Residents of independent-living care facilities left out in cold by federal on-site vaccination program


Misleading information from the federal government has disrupted and delayed COVID-19 vaccinations for hundreds of thousands of vulnerable seniors nationwide, according to providers of housing for seniors.

After the Trump administration announced in October that a partnership with major pharmacies would deliver on-site vaccinations to residents in long-term-care facilities, communications from the U.S. Department of Health and Human Services said the program would be open to independent-living facilities, which typically provide meals, housekeeping, transportation and other services, as well as assisted-living and skilled-nursing facilities, which provide higher levels of care.

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Caught off-guard, facility staffs are left struggling to book off-site vaccine appointments one resident at a time, prevailing upon local institutions for help setting up vaccine clinics and transporting residents to mass vaccination sites.

Many independent-living facilities enrolled in the program and waited two months or more for an opportunity to schedule their on-site vaccination clinics, only to learn in late December and January that they had been excluded from the program without notice or explanation, providers and industry groups say.

Caught off-guard by the switch, facility staffs are now spending weekends trying to book off-site vaccine appointments one resident at a time; pleading with local health departments, hospitals and fire departments for help conducting vaccine clinics; and transporting busloads of frail residents to arenas and other mass vaccination sites.

The long wait for on-site clinics that never materialized, followed by the scramble to secure vaccines through other means, has consumed precious months, while COVID outbreaks have continued to threaten the lives of independent-living residents and staff, providers say.

“Our biggest disappointment is that an entire group of the most vulnerable population got left out” of the program, says Karen Sheean, chief people officer at Holiday Retirement, which operates more than 250 independent-living communities with about 30,000 total residents. Residents who are not yet vaccinated are fearful, she says, knowing that they’re at the highest risk living in a congregate setting yet still blocked from the program.

Many independent-living staff members haven’t been able to get the vaccine, either, providers say, because they’re not considered healthcare workers.

The independent-living landscape

There are more than 800,000 independent-living units nationwide, industry groups say, roughly evenly split between free-standing communities and those that are components of campuses, such as continuing-care retirement communities (CCRCs), providing multiple levels of care.

While free-standing independent-living communities have been excluded from the federal pharmacy partnership program, CCRCs and residents of HUD Section 202 housing for the low-income elderly are eligible, according to the Centers for Disease Control and Prevention. Even so, independent-living residents within CCRCs have also in many cases been shut out of on-site vaccination clinics, providers say.

That “has been profoundly distressing and confusing for both the older adults and the staff of these communal-living residences,” LeadingAge, an association of nonprofit senior-care providers, said in a January letter to the CDC and administration officials.

Eligibility for the on-site vaccination program, known as the Pharmacy Partnership for Long-Term Care, “was designed to ensure the program serves those at highest risk of infection and severe illness from COVID-19 who need on-site vaccination services,” says CDC spokeswoman Kate Grusich. “Individuals living in independent-living retirement communities, however, are often highly active and can go offsite to get vaccinated, which is more efficient for vaccine delivery.”

Independent-living providers and industry groups say that’s a misperception. The average age of independent-living residents is 83, compared with 84 for nursing-home residents, and about 70% of independent-living residents have four or more chronic conditions, according to the consulting firm ATI Advisory. Many live with vision and hearing loss and impaired mobility and hire their own in-home caregivers, whose movement in and out of the buildings can further boost viral transmission risk, providers say.

Including independent-living residents in the pharmacy partnership program should have been “a no-brainer,” says David Schless, president of the American Seniors Housing Association. “I just don’t understand why this hasn’t happened.”

See: Want your loved one in a nursing home to get a COVID-19 vaccine? Ask these questions first.

‘I was never in a conversation where I heard about independent-living facilities being excluded.’

— Paul Mango, former deputy chief of staff for policy at the Department of Health and Human Services

When the on-site vaccination program was announced in October, independent-living providers say that their eligibility seemed certain. HHS communications about the program provided a link at which independent-living facilities could enroll in the program, and, in a late October question-and-answer session, HHS officials stated that both free-standing independent-living communities and those within CCRCs would be eligible, according to multiple industry groups that were represented on the call.

