We’ve all been so isolated. Ever since March, everything is a Zoom meeting.”

Long-term care facilities have been ground zero for the COVID-19 pandemic but many proved ill-equipped for the challenge. Though facilities are required to have someone focusing on infection control, only 3 percent of those staff have taken a basic infection control course. The North Carolina Health Care Facilities Association, the statewide industry group for skilled nursing facilities, sent out a memo about an upcoming course being offered by the Mountain Area Health Education Center and Somers signed right up.

Nursing Home COVID-19 Action Network’s training series is just one of eight pandemic-related continuing education series operated by MAHEC using this model. They include screening/treating COVID-19 in primary care; acute care for hospital inpatient; and developing resilience in the healthcare workforce.

A way to expand learning

After seeing patients wait a long time to be treated for hepatitis C, Sanjeev Arora, a liver specialist at the University of New Mexico Health Sciences Center in Albuquerque, got the idea of teaching rural physicians how to screen, diagnose and treat patients.

Arora believed that if patients didn’t have to drive six hours to see him, many more of these hepatitis cases could be treated effectively.

That’s where Project ECHO comes in. Instead of moving people, the ECHO (Extension for Community Healthcare Outcomes) model, using remote learning technology to involve people who are actually delivering the care in the teaching process. The technique moves knowledge out to more people, allowing for expanded treatment capacity and making better health care available, particularly in remote and rural areas.

The model was so successful it has been replicated all across the country, particularly in areas when geographic and socioeconomic barriers make access to specialty care difficult, if not impossible. Topics include advanced disease management techniques for conditions ranging from Type II diabetes, epilepsy and chronic obstructive pulmonary disease to substance use disorders and other complex behavioral health problems.

Bringing Project ECHO to MAHEC

When Lourdes Lorenz-Miller, MSN, trained to bring Project ECHO to MAHEC in September 2017, she was told that it takes six months to get similar programs up and running.

A month later, UNC Health Sciences at MAHEC became one of the first academic health centers in the state to offer a continuing education ECHO for rural physicians. In January 2018, they unveiled the school nurse ECHO, followed by one for treating chronic pain in patients with opioid use disorder.

“Project ECHO allows us to share what we have learned with providers and their patients across the region,” says Lorenz-Miller. “ECHO learning isn’t from up top but from each other who are on the front lines. It has the potential to address health challenges in a big way by reaching more people. That is what makes this model so exciting.”

To date, MAHEC has developed 10 different ECHO series: chronic pain management, behavioral health, rural medicine, high-risk prenatal care, geriatric care, oral health, adverse childhood experiences and school health. These workshops have trained more than 8,000 participants from all 16 WNC counties and 96 counties statewide.

The training model

The training sessions follow a standard pattern. Actual case studies are submitted by participants or experts in advance for feedback and recommendations for next steps. In each training session, MAHEC’s experts share specialized knowledge in real-time with providers who, in turn, share their first-hand experiences. The other participants on the call get a chance to weigh in with suggestions and tips about what’s worked for them in similar situations.

Nurses, physicians and pharmacists receive continuing education credits for participating.

Programs are paid for in a variety of different ways. For example, the ulcerative colitis ECHO is free to participants because it attracts sponsors. In contrast, an eight-week school nurse training costs $115.

The nursing home ECHO is supported by the federal Agency for Healthcare Research and Quality (AHRQ) in collaboration with the non-profit Institute for Healthcare Improvement (IHI).

Participating nursing homes receive a $6,000 stipend.

The training program is designed to meet five key benchmarks:

keep the virus from entering nursing homes;
identify infected residents and staff;
prevent spread between staff, residents and visitors;
provide safe and appropriate care to residents with mild and asymptomatic cases of the virus;
ensure staff is adequately trained to implement best-practice safety measures.

Somers and her staff welcomed the detailed plan.

“The information stream has been very confusing, not only for physicians but for people that work in clinics and nursing homes because there wasn’t any kind of national strategy,” says Somers. “The CDC was saying something, the state was saying something else and there was a lot of confusion. This way everybody gets the same training and information.”

Most of the participants work for standalone facilities and struggle to keep abreast of ever-changing directives. However, Westwood is one of many nursing homes owned and operated by Principle Long Term Care. Somers and her team have relied on the corporate office to sort through and keep them informed on the latest coronavirus-related news and policies.

Nonetheless, she still believed there were reasons to participate in the ECHO, like hearing from someone going through the same thing.

