AARP: Making Seniors a Priority in Getting COVID-19 Vaccines

Published in Pawtucket Times on January 11, 2021

Last month, a statement the Rhode Island Department of Health (RIDOH) announced recommendations from the Rhode Island COVID-19 Vaccine Subcommittee for hospitals that vaccinations would begin for frontline hospital workers against COVID-19. This recommendation was made at an emergency meeting of the Subcommittee. RIDOH has accepted this recommendation and has communicated to hospitals that they may begin vaccinating these workers, as soon as vaccine arrives.

Two doses will be needed for someone to be fully immunized. Second doses will start arriving in Rhode Island in roughly three weeks. Rhode Island expects to receive approximately 10,000 doses of Pfizer vaccine the first week it is available, and approximately 19,000 doses of Moderna vaccine the first week it is available. Vaccine will come to Rhode Island in weekly allotments over the coming months, says RIDOH.

Epidemiologists, primary care providers, pharmacists, pediatricians, long-term care advocates, ethicists, nonprofit leaders, school leaders, faith leaders serve on Rhode Island’s COVID-19 Vaccine Subcommittee.  This group is responsible for performing an independent review of the process for evaluating the safety and efficacy of the vaccine. The Subcommittee is advising RIDOH on how to prioritize distribution of the vaccine to ensure that it is done equitably, and in a way that best protects the State as a whole.

At press time, the U.S. Food and Drug Administration (FDA) has granted an Emergency Use Authorization for a COVID-19 vaccine developed by Pfizer, and a vaccine made Moderna.

Making COVID-19 Vaccine Available Throughout the Ocean State

“After a rigorous scientific review, we know that COVID-19 vaccine is safe. We also know that it is one of the most effective vaccines ever developed,” announced Director of Health Nicole Alexander-Scott, MD, MPH in the Dec. 14 statement. “In the coming weeks and months, as vaccine becomes more available, getting vaccinated will be one of the most powerful things you can do to keep yourself and the people you love safe from COVID-19. We are going to work to ensure that every person in every community in Rhode Island has access to the vaccine, especially those communities hardest hit by this virus,” she said.

Added, Philip Chan, MD, MS, Consultant Medical Director for RIDOH’s Division of Preparedness, Response, Infectious Disease, and Emergency Medical Services, “We have never had a vaccine that has been – or will be – more closely monitored than the COVID-19 vaccine.”

“Teams of scientists at the national level have been scrutinizing thousands of pages of technical data for weeks, focusing on vaccine effectiveness, safety, and the manufacturing process, and our own local review has happened here in Rhode Island. I absolutely plan on getting vaccinated when it is my turn.,” said Chan.

According to RIDOH, the national vaccine trials for the COVID-19 vaccine involved tens of thousands of people to make sure they meet safety standards and people of different ages, races, and ethnicities. There were no serious safety concerns. (When vaccinated against COVID-19, people do sometimes develop post-vaccination symptoms such as soreness at the spot of the shot and headaches. This is normal, healthy, and expected. It means your immune system is working to develop protection.) Several systems are in place to do ongoing safety monitoring of the vaccine.

As of January 8, the last update on RIDOH’s COVID-19 Data Tracker, out of the 31,541 does administered, 29,743 have been vaccinated with their first of two doses, only 1,798 people were fully vaccinated with two doses.

Don’t look for the roll out of COVID-19 to take days or weeks, it will take months to complete, warns RIDOH officials. Phase 1 of the vaccination program is expected to run through late March.  At press time, the state is currently working its way through the top three tiers of this phase, including hospital staff, healthcare workers, EMS personnel, home health and hospice workers, nursing home staff and residents, high-risk incarcerated persons, first responders, school nurses, and even hard-hit communities.

Finally, those in the final two tiers of Phase 1 to be vaccinated include outpatient providers (Dentists, primary care), Dialysis Center workers and death care professionals, expected to begin Jan. 25, and adults over 75 years of age, expected to start by February.

