Vaccinated, But Still Restricted: Long-Term Care Facilities In PA Cautious To Return To Normal
The past year has been boring for 88-year-old Jan McGrath.
The retired nurse lives with her husband, Bill, at Westminster Place, a licensed personal care home in Oakmont. McGrath said she spends a lot of time reading, mostly westerns and mystery novels. She also watches some TV.
“I like Hallmark, 'cause when you watch Hallmark you don’t have to think,” said McGrath, who finds the news depressing, and misses her family.
While the pandemic has caused people around the globe to experience isolation, depression and ennui, life at long-term care facilities has been particularly bleak. Strict and lengthy lockdowns were mandated within these communal settings, which are particularly vulnerable to coronavirus outbreaks. More than half of the COVID deaths in Pennsylvania have been among long-term care residents, the vast majority of whom are elderly or medically fragile.
As a result, long-term care facilities were prioritized for vaccinations, and at this point the Pennsylvania Department of Health reports that 95% of them have held at least one vaccine clinic, or have a plan to hold these clinics.
Though both McGrath and her husband are fully vaccinated, she said her life hasn’t changed much.
“We’re still in lockdown. We still have our trays delivered to our apartments," she said. "We can go out in the hallway, but we have to have our masks on.”
These precautions remain in place despite new federal guidance saying that fully vaccinated people, can enjoy a greater level of freedom.
“Not everybody in here is vaccinated,” said McGrath.
In fact, a couple of weeks after Westminster opened up in a limited capacity to visitors, someone tested positive for the virus. So, in accordance with state guidelines, indoor guests were banned for 14 days.
New guidance from the Centers for Medicare and Medicaid Services might soon change some of these rules, especially when it comes to indoor visits. But unvaccinated staff and residents remain an issue for many personal care, nursing and assisted living homes.
“That’s what keeps me up at night,” said Dr. David Nace, president of the Society for Post-Acute and Long-Term Care Medicine. “With each week passing, the number of residents coming into long-term care is going up. We need to have a system in place that works efficiently to vaccinate them. And we don’t have that right now.”
And getting a resident to a pharmacy or clinic for a vaccination can be logistically challenging.
“When you have individuals in long-term care, especially in the skilled nursing side of things, who are debilitated and putting somebody in an ambulance, that’s not an optimal solution,” said Nace, who is also chief medical officer for UPMC’s 30 senior communities.
In Pennsylvania, the one-shot Johnson & Johnson vaccine doses are reserved for educators, meaning that the two-dose vaccines are currently the only options for long-term care residents.
Vaccine hesitancy also plays a role, as there are many residents and even more staff who have chosen not to get vaccinated. The state doesn’t track long-term care vaccination rates, so it’s up to these mostly private facilities to decide whether to disclose this information.
A February survey from the Centers for Disease Control and Prevention found that of 11,460 skilled-nursing facilities that have received at least one vaccine clinic, a median of 77.8% of residents and just 37.5% of staff had been received the vaccine.
Researchers said that, “side effects … high staff member turnover, staff members working in multiple facilities, and limited resources for staff member outreach and education” were all potential barriers to vaccination.
The survey’s rates fall short of what experts estimate are needed to achieve herd immunity. But another hurdle that keeps residents from returning to normal life is what goes on outside facilities.
“Community spread equals a greater likelihood of spread in long-term care. So, one of the things we’ve called on the Wolf Administration and the legislature is we need to set up mass vaccination clinics, community vaccination clinics,” said Zach Shamberg, president of the Pennsylvania Health Care Association.
The Wolf Administration has consistently said that the limited vaccine supply is the main obstacle with the speed of vaccinations. Still, when it comes to the percent of a state’s population that has been vaccinated, Pennsylvania ranks in the bottom half.
“We've got to get these processes sped up so that we can ensure we decrease community spread, we increase the likelihood of a better tomorrow for our friends in long term care,” Shamberg said.
But there’s reason for hope.
Analysis from the health policy nonprofit Kaiser Family Foundation found a drop in both new cases and fatalities among nursing homes residents — and that this decline coincided with the start of vaccine administration at such facilities.
Perhaps sometime this summer, after more people have been vaccinated, Jan McGrath will be able to gather with her 8 children, 26 grandchildren and 13 great-grandchildren.
“Seeing them would be the greatest thing,” she said.
Until then McGrath will make do with Zoom calls and mystery novels.