“It’s an unbelievable experience when you find out that COVID is in your building and that the staff has got COVID,” says Somers. “It takes long hours and everybody has to do many different jobs.

“One night, my job was to collect trash in all the rooms because the housekeepers were out. Thank goodness my dietary staff never went down because I would have had to be in there cooking and that might have been a problem.”

photo shows an elderly woman in a dress and cardigan looking out a window covered by a lace curtain

NC advocates: Adult Protective Services needs multi-million dollar boost from state to fight abuse and neglect

January 27, 2021 by Thomas Goldsmith

NC advocates: Adult Protective Services needs multi-million dollar boost from state to fight abuse and neglect - North Carolina Health News

Adult Protective Services in every county are charged with discovering and dealing with abuse and neglect of adults with disabilities. Now COVID has added cost and other burdens on workers.

By Thomas Goldsmith

Sharnese Ransom works to protect adults with disabilities from neglect and abuse, both in her Raleigh neighborhood and when running the statewide group that represents North Carolina’s frontline troops against abuse of aging adults.

The 2020 arrival of the pandemic has made it tougher on both settings. In fact, the state’s most influential groups on aging issues are pressuring Gov. Roy Cooper to include $7 million for Adult Protective Services in his budget for the fiscal year starting July 1.

But that’s five months away. Right now, the pandemic is a menacing presence in neighborhoods like Ransom’s, where informal community concerns about vulnerable people often arise. It’s harder for that information to reach APS when there’s a pervasive fear among older people about contracting COVID-19.

“What I see is people afraid to get the virus and they stay so isolated,” Ransom, executive director of the North Carolina Association of County Directors of Social Services, said in a recent phone interview.

“There’s just a lot of self-neglect occurring out there,” she said. “In my neighborhood, I know where seniors live, I’m always going to their door, putting a note on the door: ‘Hey, this is Sharnese again. Do you need anything? Give me a call!’”

Her organization is in good company in pressing for more state funding in light of longstanding needs and the impact of COVID. Other advocates include the Governor’s Advisory Council on Aging, the NC Partnership to Address Adult Abuse, NC Senior Tar Heel Legislature, AARP NC, Friends of Residents in Long-Term Care, and the NC Coalition on Aging.

Calling on Cooper

“Rising caseloads demand greater funding so that staff may spend adequate time with clients and investigate abuse, neglect and exploitation complaints,” Roger Manus, chair of the Governor’s Advisory Council on Aging, wrote Gov. Roy Cooper in January. “The lack of adequate pay and impossible caseloads contribute to high turnover rates among APS staff.”

In North Carolina counties, social services officials have seen the pandemic as increasingly cutting into the statutory right of people with disabilities and older adults to be free from abuse and neglect. In 2020, APS offices also faced practical shortcomings posed by COVID-19, as well as in state funding.

“In smaller counties, they need more dollars for staff and services,” said Craig Burrus, assistant division director for adult and family service at Wake County’s Human Services operation. “I’m sure there’s more stress on them to have the things they needed because of COVID.”

Adult Protective Services represents one of the small, but vital, government operations that compete at the start of every General Assembly session for more money, ideally for a recurring boost. Their competition for a bump amid a multi-billion state budget can have real-life fallout, especially in small counties.

At the face-to-face level of social services, some COVID-wary staffers in Greene County have shied away from making in-person visits in order to deal with complaints and violations, Angela C. Ellis, director of county social services, said in a phone interview. Some clients and caregivers worry that investigators themselves will bring infection into homes as they try to meet increasing demand and handle more complex cases.

“We did see an increase in APS complaints,” Ellis said of the pandemic presence in Greene County. “They were very intense cases and that put the strain on workers. We’d have cases where you’re already dealing with mental health issues and then you have to add on physical abuse and financial exploitation.

“A lot of workers were burned out.”

Once a victim of abuse or neglect is located and stabilized, counties can use home health workers to check on his or her progress, but that can also stretch slim county budgets.

It’s the law

Across the state, Adult Protective Services is legally mandated to take reports on neglect or abuse of people with disabilities and older adults — whether physical, mental or financial. The service is then required to take action, with their own staffs, using county, federal and community resources.

Advocates say a persistent and structural problem for APS lies in the state’s failure to pay more than about one percent of the service’s cost, effectively demanding that counties use their own cash along with using federal grants to fulfill a state-mandated service.