Phase 2 is expected to kick-in by late March.  A number of factors are being considered to target the distribution of COVID-19 vaccinations a person’s age, high-risk conditions, occupation and geography.  

Make Older Rhode Islanders a Priority in Receiving Vaccines

AARP Rhode Island, representing 132,000 older Rhode Islanders, calls for Governor Gina Raimondo to make the state’s seniors a priority in its time-line for on distributing COVID-19 vaccines.  The Jan. 8 correspondence, cosigned by Kathleen Connell, State Director of AARP Rhode Island and Phil Zarlengo, the group’s State President, called on Raimondo “to increase COVID vaccination transparency,” as it relates to older Rhode Islanders.

AARP Rhode Island asked the Governor to include the numbers of Rhode Islanders vaccinated by age and other criteria on a daily/weekly basis on RIDOH’s COVID-19 Data Tracker.  Specially, the largest state-wide advocacy group called for the state’s website to include:

·         the numbers and percentages of older Rhode Islanders by race and ethnicity, that have been vaccinated:

·         the number of Rhode Islanders vaccinated and their age demographics on a daily/weekly basis;

·         a clear and easy-to-understand schedule of vaccine administration for all populations; and the process by which individuals may seek and obtain a vaccine;

·          the numbers and percentages of long-term care residents, by facility, that have received their first and second doses of vaccines;

·         the numbers and percentages of long-term care staff, by facility, that have received their first and second doses of vaccines.

While acknowledging the many challenges the state officials must tackle in determining how to equitably, safely and effectively distribute COVID-19 vaccines, Connell and Zarlengo call for Rhode Islanders age 50 and older to be made a priority in receiving a vaccine.

“The data clearly show that the older people are, the higher risk they face if they contract COVID-19.  Given that older individuals are at a greater risk of death from COVID-19, we strongly urge you to ensure that Rhode Islanders age 50 and older are prioritized to receive a vaccine.  These individuals must be given priority access to vaccines, in addition to those individuals receiving care in nursing homes and other long-term care facilities,” say Connell and  Zarlengo.

“For years, the long-term care system has been shifting away from institutional care in nursing homes to home and community-based settings (HCBS). Here in Rhode Island, a significant percentage of long-term services and supports are provided in the home or settings such as assisted living facilities, residential care facilities, veterans homes, and in individuals’ own homes,” says Connell and Zarlengo, stressing that this why the state should prioritize seniors, especially those with underlying conditions, receiving care in these additional settings and the staff providing care, to receive a COVID-19 vaccine.

Finally, AARP Rhode Island’s correspondence urges the Governor to ensure that all providers are fully complying with established state procedures for vaccine distribution and prioritization. “We urge you to investigate and take swift action against anyone who attempts to commit fraud, including by inappropriately selling the vaccine or intentionally providing vaccines to those who do not meet qualifying criteria in an attempt to circumvent the distribution process.”

From AARP’s National

 “We urge public health officials at the state and local level, as they decide on vaccine allocations, to rely on the evidence and make plans backed by science.  As production is ramping up, AARP is advocating hard to ensure every older American who wants to get the vaccine can get it.  It’s also vital that distribution plans for authorized vaccines are smoothly implemented.  There’s no time to waste: it’s time for full-scale mobilization, and any delays or early bottlenecks in distribution systems need to be addressed urgently,” says AARP Executive Vice President and Chief Advocacy & Engagement Officer Nancy A. LeaMond in a Dec. 28 statement.  

 

AARP’s new COVID-19 Dashboard for national/local Nursing Home Data

Published in RINewsToday.com on October 26, 2020

While public health experts are predicting a second spike of the COVID-19 virus, expecting it to hit the nation as early as – now – and reaching its peak in December, AARP releases its Nursing Home COVID-19 Dashboard created to provide four-week snapshots detailing the infiltration of the virus into the nation’s nursing homes and its impact on residents and staff.  AARP’s latest Public Policy Institute analysis is the result of the Washington, DC-based aging advocacy group’s successful efforts to push for the public reporting of nursing home COVID-19 cases and deaths.

