Pharmacies are nearly finished giving COVID-19 vaccine to staff and residents at Nevada’s nursing homes and assisted living centers, but an unknown number of long-term care facilities that didn’t qualify under the federally run program have been left to fend for themselves.
“We’re really at the mercy of the local health department as far as when they’re scheduling and when they are finding the pharmacies, and when they’re available,” said Margie Guerrieri, a spokeswoman for the parent company of Sterling Ridge Assisted Living in Las Vegas, one of the homes excluded from the vaccine program.
Officials with the state Department of Health and Human Services, Gov. Steve Sisolak’s COVID-19 Response Task Force and the Southern Nevada Health District would not say how many facilities were excluded from the program despite numerous inquiries from the Review-Journal.
The state agency and the health district each directed reporters to the other for details on how many and which facilities have not yet been visited by mobile vaccination clinics.
But in what could be an indication of the scope of the problem, the Washoe County Health District partnered with Safeway to vaccinate staff and residents of the approximately 10 facilities that were left out of the program, said health officer Kevin Dick. The federal program covered the remainder of the 31 assisted living facilities and 10 skilled nursing homes in the county.
Searching for a partner
The health district in Clark County is still working with the state to find a pharmacy partner to begin delivering vaccines to vulnerable staff and residents of the impacted homes, spokeswoman Stephanie Bethel said.
The state’s effort is part of a national drive overseen by the federal Centers for Disease Control and Prevention to target those most vulnerable to the new coronavirus. In Nevada, for example, 436 employees or residents of such homes have died from COVID-19, or more than 9 percent of the total of 4,663 deaths in the state, according to the Centers for Medicare & Medicaid Services.
But that program, which covers more than 75,000 facilities around the nation, has come under criticism after getting off to a slow start. Among other things, public health experts have questioned its heavy reliance on pharmacy employees to visit the care facilities instead of utilizing medical staff already employed at many centers.
Some states have responded to issues surrounding long-term care facilities better than others, said Guerrieri, the spokeswoman for Well Age Senior Living, owner of the Sterling Ridge facility in Las Vegas. Residents and staff at the company’s facilities in Colorado, where Well Age is based, all have completed their vaccinations, she said.
“We are ready and willing to have any resident get the vaccine, but the state is what’s holding us back right now,” Guerrieri said.
West Virginia, one of the states leading the nation in the efficiency of its vaccine distribution effort, chose to opt out of the federal government’s program, instead creating a network of independently owned pharmacies.
Facing the uncertainties of getting a shot in-house, some Sterling Ridge residents made appointments at community vaccination sites.
Among them was 92-year-old Estelle Roberts, who said managers at the facility posted a notice on her door in January that read, “We are still waiting on the state to issue us a date for COVID vaccination clinic here at the community, however, we may be able to bus residents to the nearby site.”
Roberts, who moved to the facility in June after breaking her hip, didn’t care for the idea of waiting.
“That disturbs me because we’re on lockdown here,” she said. “But after employees finish their shift, we don’t know what they do or where they go.”
Instead, Roberts’ daughter, Dori Roberts-Lombardi, 65, scheduled an appointment at Cashman Center to get her mom’s first dose, then waited with her for nearly three hours past the appointment time on Thursday to get her a second shot at the Las Vegas Convention Center.
Now that Roberts is fully vaccinated, she’s eager to see her new great-grandson. But she wonders what she would have done if she didn’t have her daughter nearby.
Most long-term care facilities in Nevada have received the vaccine on-site through CVS Health, Walgreens and a Managed Health Care Associates Inc. pharmacy, with skilled nursing facilities beginning on Dec. 21, and assisted living and other care facilities on Jan. 4.
Status of the rollout in Nevada
Long-term care facilities are second in line in Nevada’s COVID-19 vaccination playbook, behind only general medical and surgical hospitals. That includes skilled nursing facilities that provide around-the-clock medical care and assisted living facilities that offer a lower level of care for those who need only some assistance.
The effort uses a strike team delivery system where a pharmacy team comes in to provide vaccinations, said Candice McDaniel, a bureau chief with the Nevada Department of Health and Human Services.
The format, she said, takes more time and is less efficient than a mass public vaccination event but addresses a critical need. Each facility is offered three different visits – for first doses, second doses and a catch-up session.
McDaniel said in late January that the state anticipated that vaccinations at the 442 long-term care facilities covered by the federal program would conclude by the week of Feb. 8, but added that the timeline was “very tentative.”
Statewide, 50,930 doses of the COVID-19 vaccine had been administered in long-term care facilities as of Thursday, according to the federal Centers for Disease Control and Prevention. Only 7,996 people were reported as having received both doses required, but that figure was likely suppressed by reporting delays.
Rosemary DeHart of Las Vegas, whose 97-year-old aunt is at Sterling Ridge in the memory care unit and can’t travel, wants to know when her relative’s turn will come.