A moving target

Paul Mango, who was until January deputy chief of staff for policy at HHS and was involved in public communications about the program, says it was always his understanding that the program would cover the whole spectrum of senior living facilities. “I was never in a conversation where I heard about independent-living facilities being excluded,” he says.

Grusich, who has served in her public-affairs role at the CDC since 2017, says that the program eligibility criteria were finalized in early December and states were provided a list of ineligible facilities in their jurisdictions.

Independent-living providers say they didn’t get the message. Hawthorn Senior Living, which operates more than 60 U.S. independent-living communities, enrolled all of its facilities in the program in late October, says Adam Bryan, director of sales and marketing. By mid-January, he says, a handful of Hawthorn’s assisted-living facilities had been able to schedule vaccine clinics, but its independent-living facilities had generally heard nothing. Finally, in response to a query from Hawthorn, the CDC told the company in a Jan. 15 email that most of its facilities were ineligible. “We were alarmed,” Bryan says. “We immediately started trying to schedule clinics in any way possible.”

That has meant taking a busload of residents to Bojangles Coliseum, a Charlotte, N.C., mass vaccination site, and assembling a team of 18 staff members to spend a Saturday morning trying to book off-site vaccinations for 120 residents in California — an effort that yielded only two appointments, Bryan says. By mid-February, he says, Hawthorn had been able to secure vaccines for about two-thirds of its facilities, while in some of the remaining facilities the effort is advancing one resident at a time.

‘Doesn’t sound right to me’

Jan Busk, an 85-year-old who lives in a Hawthorn community in Vancouver, Wash., took the facility’s bus to a local clinic to get her first vaccine dose in late January. She was “a little bit shocked,” she says, to learn that she and her neighbors weren’t eligible for the federal pharmacy partnership program. “We’re all of a certain age,” she says. “It doesn’t sound right to me.”

The status of independent-living residents in CCRCs has been particularly murky, providers and industry groups say. These residents’ access to on-site vaccine clinics has varied depending on the region and the pharmacy conducting the clinic, says Ruth Katz, senior vice president of public policy and advocacy at LeadingAge. “What we ended up with is a patchwork quilt of epic proportions.”

Juniper Communities, which enrolled all its facilities in the pharmacy partnership with CVS Health Corp.
initially couldn’t get any clinic dates for one of its CCRCs, while another got a clinic date for the CCRC’s skilled-nursing residents but not for anyone else, says Lynne Katzmann, Juniper’s CEO. The company was ultimately able to arrange vaccines for independent-living residents through a local hospital and other sources, she says.

CVS spokesman Mike DeAngelis didn’t respond directly to questions about the company’s vaccination of CCRC residents but said the CDC has “made numerous adjustments in facility assignments and vaccine allocation, and we continue to work through vaccination clinics with each facility assigned to us on a case-by-case basis to meet their needs.”

Industry groups say the CDC should open the pharmacy partnership program to all residents, regardless of facility type. Although the program started months ago, “it’s not too late,” says James Balda, president and CEO of Argentum, which represents independent-living facilities and CCRCs as well as assisted-living and memory-care providers. “There’s still a chance for independent living to be included, and they should do it and do it quickly.”

The CDC says it’s not going to happen. “CDC is not enrolling any additional facilities in this program, which will wind down after the final round of on-site vaccination clinics are complete later this spring,” Grusich says.

The Biden White House did not respond to a request for comment about independent-living facilities’ exclusion from the vaccination program.

Under the Federal Retail Pharmacy Program, launched in mid-February, some retail pharmacies are receiving limited vaccine supplies aimed at priority groups. “As that program expands and supply becomes more readily available, residents in independent-living and senior retirement communities will have increased opportunities to get vaccinated on site,” Grusich says.

Now that many states have opened vaccine eligibility to everyone 65 or older, however, some in the independent-living industry say the stiffer competition for limited doses is putting their residents at further disadvantage. “It’s very frustrating,” Schless says. With so many independent-living facilities already struggling to secure vaccines for their residents, “a lot of us have wondered if this is going to make it even harder.”


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