State budget writers for the House included $893,041 for APS in both years of the 2019-2020 budget, but the increase for APS was drawn from a federal trust fund, not from any additional state allotment and not recurring for coming years.

When it comes to getting money from the legislature, agencies look for those recurring dollars before hiring new staff or starting new initiatives. It’s hard to hire staff, for example, when the dollars are only guaranteed for a year or two.

“Funding from this source and from state sources recommended above should be recurring in order to afford the stability necessary for stakeholders to have the confidence to make the necessary reforms which would meaningfully protect senior North Carolinians,” Governor’s Advisory Council on Aging members wrote Cooper recently.

More than 30,000 complaints and reports poured in statewide in 2020 to APS offices. Those employees were meeting COVID-related demands such as having to schedule additional time to protect their own health and to meet clients and caregivers safely. They also had to compete with other county departments for funding, staff hours and personal protective equipment, or PPE. The federal CARES Act provided some much-needed funds, but other dollars that usually come from nonprofits, churches and contractors dried up in the pandemic, county social services directors said.

Managers also had to protect the health of their workers and the stability of their workplaces as they went about their rounds.

“We still have to continue to go out into the homes and the facilities,” Cindy Perry, director of Social Services in Bertie County, said on the phone. “But we try to keep our staff out of the facilities as much as possible.”

Many cases go unreported

Neglect, abuse and fraud targeting older people can lurk beneath the reluctance of victims and caregivers to turn abusers in — whether because of shame or lack of the follow through on a complaint. The effects are stark, according to the current aging plan from the Eastern Carolina Council Area Agency on Aging.

“The effects of abuse are devastating on our older adults. Abuse results in increased rates of depression, mental health issues, and increased mortality rates,” the plan’s authors say. “Older adults that are victims of abuse are more likely to be admitted into long-term care facilities and are twice as likely to be hospitalized.”

Scammers of older and disabled people are too often relatives and close acquaintances. It’s not uncommon for them to have absconded with savings squirreled away for victims’ retirement years. When that money is gone, poverty can result.

On top of other COVID-19 concerns, Perry and others have had to deal with an increase in scam attacks on older people. In a low-life ploy often pulled on people with dementia, criminals may call posing as a relative or other trustworthy person who wanted money sent to them in another country. (A tip: Don’t do it.)

Feeling the weight of COVID fears, policies

People who first encounter instances of such cold-blooded crimes should be aware: When these criminals go low, they go really low.

These days, law enforcement principals say scammers are raking in money by fraudulently charging for spots on a non-existent list for a COVID vaccine shot. In an AARP alert, Tom Miller, Iowa’s attorney general, says that some scammers even offer older people “tickets” that supposedly secure a waitlist spot for a vaccination.

Meanwhile, a raft of new policies designed to slow the pandemic’s spread has further complicated APS issues. For example, stay-at-home rules set by Gov. Roy Cooper meant that people facing neglect and abuse were far less likely to attend church or visit other community spaces where they might receive help or tips in facing the very disease that keeps them at home.

The isolation engendered by COVID can keep news of outbreaks and individual cases from reaching APS through informal channels. Suspected neglect or abuse is less likely to be reported to APS by a relative, acquaintance, law enforcement officer, banker, doctor or lawyer because those encounters have gone away.

“This is something that we all have a stake in and that we all should be supportive of,” Harold Barnette, chair of the North Carolina Coalition on Aging committee on health and equity, said at a recent meeting. “As this epidemic demonstrates, a vulnerable group can be a vector for infection and spread to everybody in society.”

APS problems widespread

Even though the COVID threat is relatively recent, counties have long faced specific requirements from the state Department of Health and Human Services to treat abuse and neglect cases in a timely manner.

“Responding quickly to allegations of adult maltreatment is essential to case decision-making to protect the adult,” reads the 2019-2020 budget for Bertie County, quoting general statutes on counties’ duty. “State law requires that a prompt and thorough evaluation is made of all reports of adult maltreatment.”

DHHS expects counties to respond immediately when receiving complaints of an emergency that could cause death, within 24 hours if the complaint says there’s danger of irreparable harm to the victim, and within three days if the complaint doesn’t say there’s danger of death or irreparable harm.

Concerns about APS during the pandemic extend far from North Carolina, as seen in a report by the National Adult Protective Services Association.

