Nursing home residents and staff account for nearly 40% of the United States’ COVID-19 deaths. That’s why they’re among the first Americans to receive a COVID-19 vaccine. WBFO’s Tom Dinki spoke with New York state nursing home residents, operators and advocates about vaccination, which began this week.
At least 21 residents of the Elderwood nursing home in Williamsville have tested positive for COVID-19 during the last six months, according to data from the U.S. Centers for Medicare and Medicaid.
Resident Eileen Folkerth is not one of them.
“I was pretty lucky, I guess,” the 83-year-old told WBFO via telephone.
But, like all residents, she can’t participate in activities outside her room, due to safety protocols.
“All you have is TV,” she said.
Folkerth may get back to a more engaging routine and what she called a “more pleasant life,” with the help of a COVID-19 vaccination. She could receive it as soon as this week.
“Maybe they’ll have a few activities here then,” she said.
Vaccines began arriving at nursing homes in New York and across the country on Monday. New York has approximately 80,000 doses of the Pfizer-produced vaccine set aside for nursing home residents and staff.
The state has opted into a federal distribution program, in which pharmacies like Walgreens and CVS will visit each of the state’s 618 nursing homes on three occasions to administer vaccines. Both the Pfizer and Moderna vaccines require two inoculations, either three or four weeks apart. The first inoculation of residents should be completed by the end of next week.
“A clinician I was speaking to, she said, ‘This is the light at the end of the tunnel.’ And it truly is the light at the end of the tunnel,” said Stephen Hanse, president and CEO of the New York State Health Facilities Association, a trade group representing four hundred nursing homes and assisted living facilities across the state.
By mid-March, all New York nursing home residents and staff who are willing to be vaccinated should be vaccinated, Hanse said.
It’s unclear how many nursing home residents and staff members are willing to be vaccinated. About 40% of Americans say they will not take the vaccine, according to a recent Pew Research poll. For Americans 65 and older, 25% say they will not take the vaccine.
However, Hanse said he’s optimistic the vast majority of nursing home residents and staff will accept the vaccine, adding that the majority of them accept the flu vaccine every year.
“We're working with the state of New York to really educate residents, staff and the public with regard to the efficacy of these vaccinations and the safety of these vaccinations,” he said. “So I think that'll go a long way.”
Still, nursing home residents have a right to refuse the COVID-19 vaccine, or any treatment, said Lindsay Heckler, an attorney with the Center for Elder Law and Justice, a Buffalo nonprofit legal agency for older adults.
“There may be additional restrictions placed on that individual who declines the treatment, but they do have the right to decline treatment,” Heckler added.
A spokesperson for the New York State Department of Health, which regulates the state’s nursing homes, did not respond to an inquiry about what restrictions will be placed on nursing home residents, as well as staff, who refuse the COVID-19 vaccine. In the past, nursing home staff have been required to wear personal protective equipment if they refuse the flu vaccine.
Even if a nursing home resident does want the vaccine, they must give informed consent, noted Richard Mollot, executive director of the Long Term Care Community Coalition, a New York City-based advocacy group for nursing home residents.
“The nursing home will say, ‘Oh, yes, we got consent,’ but there's no proof of that. And too often, in fact, when we speak to family members, they don't even know about the treatment that's being given,” he said. “Of course, we hope that the vaccine is safe, we hope that it's effective, but a significant part of that is making sure that the people are aware of what they're getting.”
Mollot is also concerned nursing homes are unprepared to deal with potential side effects from the vaccine, like fever and muscle aches.
“Unfortunately, too often in nursing homes ... there's not good professional oversight or even a professional environment to make sure that people are safe for the duration after receiving an injection like this,” he said. “It's not like a hospital, where you have registered nurses and doctors who are constantly around observing and who could address the situation quickly.”
However, that shouldn’t be too big of a concern, said Dr. Nancy Nielsen, senior associate dean for health policy at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences. People 65 and older actually reported fewer side effects than younger people during both the Pfizer and Moderna clinical trials.
“Now, who knows whether that's just because they're tougher and they've been through real problems in their lives,” Nielsen said. “Some people complain about some muscle aches, but the whole thing is over in a day. So I don't anticipate that that's going to be a problem in nursing homes.”
More than 7,300 New York nursing homes residents, including 680 in Western New York, have died of COVID-19 since the pandemic hit the U.S. in March, according to state Department of Health data. It’s unknown how many potentially thousands more died after being taken to a hospital, as state Health Commissioner Dr. Howard Zucker has refused to release the number.
For Mary Jane Meinzer, a 91-year-old resident of Schofield Residence nursing home in Kenmore, those statistics are more frightening than any vaccine side effect.
“It's scary,” she said, adding she was tested for COVID-19 earlier that morning and, despite feeling OK, was worried it would come back positive.
Meinzer said she hopes the vaccine brings her one step closer to regular visits from her children, which haven’t been allowed to happen since the pandemic began.
“I dream about them,” she said. “The other day, I fell asleep and I dreamed that I was cooking a spaghetti dinner for my whole family and they were all coming to dinner. Then I woke up.”
But regular visitation with no restriction could still be a long way off.
The general public is likely several months away from having the vaccine readily available to them. Plus, much of the state is in a yellow or orange COVID zone, which automatically prohibits nursing home visitation.
“I don't think [the vaccine’s] going to have a huge impact right now on the visitation piece because of the increase in the number of positive cases in facilities across Western New York,” said Randy Gerlach, president and CEO of Schofield Care, the group that operates Meinzer’s nursing home.
And while the vaccines prevent severe illness, it’s still unclear whether they prevent infection and transmission, so masks, social distancing and PPE will still be needed even once the majority of nursing home residents and staff are vaccinated.
Hanse, of the New York State Health Facilities Association, said he’s hopeful nursing homes could fully open for visitation sometime this summer. He said his group is also pushing the state to implement visitor restrictions on a facility-by-facility basis.
“We're going to continue to advocate and work in partnership with the state to implement visitation policies that are unique to each facility and recognize the uniqueness of the community those facilities are in and the localized prevalence of COVID in those communities, to really do our best to open our doors to family and loved ones,” he said.
That can’t come soon enough for Mollot, who said the visitation ban, as well as the lack of inspections and general oversight, has been “catastrophic” for residents.
“There is the rise of COVID, but more so, at least from what we're hearing, is just the persistence of people who are suffering and who are dying of loneliness, of neglect, not receiving even basic services — help with dining, with toileting,” he said. “People that are decreasing in their ability to talk and to engage. People who haven't gotten a haircut in nine months and are just depressed and dirty. That's not acceptable.”
Just because the pandemic in nursing homes is ending, advocates like Mollot say that doesn’t mean all of the issues in nursing homes are resolved. The pandemic simply exposed longstanding problems like infection control and short staffing, they say, and now is a chance to reconsider better oversight, as well as alternatives, like home-based care.
“[The pandemic] really exposed the rot in the system, frankly,” Mollot said. “We can't go back to where we were. We have to move forward in a way.”