Using data collected by the Centers for Medicare & Medicaid Services—which is self-reported by nursing homes—the AARP Public Policy Institute, in collaboration with the Scripps Gerontology Center at Miami University in Ohio, created the AARP Nursing Home COVID-19 Dashboard to provide four-week snapshots of the virus’ infiltration into nursing homes and impact on nursing home residents and staff. The first release of the dashboard on October 14 reveals that nursing homes in every state reported shortages of PPE, ranging from 8 percent of facilities in the best-performing states, to 60 percent in the lowest-performing state. The dashboard also compared state and national data on COVID-19 cases and deaths, staff cases and staffing shortages.

Key Findings of AARP’s First Dashboard

The AARP Public Policy Institute will analyze data and report on key findings as the dashboard is updated over time.  Here are some observations about AARP’s first Dashboard (using data from August 24 to September 20, in which 95 percent of the nation’s 15,366 nursing homes submitted data for this time period):

According to the database, in every state, nursing homes indicated a shortage of PPE (defined as not having a one-week supply of N95 masks, surgical masks, gowns, gloves and eye protection during the previous four weeks). Nationally, about one quarter (25.5 percent) of nursing homes had a PPE shortage during the Aug. 24 to Sept. 20 reporting period. In the highest performing state, 8 percent of nursing homes had a PPE shortage; in the lowest-performing state, 60 percent did not have a one-week supply.

The researchers note that while considerable attention has been paid to infections among nursing home residents, it is also critically important to consider direct-care staff. In the four weeks ending Sept. 20, one-quarter (24 percent) of nursing homes had at least one confirmed COVID-19 case among residents, and twice as many (50 percent) had at least one confirmed staff case. Per 100 nursing home residents, there were 2.6 COVID-19 resident cases and 2.5 staff cases, corresponding to a total of about 55,000 cases nationally.

Finally, there is considerable variation across states. COVID-19 deaths in the four weeks ending Sept. 20 averaged 0.5 per 100 residents across the nation (about 1 out of every 200 residents). At the state level, the death rate was as high as 1.2 per 100 residents (about 1 out of 80), and several states reported no resident deaths in the past month.

Looking at Rhode Island, AARP’s first dashboard detailed the following: 

·         2.2 COVID cases per 100 residents

·         0.2 COVID deaths per 100 residents

·         1.7 staff cases per 100 residents

·         19.7 percent of nursing homes without a 1-week supply of PPE

·         28.9 percent of nursing homes with staffing shortages

AARP’s dashboard will be updated every four weeks to track trends over time and will evolve to include more categories to follow other measures of interest.

As Others See It – in Rhode Island

“We have been very clear in our messaging: No state has done a good enough job to protect nursing home residents and staff,” said AARP Rhode Island State Director Kathleen Connell. “That said, it is good to see that in the first round of data postings on the AARP Nursing Home COVID Dashboard shows Rhode Island in better-than average shape compared to other states. But to our point, anyone in Rhode Island with a loved one in a nursing home expects – hopes and prays – for more than ‘better than average.”

“As we see daily reports of increased cases and deaths, safety concerns for nursing home residents and staff should be increasing as well. The pandemic is far from over and among many complicated aspects of dealing with it is transparency. The COVD Dashboard provides the public with a benchmark and tracks monthly changes; people need to pay attention and demand action at all levels to make nursing homes safer. These aren’t just numbers. These are lives,” says Connell.