“During this time, mandated reporters of abuse such as in-home care workers, medical providers and bank personnel are not available to observe and report suspected maltreatment to Adult Protective Services, the first line responders to maltreatment of older persons and younger adults with disabilities,” the report said.

“Also, many families are experiencing extreme emotional and financial stress which too may increase the risk of neglect or financial abuse.”

We see a group of healthcare workers holding signs that say, "#CherrySpringsStrong" while wearing masks and scrubs in the hallway of the long-term care facility.

Concerns grow over COVID fatalities in NC assisted living facilities

January 22, 2021 by Thomas Goldsmith

Concerns grow over COVID fatalities in NC assisted living facilities - North Carolina Health News

Assisted living centers in North Carolina and nationally notice growth in the numbers of COVID-related cases and deaths.

By Thomas Goldsmith

It’s a statistic that could easily fly by at a time when the number of statewide COVID-related deaths have passed 8,300.

But there are good reasons to take a deeper look at the 200 North Carolina residential-care residents who have been listed as COVID-related deaths each week beginning with Dec. 22 as recorded in state Department of Health and Human services data.

Each week’s total amounts to about one in four of the total 817 deaths tied to COVID among assisted living residents since the beginning of the pandemic in 2020.

The grim statistics are driving some regulators’ and academics’ increased concern about COVID-related deaths in assisted living facilities, in addition to those in the more medically intensive nursing homes.

Researchers have suggested reasons to ramp up the attention paid to deaths in assisted living settings, where residents are generally healthier and therefore, thought to fare better generally than those in nursing homes.

Nursing homes vs assisted living
Although the types of U.S. long-term care facilities are sometimes confused, nursing homes and assisted living centers serve different functions for fragile older people and their families.

Assisted living facilities in North Carolina grew out of the former county rest-home system, are regulated by the state Department of Health and Human Services, and generally take care of personal and health care needs of people with less intensive medical conditions.

Skilled nursing facilities, commonly known as “nursing homes,” concentrate on residents’ medical care with additional services and are strictly regulated by the federal Center for Medicare and Medicaid Services.

Sources: NC DHHS and the Centers for Medicare and Medicaid Services

For one thing, more than half of assisted living residents — about 53 percent are 85 or older, while 42 percent of skilled nursing facility residents are in the same age group, according to research in the Journal of American Medical Directors Association by Cheryl Zimmerman, distinguished professor at UNC School of Social Work; UNC geriatrician Dr. Philip Sloane; and colleagues.

“More so, many have the chronic underlying conditions implicated in COVID-19: 34% have heart disease, 17% have diabetes, and 15% have lung disease, and more than a quarter have between four and 10 chronic health conditions,” the authors wrote. “Thus, the assisted living population is at high risk for being affected by COVID-19 and suffering serious outcomes.”

On the national level, U.S. Sen. Elizabeth Warren (D-Mass.) and colleagues commissioned a July report that explored the incidence of COVID in assisted living centers.

“The fatality rate for diagnosed cases (in assisted living), while highly sensitive to the testing rate, is nearly six times the national average, and is comparable to — or even higher than — the fatality rate for nursing home residents with COVID-19,” the report says.

COVID-related concerns listed by 11 major assisted living providers surveyed for the Warren report included high levels of hospitalization for COVID patients in assisted living, the lack of federal testing requirements, inadequate sick-leave policies that put staff and residents at increased risk of infection, and practical and financial obstacles to ensuring supplies of personal protective equipment or PPE.

In addition, congressional researchers found that public and private health-care officials lack full information because assisted living providers aren’t required to match the skilled nursing facilities’ strict requirements for reporting cases and deaths to federal regulators at the Centers for Medicare and Medicaid Services.

More attention in North Carolina has gone to the 2,877 fatalities — or 10.4 percent of the state’s deaths — recorded among 27,867 cases in skilled nursing facilities. However, an NC Health News review shows that about 6.7 percent of the state’s assisted living residents die once they have contracted COVID-19. That compares to a 10.7 rate of skilled nursing facility residents with COVID.

“I know that it’s difficult to keep it out of facilities despite many providers’ best efforts,” said Jeff Horton, executive director of the NC Senior Living Association, a trade group.

As of Jan. 15, NC DHHS figures for assisted living centers showed nearly as many current outbreaks in assisted living facilities, at 334, as in skilled nursing facilities, which had 356.

