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The state Department of Health erred in not explicitly including personal care, assisted living and other congregate settings for seniors along with nursing homes in its plan for vaccinating residents and staff in long-term care facilities, according to advocates for seniors who testified at a joint committee hearing of the State Senate on Thursday.
Those errors resulted in inconsistencies and delays in getting lifesaving shots to many in the group that accounts for more than half the coronavirus deaths in Pennsylvania, according to those advocates, including Aging & Youth Chairwoman Judy Ward.
In keeping with federal guidance, the DoH plan outlined the state's version of a national partnership with CVS and Walgreens, calling for vaccinations at all nursing homes, but the plan failed to specify that those shots should also occur at the personal care, assisted living, independent living and other retirement communities, which are likewise full of people vulnerable to the coronavirus, according to the advocates.
There was ambiguity and conflicting messaging for three weeks, which led to inconsistent outcomes, with some multi-function retirement campuses getting shots for their nursing, assisted living, personal care and independent living components, but others, even right down the street, or served by the same pharmacy chain, getting only shots for nursing homes, according to testimony by Adam Marles, CEO of LeadingAge PA, which represents 360 nonprofit providers of senior housing, health care and community services.
"These inconsistencies in access and vaccine administration have left tens of thousands of seniors without a plan for how to receive vaccines," Marles said.
In the absence of definitive inclusion in the federal pharmacy partnership, many seniors in congregate settings have been consigned to trying to get vaccinated through the state's interactive website map, which requires a computer and technological savvy that many don't possess, Marles said.
"These individuals are lumped into the fend-for-yourself and ever-growing eligibility pool of Phase 1A," Marles said.
"That wait and navigation may sound reasonable to those of us with office jobs," Marles said. "Now think about the senior living in a continuing care retirement community who is likely 85 years old or older."
All 650 nursing homes have had at least one of their three prescribed visits by pharmacy vaccinators, with the partnership's nursing home mission slated to finish by early March, according to Acting Health Secretary Alison Beam.
But only 32 assisted living or personal care homes among the 1,200 such facilities in the state have had visits scheduled, said Zach Shamberg, CEO of the Pennsylvania Health Care Association.
Those visits are likely to be finished by mid-April, according to Beam.
The confusion continues about "what levels of care in senior living campuses should be part of the vaccine process," stated Suzanne Owens, CEO of the Peter Becker Community in Montgomery County, which has 500 long-term care residents.
Initially, Owens' community was given a date for vaccination of both skilled nursing and personal care residents, but before that date, CVS told the organization that personal care residents wouldn't be getting shots until March 8 -- and that "residential" clients might not qualify for the federal partnership program at all, and would need to seek vaccinations as part of the general community, Owens said.
The situation led her to express dismay on the TV news in Philadelphia, resulting in vaccinations for all her residents in January, she said.
But that didn't translate to a general shift in policy with the DoH, she said.
In addition to creating the ambiguity that led to the ongoing delays in vaccinations at the facilities that don't provide skilled nursing care, the DoH also didn't begin the partnership vaccinations even for the nursing homes until Dec. 28 -- two weeks after hospitals began vaccinating health care workers, Shamberg said.
That was inexcusable, given the vulnerability of his constituents, he said.
Lots of individuals are clamoring for shots, and lots of groups are arguing for better placement in line, and many have good arguments, according to Marles.
"(But) the fact remains that older Pennsylvanians in congregate settings are at greatest risk of death," he said.
The current priority group -- 1A -- is about 4 million strong, comprising health workers, everyone 65 and up and everyone 16 to 64 who has compromising health issues, with no distinctions among them, Marles observed indirectly.
"When everyone is a priority, no one is," he said.
There needs to be more urgency in getting seniors in congregate care vaccinated -- on their campuses, because it's not safe or practical for them to go out into the community for inoculations, according to Owens.
Reportedly, only 17% of all doses allocated in the state so far have gone to long-term care facilities, and that needs to rise, Schamberg said.
Long-term care facilities need to become "truly prioritized," he said.
And the effort needs to be ongoing, because the three-visit protocol for the current federal partnership doesn't take into account new residents and new employees who come after the point when the prescribed visits can provide the necessary two shots, according to Owens.