On the other hand, the Rhode Island Department of Health questions the accuracy of AARP Nursing Home COVID-19 Dashboard as it relates to its Rhode Island findings. “The data don’t accurately reflect the Rhode Island reality in part because of how the questions are phrased,” says Joseph Wendelken, RIDOH’s Public Information Officer, specifically related to PPE data. “The question asks about PPE in the nursing homes. Nursing homes receive a weekly supply of PPE from their corporate warehouses. The question asks about one point in time. On occasion, reporting happens shortly before facilities receive their re-supply,” he says.

“RIDOH has taken several steps to protect nursing home residents, says Wendelken, noting that his department has built Congregate Setting Support Teams to conduct targeted to facilities regarding infection control, PPE, testing, and staffing. 

“We have weekly contact with facilities. We’ve worked with facilities to develop creative plans for reopening. We have implemented regular testing of staff every 10 to 14 days. We will take the lessons and experience we’ve gained from these past seven months and apply them to the increase in cases we see today,” adds Wendelken. 

According to Scott Fraser, President/CEO, of the Rhode Island Health Care Association (RIHCA), the AARP analysis shows what his organization has been saying in the last few weeks and months—that COVID-19 cases in nursing homes continue to drop. “Rhode Island is below the national average in all categories measured for this dashboard,” he says, stressing that the number of cases in nursing homes is dropping as is the number of deaths,” notes Fraser.  

The successful efforts to protect nursing home residents and staff can be directly linked to the measures the facilities have taken since the pandemic first hit, notes Fraser. “We are stocking up on PPE. We initially suspended visitation.  We are testing staff regularly and residents when necessary.  We are carefully monitoring visitors and vendors who come into our homes.  We isolate and quarantine anyone who tests positive or any new resident who moves into our facilities,” he says. 

Fraser says that RIHCA continues to advocate for regular testing of vendors who come into the state’s nursing homes, including ambulance drivers, lab technicians, and hospice workers.  RIHCA continues to call on RIDOH to renew the policy of having two negative tests before a hospital patient can be released to a nursing home and to allow those certified nursing assistants who received temporary emergency certifications to obtain their permanent licenses.

A Call to Action

More than 84,000 residents and staff of nursing homes and other long-term care facilities have died from COVID-19, representing 40 percent of all coronavirus fatalities in the U.S., according to Kaiser Family Foundation’s most recent analysis released on Oct. 8. Yet in its statement announcing the release of its Dashboard, AARP charges that federal policymakers have been slow to respond to this crisis, and no state has done a good enough job to stem the loss of life. 

According to AARP, policymakers have taken some action, such as requiring nursing homes to self-report COVID-19 casers and deaths at the federal level, ordering testing, and providing limited PPE and other resources to nursing homes. But more must be done, says the nation’s largest aging advocacy group in its statement urging elected officials “to acknowledge and take action to resolve this national tragedy — and to ensure that public funds provided to nursing homes and other long-term care facilities are used for testing, PPE, staffing, virtual visits and for the health and safety of residents.”

COVID-19 cases across the U.S. are again on the rise, and nursing homes remain a hotbed for the virus, says AARP promising to “continue to shine a light on what’s happening in nursing homes so that families have the information they need to make decisions, and lawmakers can be held accountable.”

AARP has called for the enactment of the following five-point plan to protect nursing home and long-term care facility residents — and save lives — at the federal and state levels:

·         Prioritize regular and ongoing testing and adequate personal protective equipment (PPE) for residents and staff — as well as inspectors and any visitors.

·         Improve transparency focused on daily, public reporting of cases and deaths in facilities; communication with families about discharges and transfers; and accountability for state and federal funding that goes to facilities.

·         Require access to facilitated virtual visitation, and establish timelines, milestones and accountability for facilities to provide in-person visitation.

·         Ensure quality care for residents through adequate staffing, oversight and access to in-person formal advocates, called long-term care ombudsmen.

·         Reject immunity for long-term care facilities related to COVID-19.