In the context of overall surges in COVID-19 cases, public health and industry officials have pointed out the correlation between increasing COVID-19 cases in the community and in long-term care. Adam Sholar, president of the North Carolina Health Care Facilities Association told NC Health News that community level of the disease ranks as the most significant factor driving an outbreak in a facility.

Horton cited the same cause: “If you look at the numbers regarding percentages of positive tests and hotspots around the state, including the number of cases and deaths related to COVID, there is a correlation to deaths and outbreaks in long-term care.”

However, some distinctive aspects of COVID-19 in long-term care may help assisted living providers guard against more serious complications, according to a Centers for Disease Prevention and Control report and other sources.

Federal regulators advised assisted living providers to push against the increases in community transmission by quickly identifying cases and reacting early to residents or staff who have or may have the disease.

“Experience with outbreaks in nursing homes has demonstrated that residents with COVID-19 may not report common symptoms such as fever or respiratory symptoms,” the CDC report said. “Some may not report any symptoms.

“Unrecognized asymptomatic and pre-symptomatic infections likely contribute to transmission in these settings.”

shows a hand holidng a small vial of COVID-19 vaccine

Vaccines arrive to NC’s prisons

January 21, 2021 by Hannah Critchfield

Vaccines arrive to NC’s prisons - North Carolina Health News

Incarcerated people and staff who are 75 or older began to receive the vaccine yesterday.

By Hannah Critchfield

North Carolina began vaccinating state prisoners Wednesday after its prison agency received its first doses of the COVID-19 vaccine from the state health department.

Correctional staff who work with COVID-19-positive incarcerated people or in prison units with outbreaks, as well as the health care staff administering shots, are also receiving the vaccine.

Around 1,000 Moderna vaccines allocated for state prisons this week have arrived, according to a Department of Public Safety press release issued Wednesday morning. About 300 more vaccine doses are expected to arrive and be administered “within days.”

Yesterday’s rollout marks the first time incarcerated people in state custody have been offered inoculation for a virus that has decimated prisons across North Carolina, leaving 40 inmates dead and thousands infected.

Roughly one in five state prisoners has had COVID-19, according to a North Carolina Health News analysis, giving the institutions a death rate that’s not quite double that of the general public.

Some correctional staff had previously begun to get vaccinated through their local health departments, said Todd Ishee, commissioner of prisons at DPS, at a press conference last week.

Only state prisoners who are 75 or older are currently being offered the coronavirus vaccine due to limited availability, according to the press release. Staff who are 75 and older, even if they do not work with COVID-positive inmates, can also get inoculated.

“All of the facilities that are open are scheduled to receive it at this point,” said John Bull, DPS spokesperson, when asked which of North Carolina’s 55 prisons will be receiving the vaccine this week.

The rollout in North Carolina’s prisons lags behind some other health providers across the state available to non-incarcerated people, who can travel to local health departments where the vaccine is currently being offered to those 65 or older.

A little over half – 23 out of 40 – of the state prisoners who have died of coronavirus were 65 or older, according to press releases and death records obtained by NC Health News. Nine of them were 75 or older.

COVID-19 vaccines will be made available to younger prisoners and staff through the prison system as the prison receives more doses from the state Department of Health and Human Services.

“Vaccination opportunity will expand to age 65 or older based on vaccine availability,” Bull said in the press release announcement.

These first vaccines will be administered by prison health care staff, though “strike teams” with possible assistance from the state National Guard will help in coming weeks as more doses become available. The Guard is currently assisting with vaccinating staff in the Central Prison “region,” one of the four designated areas DPS has set up to receive initial doses of the vaccine.

From there, the COVID-19 vaccine is being distributed to all nearby prisons in the region.

Getting vaccinated is currently voluntary for both incarcerated people and staff members.

That could change, according to previous statements made by Ishee, who noted it would be a decision made in consultation with the state health department.

“But we are not there right now,” he said at a Jan. 14 press conference. “It is voluntary, and we really hope that our staff and our offenders will jump on board and get vaccinated.”

We see Ester Amy Fischer hugging her mother while they take a selfie. Her mother Barbara, who wears a purple shirt with spotted patterns, is smiling with laughter.

For some long-term care residents, vaccine comes too late

January 20, 2021 by Hannah Critchfield

For some long-term care residents, vaccine comes too late - North Carolina Health News

What happens when an outbreak strikes a facility while residents inside wait for a vaccine?

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.

