Nursing Home COVID-19 Vaccination Clinics to Begin as Early as Dec. 21st
The Department of Health (DOH) provided a webinar for nursing homes on Dec. 10th regarding the COVID-19 vaccine and its distribution and administration to residents and staff. Many issues were discussed, and even more questions were posed, all of interest to members on the long term care continuum. Dr. Howard Zucker, Commissioner of Health; Val Deetz, deputy director, Center for Health Care Provider Services and Oversight, DOH Office of Primary Care and Health Systems Management; and Loretta Santilli, DOH Office of Public Health Practice, were the presenters. A recording of the webinar is available here; slides will be posted when they are available.
The webinar offered a high-level overview of the dovetailed federal and state COVID-19 vaccination programs. The Department acknowledges that this is a swiftly moving process and that information is changing daily. They encourage providers to be flexible and patient and will work to provide information and answers to questions as soon as possible.
As members know, the federal Pharmacy Partnership for Long Term Care (the Partnership) will engage long term care facilities (LTCFs) with pharmacy partners CVS, Walgreens, and a few additional pharmacies to deliver the vaccine to facilities. Initially, this process will entail vaccinating 90,000 nursing home residents and a portion of their 131,000 nursing home employees. This program will administer the Pfizer vaccine.
In addition to the federal approval process, New York State will have two panels review the vaccine and its distribution plan before this process gets underway. The State Clinical Advisory Task Force will review the safety profile of the vaccines and clinical best practices. The State Vaccine Distribution and Implementation Task Force will review how and in which order it will distribute and operationalize administration of the vaccine.
New York State has activated the federal Partnership, thereby enabling the delivery of vaccine to New York State upon approval. A rough timeline is below:
- Dec. 11th-14th – Food and Drug Administration (FDA) Emergency Use Authorization (EUA) and Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommendations regarding the Pfizer vaccine
- Dec. 15th – Possible first delivery of vaccine to pharmacies
- Dec. 21st – First doses administered at LTCFs
There will be two phases of vaccine distribution under the federal Partnership:
- Phase A – Includes just skilled nursing facilities (SNFs). At this time, only Phase A has been triggered.
- Phase B – Includes all other LTCFs, assisted living/adult care facilities (ACFs), intellectual/developmental disability (IDD), and other congregate settings. This phase will be triggered shortly.
As described below, the federal Partnership will administer vaccines through three consecutive on-site clinics, with the first vaccine clinic visits to be held in nursing homes between Dec. 21st and Jan. 21st. The second vaccination clinics will be held approximately 21 days after the first, and the third approximately 21 days later.
Vaccine Clinic Framework:
The first phase of the federal Partnership will include nursing home residents and staff. Administration will be conducted by pharmacy partners over three on-site clinics as follows:
- Clinic #1
- All nursing home residents;
- A portion of the nursing home staff (DOH suggested 1/3 of staff).
- Clinic #2
- Second dose for nursing home residents and staff who participated in Clinic #1;
- First dose for an additional 1/3 of nursing home staff at option of facility;
- First dose for nursing home residents who missed first clinic, are newly admitted residents, or were ill or contraindicated at the time of first clinic.
- Clinic #3
- Second dose for nursing home residents and staff who received their first dose in Clinic #2.
The Department recommends that only a portion of the staff be vaccinated in the first clinic to ensure staffing coverage to care for residents if staff have side effects and must be absent from work. The Department recommends that LTCFs choose staff to be vaccinated from various cohorts/departments to ensure that full shifts or departments are not absent with symptoms.
There will be staff and residents who are not vaccinated during the federal Partnership clinics. Options for additional residents and nursing home staff will include:
- Regional Health Care Provider (HCP) Hubs – coordinated by the 10 economic development regions
- Local Health Departments using “push PODs” to deliver vaccine on site at LTCFs
- Pharmacy providers (enrolled in the State COVID-19 Vaccination Program) vaccinating on site at the facility
If a LTCF has an existing partnership with a pharmacy, that pharmacy may administer vaccines. These HCP vaccine options will also serve home and community-based services (HCBS) staff, public safety personnel, and other front-line HCPs. Existing long term care pharmacy partners of facilities will have access during Phase 2 (State Program) to provide the vaccine. This also includes small chains and independent pharmacies.
Close observation of patients is critical after vaccination, especially in the first 30 minutes after administration. The Department recommends keeping a close eye on residents for unusual symptoms and maintaining an accessible supply of equipment and medications that might be needed in the event of a code or anaphylaxis or other reaction. Information on contraindications, possible reactions, or side effects will be shared by the CDC and FDA.
Dr. Zucker stated that individuals with a prior case of COVID-19 are advised to receive the vaccine. The Department will look into the time clearance for when the vaccine can be given to an active COVID-19-positive or recently active COVID-19-positive patient. If this clearance timeframe is short, hospitals may be able to provide vaccination before hospital discharge and admission to a nursing home.
Providers inquired about the minimum/maximum gaps between vaccine doses – the minimum timeframe for the Pfizer vaccine is 21 days. The Department will provide additional information about the maximum timeframe when it becomes available.
The vaccine is not approved for individuals under age 16. It is also unclear whether the vaccine is appropriate for staff who are pregnant or post-partum. If staff or residents have significant allergies with anaphylaxis, please check with the facility’s medical director, or the individual’s personal physician should be consulted prior to administering the vaccine.
Consent and Operational Issues/Questions:
Facilities should record consent and refusal of all residents and staff. Providers asked if verbal (as opposed to written) consent from residents would be allowed considering the tight timeframe for this process. This would be helpful for patients who lack decision-making capacity and have distant health care agents or surrogates. The Department will consult with its counsel’s office on this question.
The vaccine cannot be mandated at this time because it is approved under an EUA. Vaccines approved through an EUA cannot be mandated.
Providers asked whether the pharmacy staff administering vaccinations in facilities will be given the vaccine and will be tested. This is not clear. The State is asking these providers to "pledge" to test their staff for COVID-19 prior to clinics. The Walgreens program materials indicate that vaccine staff will undergo COVID-19 testing prior to clinic dates.
Some inquired whether hospitals will be required to provide the vaccine prior to LTCF admission. The Department said that depending on time clearance, hospitals may be required to offer the vaccine to patients prior to discharge. However, the patient cannot be mandated to accept the vaccine.
For individuals discharged from LTCFs who have received a first dose through the federal Partnership clinic, DOH advised that facilities track discharges and schedule a follow-up appointment with those individuals to ensure that they return to the facility for a second dose on the appropriate date.
In addition to records maintained through the governmental and provider records systems, individuals who are immunized will be given a vaccine card recording each dose administered. The Department recommended that individuals take a photo of the card and save it in their smartphones if they are able to do so.
Although the clinical trials show that the vaccines prevent people from becoming ill with the virus, there is not yet sufficient data to know whether individuals may be able to transmit the virus even after vaccination. Thus, vaccinated individuals will still require personal protective equipment (PPE) after vaccination. The Department indicated that staff testing will not be modified at this time. We expect that many of the clinical and operational questions will be addressed over the coming days as various governmental entities issue their recommendations.
LeadingAge NY will provide members with more information as it becomes available.