To see AARP Nursing Home COVID 19 Dashboard, go to:

www.aarp.org/content/dam/aarp/ppi/pdf/2020/10/rhodeisland-nursing-home-dashboard-october-2020-aarp.pdf

Bill Protects Nursing Home Residents, Providers

Published in the Pawtucket Times on June 1, 2020

This month, U.S. Senator Bob Casey (D-PA) and Senator Sheldon Whitehouse (D-RI) throw a bill in the legislative hopper to slow the spread of novel coronavirus (COVID-19) in nursing homes. It’s a common-sense legislative proposal and needed.

A recently released Kaiser Family Foundation study reported, “COVID-19 has had a disproportionate effect on people who reside or work in long-term care facilities, including the 1.3 million individuals in nursing homes; 800,000 in assisted living facilities; 75,000 in intermediate care facilities; and 3 million people who work in skilled nursing or residential care facilities.”

Combatting COVID-19 in Congregate Settings

With COVID-19 quickly spreading throughout the nation’s nursing homes and intermediate care facilities, Casey and Whitehouse’s legislative proposal, S. 3768, The Nursing Home COVID-19 Protection and Prevention Act, seeks to provide needed resources to facilities to protect frail residents and staff. Residents in these facilities are among the most vulnerable because of their age and underlying medical conditions. According to an analysis conducted by Gregg Girvan for the Foundation for Research on Equal Opportunity, as of May 22, in the 39 states that currently report such figures, 43 percent of all COVID-19 deaths have taken place in nursing homes and assisted living facilities

As more than 20,000 nursing homes residents and workers have died due to COVID-19, according to the latest reports, on May 19, 2020, Casey and Whitehouse introduced S.3768 to help states, nursing homes and intermediate care facilities put the brakes on the spreading of the deadly COVID-19. The legislative proposal, with 14 Democratic cosponsors (including Rhode Island Senator Jack Reed}, would help states implement strategies to reduce the spread of COVID-19 in congregate settings, including through the purchase of personal protective equipment (PPE) and testing and to support nursing home workers with premium pay, overtime and other essential benefits.

S. 3768 was referred to Senate Health, Education, Labor, and Pensions. As of March 30, 2020, a Congressional Budget Office cost estimate or this measure has not been received.

Days after the introduction of 25-page Senate legislative proposal, a House version (H.R. 6972) was introduced by Rep. Ana G. Eshoo (D-CA), cosponsored by Reps. Janice D. Schakowsky (D-IL), Donna E. Shalala (D-FL), Madeleine Dean (D-PA), Seth Moulton (D-MA) and David N. Cicilline (D-RI). The House bill was referred to House Energy and Commerce

“This virus spares no state, no county, no facility. The unprecedented crisis unfolding in our Nation’s nursing homes demands an immediate, extraordinary response. Reports indicate nursing home residents and workers account for roughly 1 in 4 deaths from COVID-19 in the United States,” said Casey, who serves as Ranking Member of the U.S Senate Special Committee on Aging, in a statement announcing the bill’s introduction. “The Nursing Home COVID-19 Protection and Prevention Act would provide $20 billion in emergency funding [for staffing, testing, Personal Protective Equipment, etc.] to devise a sorely needed national, coordinated response to stem the spread of this terrible virus in nursing homes and intermediate care facilities,” notes Casey.

According to Casey, the Senate bill would also require the U.S. Department of Health and Human Services (HHS) to develop guidance on cohorting best practices, including on how to safeguard resident rights. It would also instruct HHS to collect and publish data on COVID-19 cases and deaths in nursing homes and intermediate care facilities, and finally fund surge teams of nurses, aides, and other critical staff to fill in at facilities where multiple residents and staff members have been infected.

“COVID-19 poses an immediate threat to the more than 1.3 million Americans, including more than 7,000 Rhode Islanders, who live in nursing homes,” says Whitehouse, noting that frontline staff across the nation are “doing heroic work under very challenging circumstances.”