We see Barbara Fischer, 83, eating dessert while holding hands with her daughter Ester Amy across the table at her assisted living facility. — Barbara Fischer dines with her daughter Ester Amy Fischer. Barbara, age 83, tested positive for COVID-19 earlier this month, before the vaccine came to her long-term care facility. Photo credit: Ester Amy Fischer

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.”

shows a young woman snuggling with an older woman — Photo credit: Ester Amy Fischer

‘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.”

We see Mark Newton sitting with his arm around his older mother on a brown corduroy couch in their home in Reidsville. Both smile, with closed teeth, and look at the camera.

Family health workers feel left behind by NC’s vaccination rollout

January 14, 2021 by Hannah Critchfield

Family health workers feel left behind by NC’s vaccination rollout - North Carolina Health News

People who work at long term care facilities were some of the first in line for the COVID-19 vaccine. Unpaid caregivers - those who care for their elderly parents or other relatives at home - aren’t being given the same priority.

By Hannah Critchfield

For Mark Newton, each visit to the grocery store tempts fate.

He arrives during early or late hours when the business is mostly empty, but he can’t control the checkout line – or the flood of fear that rushes in every time he finds himself surrounded by other too-close patrons, their noses peeking out over masks, or mouths and noses on full display.

Newton, a retired carpenter with diabetes, is in his 50s. He’s the primary caretaker for his 82-year-old roommate, who suffers from dementia, and also happens to be his mother.

Like many North Carolinians, he still isn’t sure when he will be offered the novel coronavirus vaccine.

“My mother getting vaccinated is great,” said Newton. “But if she gets COVID-19, it’s going to be from me, because I’m the only one that goes out and gets us what we need.”

Over the last few weeks, health care workers who interact with COVID patients and employees who work with older people in long-term care facilities in North Carolina have been offered the vaccine.

People who assume unpaid home health caretaking roles for elderly family members or loved ones have not. Many of these workers feel left behind by the state vaccine plan and remain confused about if they have any priority for immunization.

“If I come down with the virus,” Newton said, “There is no one else to take care of her.”

Digging for information

North Carolina’s current plan for the COVID-19 vaccine rollout mirrors past federal Centers for Disease Control and Prevention recommendations for distribution.

Employees who work with older or at-risk people in long-term care facilities such as nursing homes were given first priority under the plan, in Phase 1a. So were professional home health workers and personal care aides who directly care for patients with COVID-19.

Family home health caregivers are different. They tend to care for one or two loved ones living in the same household and are often not compensated for their labor.

The scope of their work varies, but they nevertheless work in close contact with people who are often elderly and at increased risk for severe illness from COVID-19. North Carolina is home to approximately 28,828 of these informal caregivers, according to the nonprofit Family Caregiver Alliance.

Newton has been his mother’s primary caretaker for 13 years. She has frequent strokes and a history of blockages in her carotid, the artery that feeds the brain, he said. Before health problems forced her to retire, she was a geriatric nurse who often worked in long-term care facilities.

“At some point, she’s going to reach a point where I can’t care for her,” Newton said. “I’m trying to make preparations for that. But I would never send her to a facility now — it would be a death sentence.”

Forty percent of all deaths due to COVID-19 nationwide have been in long-term care facilities, in North Carolina that number has been closer to 46 percent. That’s led many family caregivers in North Carolina to delay placing their loved ones in a group home until the pandemic subsides, no matter how useful or needed it might be.

Newton doesn’t know where he fits into the state’s plan as an unpaid caregiver.

“Resources are never, never painlessly handed to you in North Carolina,” said Newton, who is originally from Rhode Island. “You have to dig for them.”

The Department of Health and Human Services, which sets the state’s vaccine plan, declined multiple requests from NC Health News to clarify where family caregivers fall in the vaccine distribution plan.

It’s likely they will be offered doses as part of group 3 of Phase 1b, which includes, “unpaid health care workers with direct patient contact.” If they’re 50 or older, these family caregivers could be vaccinated earlier, in group 2.

Some North Carolina counties began moving into group 1 of Phase 1b this week, which prioritizes people who are 75 and older.

We see a slightly-shaky picture of two elderly white people smiling at the camera in front of a yellow background. — Robb, 71, and Penny Amrine, 73, in their home in Cary, North Carolina. This is their first selfie.
Photo credit: Robb Amrine

‘We’re out here on a limb’

Robb Amrine wasn’t sure if he’d be included as a home health care worker in Phase 1a, but he thought his wife Penny – “my precious coin for 49-and-a-half years,” he said – would surely be next in line.

