Where days matter. Waiting for the vaccine at RI nursing homes, long term care

Photo: Alice, in her nursing home lobby, during the week when residents were allowed out of their rooms. Since the coronavirus began in March residents have been primarily confined to their rooms.

What is the process for nursing homes?

One woman in a nursing home has been watching the news. She’s picked out the outfit she’ll wear for the big day. For the day “Gina says we can get the shot”. That’s how one 94 year old described her excitement. She watches the news. She has seen the UPS and FedEx trucks on television delivering the vaccines. She watched the doctor at Rhode Island Hospital get the first one in Rhode Island. “That’s right. They need it before we do,” she says.

This is a generation that is used to being patient, to waiting, to live graciously with disappointments, and to not always have things go as they think they will. But you can’t deny the hope in her eyes. Since March, this 94 year old has been confined to her room, sitting on her bed, sometimes on her chair, watching television, eating her meals alone in her room. Waiting. “Yeah, it would be nice to get my hair done again. My nails. To just walk around…” The sparkle isn’t as bright as it was in the precious time she has lost from a fuller life, such as it was. To clap with the live music down in the main dining room. To nod a simple hello to fellow residents. To sit in the lobby and watch her world go by.

No vaccine for nursing homes – yet.

There was surprise and concern when nursing home and long term care residents were not included in this week’s celebratory vaccine arrivals. Especially after seeing the UK give their first to a nursing home resident. With hospital workers getting their vaccines this week, rumors were that nursing home residents would not get theirs until after Christmas and hopefully before the first of 2021.

It’s all about consent

The process still seems unclear, but it looks like one step not going smoothly is consent forms that have to be completed prior to vaccines being given. A variety of methods of obtaining consent have been mentioned by different sources we’ve contacted. Some say because this is a US emergency order, verbal permission is all that is needed. Others say a lengthy written consent form that has to be read (or read to) the resident and signed is required. Residents who are unable to give consent must have consent given by family members. Some sources have said that consent could be given by family via email.

Many nursing homes were still trying to get residents’ preapproval to be immunized, said Kathleen Heren, the Rhode Island’s long-term care ombudsman. Heren said, “We’re still working on how we’re going to get people vaccinated who do not have someone to sign for them, or for those with dementia.”

A drive-through consent signing for families

One Rhode Island nursing home has sent out text messages to family members – it reads:

“Attention all family members – this message applies to only the responsible party to those that have residents residing at (  ) that are NOT able to sign consent forms. COVID 19 vaccine intake and consent forms are now available and need to be completed as soon as possible. The first drive through consent signing will be tomorrow between 9:30am and 11:30am. You will be greeted by an associate at the main entrance to receive the form then may park and complete them. Please bring your own pens and wear a mask. A date for vaccinations is not available at this time. As we receive information we will relay it you. Thanks you for your prompt attention in this matter.

The consent form for CVS

While we have not had response from our request to CVS locally, but this consent form is being used in Washington, DC for CVS. There may be different forms used in different states. That is unclear.

Cheryl Phillips, MD, AGSF, President and CEO of SNP Allliance in Washington, DC, who provided the form being used in the DC area, said that “actual consent is not required under the Emergency Use Authorization, which makes the dense ‘consent form’ even more puzzling and problematic… I am still puzzled about all the diseases and conditions to check off – and whether or not they preclude vaccination”.

All they want for Christmas…

Shipments have been said to begin next week and are being made directly from Pfizer to CVS, and CVS takes over from there to the nursing homes who have contracted with them. We don’t know if that is every facility in the state, or how those not contracted will get the vaccine.

The logistical perfection of Pfizer to hospitals seems to have been flawless. Not so in the nursing home and long term care system, where there are still more questions than answers. But if it was to become complex at some point, this is where the flawless system will be challenged.

Alice says, “my outfit is right there… it’s ok.. it’ll get here when it gets here”.

Hopefully the system of providing the vaccine to the general public, through the pharmacy network, will return to a flawless logistical process.