Four months ago, even as the coronavirus vaccine was making its way to Connecticut and the promise of protection drew close to reality, nursing homes were weathering another increase in COVID-19 cases.
Testing inside the facilities was accelerating, special recovery centers for COVID-positive residents were taking on more patients, and illnesses among employees meant that many buildings were short-staffed. In December, 70 to 80 nursing home residents were dying per week. By the end of that month, more than 100 fatalities were recorded some weeks.
The outlook has improved since then. With more than 14,000 nursing home residents and more than 16,000 workers fully vaccinated, the state recorded just nine new cases and one new death during the final week of March.
But health officials know how quickly a single infection can trigger a large outbreak, and they have turned their attention to a small but significant population: unvaccinated, short-term nursing home residents.
A widespread vaccination effort took place in the state’s 209 nursing homes this past winter, but short-term residents – who make up about 25% to 30% of a facility’s population – come and go. As new, unvaccinated residents arrive at the homes, managers are trying to find ways to inoculate them.
“The population at nursing homes changes. Lots of stays are short-term,” said Adelita Orefice, senior adviser to the state’s public health commissioner. “We are working to make sure that every facility is matched to a long-term pharmacy vaccinator so we have confidence that each home has access and can get shots into arms.”
In the coming weeks, every nursing home will be paired with a pharmacy or other provider that can address the facility’s vaccination needs on an ongoing basis. The effort is part of a new program dubbed Operation Matchmaker.
Providers are responsible for immunizing new residents and staff, especially the revolving door of short-term residents, who typically stay for a month or less for rehabilitation services. Part of that strategy involves making the single-dose Johnson & Johnson vaccine available for these new residents.
At the same time, the state has sent a memo to administrators at Connecticut’s 27 acute care hospitals recommending that patients who are being discharged to nursing homes or assisted living facilities be vaccinated with the Johnson & Johnson shot before their departure.
Hospital administrators can request additional supply of the Johnson & Johnson vaccine for this group of patients.
“We have been in conversation with hospitals, and some of them are already implementing programs to vaccinate people headed to long-term care facilities,” said Dr. Vivian Leung, coordinator of the Healthcare Associated Infections Program at the state health department. “We have spoken to them about the need for this and our desire to get people vaccinated before they go to a long-term care facility.”
While nursing homes wait to be paired up with long-term vaccine providers, state officials have arranged a series of “catch-up” clinics – appointments for new residents and staff, along with anyone who missed an opportunity when CVS and Walgreens visited the facilities from December to March. Three providers are shuttling around Connecticut to deliver shots at the “catch-up” clinics – Griffin Hospital, Hartford HealthCare and Nutmeg Pharmacy.
Anyone who received a first dose of the Pfizer or Moderna vaccine during the CVS and Walgreens visits can also get their second shot at the “catch-up” clinics. The single-shot Johnson & Johnson vaccine is being offered to everyone else. National Guard teams are being deployed to help immunize people at these special clinics.
At the Beechwood Post-Acute & Transitional Care Center in New London, five new residents were inoculated during a “catch-up” clinic on Friday. Three staff members who initially had held off also received a vaccine.
“It’s a relief,” said Bill White, whose family owns the facility. “A few staff members had said, ‘I didn’t get it then, but I’d like to get it now.’ And then we have residents who weren’t here before – we didn’t have an option for them. So the catch-up clinic is a nice benefit.”
White said the long-term provider partnership is needed to keep vaccination rates high in nursing homes. His facility has a 94% participation rate among residents and 75% among staff, but those percentages could change as short-term residents rotate through and new staff come on board.
In the meantime, many buildings have procedures in place to isolate new, unvaccinated residents to ensure they are negative for COVID-19.
“This is our most critical need,” White said. “Absent that, it continues to be a bit of a crapshoot. If we really want to have stability, keep people safe and keep our businesses moving forward and growing again, we need to be able to rely on that.”
Testing remains a priority
Regular testing of nursing home staff and residents began in May and has remained a priority since. Even as the number of vaccinated workers and residents keeps climbing, state officials said they are not yet relaxing a requirement that staff members be tested once a week.
Residents are tested weekly if there is an outbreak in the facility. An outbreak is defined as a single staff case where the employee spent any part of his or her infectious period inside a nursing home, or a resident case that originated at a facility.
“There’s so much at play right now,” Leung said. “There’s the ever-changing vaccination rates, which we’re watching very closely. … We want to get to a place where we’re comfortable with community transmission rates, which are increasing in Connecticut.”
“We also want to get a better handle on the potential impact of more transmissible variants, such as the B.1.1.7 U.K. variant, which is circulating in high numbers,” she added. “So we’re going to continue weekly staff testing for the near future.”
The state, which pays for universal testing in nursing homes, was supposed to support the effort through the end of March. That funding has been extended through April 30.
Facility operators praised the decision. Timothy Brown, a spokesman for Athena Health Care Systems, which owns 24 nursing homes in Connecticut, said the broad testing still turns up a few positive results, allowing facilities to isolate infected residents and staff.
“Between staff, who may be asymptomatic, and visitors, who are now coming back into the buildings … we definitely think testing is still one of the vital keys in stopping COVID from getting into nursing homes,” he said.
Leung said the state will continue to reevaluate whether the frequent testing is needed.
“We are following all potential ways that long-term care facility residents could get sick, and we’re always looking for the holes and ways to plug them up,” she said. “We’re also looking for ways to return life to normal – [including] whether we can dial down some of the testing, which we know can be annoying for staff.”