Penny has dementia, as well as a series of other preexisting conditions such as diabetes and hypothyroidism that place her at increased risk for severe illness from COVID-19.

But she’s 70, five years shy of the cutoff for the current distribution round, known as Phase 1a.

Amrine, who is 71, has been the primary caretaker for his wife for the last three years, administering insulin and ensuring she takes medications daily in their Cary home. Without him, she’d need to live in a skilled nursing facility, he said.

When Amrine found out neither of them would be in the initial rollout of phase 1b, it was an ineffable blow, he said.

“It’s beyond frustrating,” he said. “We’re talking about our lives and we’re talking about our health. And all I have to do is go out and get the COVID-19 virus, and she’ll be infected.”

Like Newton, he still doesn’t know when it’ll be either of their turns for vaccination and is waiting for a response from WakeMed Hospital in Raleigh, where he called in an attempt to clarify the plan last week.

Currently, Amrine believes both he and his wife will need to wait with other individuals who are 65 or older for a chance to get vaccinated in Phase 2, despite his caretaking role and her risk factors. This week, federal officials gave states the latitude to offer the vaccine to everyone over the age of 65. North Carolina has about 1.8 million people over 65 but has only received about a half-million doses of vaccine.

“We don’t understand why we were carved out of the equation, other than the fact that I believe is because it’s just easier. ‘Show me your ID that’ll tell me how old you are’ is a yes-no situation, versus, ‘Let’s delve into your health history’ with HIPAA laws and so forth, and, ‘Can you really prove that this is true that you have these conditions or do this [caregiving]?’”

For now, they, like many Tar Heels, remain in limbo.

“We’re out here on a limb and have no idea when, what could happen, where, nothing,” he said.

Assessing risk

Scientists don’t yet know if receiving the COVID-19 vaccine prevents someone from spreading the virus to others. It’s played a role in consideration of who should be prioritized in the rollout.

“You have to think about a person’s risk of getting the disease, and their risk of transmitting it, and the risk of getting ill from it,” said Philip Sloane, a geriatrician and co-director of the Program on Aging, Disability, and Long-Term Care at the University of North Carolina School of Medicine. “The number one thing is to get the care recipient vaccinated. They’re the ones who you’re really trying to prevent getting infected because they’re at highest risk.”

Family caregivers may be deprioritized because of their relatively low-level of interaction with others in their work, according to Sheryl Zimmerman, director of aging research at the UNC School of Social Work and fellow director at the Program on Aging, Disability, and Long-Term Care.

“Family caregivers are surely essential workers,” she said. “But the number of people for whom they’re responsible is fewer than all other, more-recognized essential workers.”

Sloane echoed this.

“Paid caregivers that travel from person-to-person are at much higher risk of getting the illness than somebody who stays home,” he said. “Family caregivers, who just take care of one or two people in the same setting, are not the same as somebody who works in a supermarket, and has to deal with 150 people in a shift, or a home health worker who goes to probably 20 or 30 homes in a week.”

After the Trump administration overhauled its vaccine strategy, urging states to provide vaccination to everyone 65 or older, DHHS Secretary Mandy Cohen told reporters at a press conference that North Carolina’s vaccine advisory committee will review these recommendations and consider if the state needs to make changes to its plan.

Such changes could mean some family caregivers, or the loved ones whose health care they oversee, will be offered the vaccine at an earlier date.

UPDATE: After this article ran, the North Carolina Department of Health and Human Services announced it was overhauling its current vaccine plan to align with new CDC guidelines released earlier this week.

Anyone 65 and older will now be prioritized for the vaccine next, after first-responder health care workers and long-term care staff and residents, in what’s now known as Group 2. Essential workers come next, in Group 3.

A spokesperson for DHHS also reached out after the article ran to clarify where family caregivers fall in the new plan:

“At this time, people who serve as caregivers to older adults would be considered frontline essential workers and included in Group 3 of the vaccine rollout,” said SarahLewis Peel, DHHS spokesperson.

“The vaccine prioritization is designed to save lives and prevent spread while vaccine supplies are limited,” she added. “North Carolina moves through vaccination phases by aligning to federal priorities while giving local health departments and hospitals the flexibility to move to the next priority group as they complete the previous one and have vaccines available.”

Additional Thanks

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