“We need to get vastly more personal protective equipment and tests to nursing homes, which care for the patients who are most vulnerable to the coronavirus. Our legislation would also help states fund surge teams, sending additional staff reinforcements to facilities where they are needed to care for patients and prevent infection,” adds Whitehouse.

Before S. 3768 was officially introduced, in early March, Washington, DC-based AARP announced its support for the Senate proposal. “AARP supports the draft of the Nursing Home COVID-19 Protection and Prevention Act that would help protect the health and save the lives of people in nursing homes and other facilities by supporting testing, personal protective equipment, staffing and more,” said Megan O’Reilly, Vice President of Government Affairs for AARP. “The proposal would also improve public transparency and help protect the rights of residents and their families, adds O’Reilly, calling on Congress “to act immediately to stem the loss of life and slow the spread of the virus.”

In the House Chamber, Rhode Island’s Cicilline, a member of the House Democratic Leadership as Chair of the Democratic Policy and Communications Committee, has also pushed for Congressional funding to stop the spread of COVID-19 in nursing homes. The fifth term Congressman has called for additional funding for the Public Health and Social Services Emergency Fund in the next package for congregate care facilities, including nursing homes. He also signed a letter to HHS Secretary Azar and Administrator Verma, of the Centers for Medicare and Medicaid Services (CMS), urging that HHS and the CMS to ensure that a significant portion of the newly allocated $25 billion for testing in the recently passed CARES Act be utilized for testing in nursing homes and other congregate living facilities.

State-wide Efforts to Combat COVID-19 in Nursing Homes

With Governor Gina Raimondo declaring a state of emergency on March 9, 2020, with the COVID-19 arriving in Rhode Island, the deadly pandemic virus spread quickly throughout the state’s nursing homes. At press time, it has been reported that 75 percent of all related COVID-19 deaths are in nursing homes.

According to Joseph Wendelken, Public Information’s Officer for the Rhode Island Department of Health (RIDOH), the state moved quickly to stop the spread of the COVID-19 virus in the community and in nursing homes. He stated: “We curtailed and then prohibited visiting early on, and we have been doing extensive testing in every assisted living facility in the state. We are doing cyclical testing, meaning that we are continually testing all residents in all homes on a rotating basis. We are giving tailored infection control guidance to specific homes, and we are helping them procure additional PPE.”

Adds Wendelken, RIDOH has established two COVID-19 Specialty Nursing Homes [at Oak Hill Center in Pawtucket and Oakland Grove Health Care Center in Woonsocket] to be a COVID-19 Specialty Nursing Home. “These are centralized facilities to accept patients who are being discharged from the hospital and who are COVID-19 positive but no longer require acute-level care. This strategy allows COVID-19 positive patients leaving the hospital to receive specialized rehabilitation and step-down, post-acute care while reserving hospital beds for patients who need acute-level care,” he said.

On Smith Hill, the Rhode Island House Republican Caucus has recently called for members of the House Committee on Oversight to meet to address the increasing COVID-19 death rate in the state’s nursing and assisted living facilities.

Putting Politics Aside…

With less than 156 days until the upcoming 2020 Presidential election, will S. 3768 reach the Senate floor for a vote. Since the beginning of 2019, more than 350 House-passed bills—including hundreds that have bipartisan support—have been buried by Senate Majority Leader Mitch McConnell (R-Kentucky) in his legislative graveyard. With no Republican Senators supporting Casey and Whitehouse’s COVID-19 bill, will it even reach the Senate floor for a vote?

It’s time for McConnell, who has called himself the “grim reaper” of Democratic legislation, to lay down his deadly scythe, making the safety of millions of residents who reside in the nation’s 15,583 skilled nursing facilities a legislative priority. The GOP Senator from Kentucky, who is in a close Senate race with Democratic opponent Amy McGrath, might consider putting politics aside during a raging COVID-19 pandemic sweeping across the nation to work with Senate Democrats to protect frail residents and nursing home staff. Kentucky voters might view protecting residents against COVID a bipartisan issue.