She said the facility has done everything they could to protect their residents, but still, waiting is hard. Her aunt tested positive months ago but was asymptomatic. Her mental condition has regressed in isolation, she said.
“We just hope it happens soon for them. It’s not their fault they’re at the tail end of everybody,” she said. “All she can say is, ‘I hope I don’t get it.’”
Ineligible for federal program
Guerrieri, the Sterling Ridge spokeswoman, said officials don’t know why the facility was declared ineligible.
Among the facilities eligible for the federal Pharmacy Partnership for Long-term Care Program are skilled nursing centers, assisted living facilities, state-run homes for veterans and “intermediate care facilities for individuals with developmental disabilities,” according to the CDC’s website.
There’s no cost to participating facilities and pharmacies bill insurance companies.
Eligible facilities could opt out of the federal program and work with a pharmacy of their choice to administer the vaccine, but they and the provider are responsible for all aspects of vaccine administration and reporting.
Other long-term care facilities that aren’t eligible include adult day care and independent living centers, those that serve only children and teenagers, and “psychiatric rehabilitation or behavioral treatment facilities and drug or alcohol rehabilitation centers,” according to the CDC.
Brett Salmon, president of the Nevada Health Care Association and the Nevada Center for Assisted Living, declined to say how many facilities represented by the group have not received vaccine but said the logistics of such a program were massive.
“This is a new system being rolled out to millions of people with multiple touchpoints who are trying to coordinate, collaborate, schedule and ultimately get everyone who wants it safely vaccinated,” he said in a statement. “There have been hiccups along the way. There is always going to be room for improvement. But we believe that overall, Nevada’s rollout has gone well in long-term care facilities.”
The CDC also declined to disclose how many and which Nevada long-term care facilities didn’t meet eligibility guidelines, directing questions to the state.
In an email on Friday, state health department spokeswoman Shannon Litz said each county is working to vaccinate residents and staff at long-term care facilities that didn’t meet enrollment requirements for the federal pharmacy program.
”The Nevada State Immunization Program coordinated with partners to provide a comprehensive list of congregate living facilities to the federal government for review to be enrolled in this program,” she said. “The facilities that were not eligible for the federal program have been shared with the Nevada county where they reside and plans are being developed to ensure the COVID-19 vaccine is made available to residents and staff.”
Pharmacies on the front line
CVS Health said it was assigned to 32 skilled nursing facilities, and 227 assisted living and other care facilities in Nevada.
As of Thursday, it reported that vaccinations had been completed at the skilled nursing facilities. At assisted living and other care facilities, CVS Health said on its website that it had finished 96 percent of first doses and 66 percent of second doses.
Walgreens, which was assigned 29 skilled nursing facilities in Nevada, said first and second doses have been completed, as have 45 percent of the catch-up sessions.
The pharmacy chain also was assigned 177 assisted living and other care facilities and has completed first-dose clinics, it said.
Under Managed Health Care Associates Inc., Consonus Pharmacy, which is providing COVID-19 vaccinations in Nevada, Oregon and Washington, is using a different distribution method than CVS Health and Walgreens.
The company doesn’t send in its own employees to give the shots, but instead works with nurses at long-term care facilities.
Consonus Pharmacy was assigned four long-term care facilities in Nevada for COVID-19 vaccinations — three large skilled nursing facilities and one assisted living facility — the company told the Review-Journal.
Clinics at the nursing homes are done and those at assisted living facilities will be finished by Feb. 18, it said.
‘No virus for me’
The Oakmont of Las Vegas was one of the first assisted living facilities in Clark County to fully vaccinate all residents and staff. On Feb. 5, 130 people at the assisted living facility got their second shot.
First in line was Valmae Ayres, 98, who was grateful for the chance.
“Who wants to get the virus? I don’t. No virus for me,” she said as she wheeled her red scooter through the halls.
When it was time to get the vaccine, she pointed a shaky finger to her left arm and rolled up her sleeve. She said she was most looking forward to going to a Chinese restaurant soon.
Nearby, one couple shared a kiss and a hug in the line, through their face masks. Don Masterson, 90, held his partner, Darlene Cox’s wrist. Their only wish after being vaccinated was to get out the front door.
“We haven’t been out of this place in almost a year,” Masterson said.
The executive director of the facility, Chris Mirando, said he is now working to secure second doses of the vaccine to administer in-house.
“These are the strongest, toughest people you’ve ever met in your whole life,” he said proudly of his residents. “And now they have a weapon to fight COVID.”
Contact Briana Erickson at berickson@reviewjournal.com or 702-387-5244. Follow @ByBrianaE on Twitter. Contact Julie Wootton-Greener at jgreener@reviewjournal.com or 702-387-2921. Follow @julieswootton on Twitter.
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