You think she should be vaccinated, hearing that the vaccine is effective in developing an immune response in older adults. Your brother disagrees. He is concerned that the vaccine was developed and does not want your mother to be among the first.
“This is a very political environment, not only in terms of vaccines, but also in terms of the existence of the virus,” said Michael Dark, a California attorney for nursing home reform. “It’s not hard to imagine the conflicts that arise in families.”
About 3 million people – most of them elderly – live in nursing homes, support centers and group homes, where more than 105,000 residents have died as a result of Covid-19. U.S. Department of Disease Control and Prevention According to the recommendations of the centers and various state schemes, they should be among the first Americans to receive the vaccine.
But the participation of long-term care residents in the fastest and most comprehensive vaccination efforts in U.S. history is shrouded in significant confusion: more than half have cognitive impairment or dementia.
This raises a number of questions. Will all adults in long-term care be able to understand the details of the vaccine and consent to receive it? If personal consent is not possible, how will families and surrogate decision makers receive the information they need in a timely manner?
And what if the surrogates do not agree by trying to interfere with the decision made by an older person?
“Imagine that a patient who has some degree of cognitive impairment says ‘yes’ to the vaccine but the surrogate says ‘no’ and says to the nursing home, ‘How dare you do this?’ Professor of Law and Bioethics at Alta Charo, University of Wisconsin-Madison Law School.
Considering these issues will come against the background of urgency. Deaths at long-term care facilities are rising dramatically, with new estimates showing 19 COSID-19 residents die every hour. With a viral outbreak, already overwhelmed employees won’t have much time to sit down with residents to answer questions or talk to family on the phone.
Meanwhile, companies running vaccination programs at CVS and Vagrains, most long-term care facilities, have aggressive schedules. Both companies have said that a large-scale rollout of the Pfizer and Bintech vaccines – the first given by the Food and Drug Administration – will begin on December 21. But in some states facilities may be supplied earlier. Together, the U.S. There are more than 15,000 nursing homes and about 29,000 aided residences
At a meeting of the Federal Advisory Committee on Immunization Practice earlier this month, the director of the CDC’s National Center for Immunization and Respiratory Diseases, Dr. Nancy Masonier acknowledged that the agency was “very concerned” that information about the vaccine could no longer be adequately explained. Word care residents.
“It’s very important for frail seniors to make sure they understand the vaccine they’re getting, but their family members do too,” he said.
Each vaccine manufacturer is required to prepare a factsheet to describe what is known about the benefits and risks associated with the vaccine, and to make it clear that a vaccine has received “emergency use authorization” from the FDA – a conditional endorsement short of full approval. Moderena’s second vaccine, following a meeting of the FDA on Thursday, is set to gain such power.
CDC expert Dr. According to Sara Oliver, there is something that residents need to be clear about: inesines The vaccine has been tested on people years of age or older, while these tests do not include individuals in long-term care.
Some operators have planned communications around vaccines and have begun intensive outreach. Others may not be well prepared.
Juniper Communities operates 22 senior housing communities (single nursing home, multiple memory care and supportive living facilities and two continuous care retirement communities) in Colorado, New Jersey and Pennsylvania. This week, he is planning an hour-long townhall video conferencing session for residents and families about the coronavirus vaccine. Last week, a similar event was held for those employees.
Juniper has an agreement with CVS, which requires each resident and staff member to fill out a consent form before all inoculations. When written consent cannot be obtained directly, verbal consent, independently confirmed, may substitute. Grains have similar requirements.
For residents with memory impairments, two juniper nurses, who have decision-making power, will be reached by phone. “One will ask questions and get verbal consent; the other will serve as a witness,” said Lynn Katzman, Juniper’s founder and chief executive officer. Separately, emails, blog posts and pre-defined voice messages about the vaccine have reached Juniper residents and staff since the end of November.
One key message is that “we’ve done this before, not on this basis, not at this level of imports, but the annual flu vaccine,” said Katzman, who plans to become the first juniper employee. The Pfizer vaccine when it comes to New Jersey.
At Genesis Healthcare, the crucial message is “these vaccines have been thoroughly studied, thousands of people have already received them, they are very effective, and no steps have been taken in the scientific process,” said Dr. Richard Pfeiffer. Was. , Executive Vice President and Chief Medical Officer. Origin, the country’s largest long-term care company, operates more than 3 nursing homes in 3 states and assists in the accommodation of approximately 1,000 employees and more than 20,000 residents in 6 states.
The medical directors of each Genesis facility have been scheduling video conferencing with families, residents and staff over the past few weeks to allay concerns. They have also distributed a letter and question-and-answer document prepared by the Society for Post-Acute and Long-Term Care Medicine, as well as information obtained through close-circuit TV channels and social media.
In partnership with researchers at Brown University, the company will monitor the side effects experienced by its long-term care residents after receiving the coronavirus vaccine. Most reactions are mild or moderate and are expected to resolve in a few days. These include fatigue, pain at the injection site, headache, body aches, fever and, rarely, allergic reactions.
Vaccines for all long-term care facilities will be administered in three visits. First, all residents and employees of Genesis will receive inoculation. Second, after three to four weeks, the same people will get a second dose, and new employees and residents will get the first dose. In third place, those who still qualify for the second vaccine dose will get one.
What if many people experience side effects of discomfort and employees do not come for a few days while receiving re-employees? “It’s a very difficult problem and we’re making contingency plans to overcome it,” Pfeiffer said.
And what about sustainable retirement communities – also known as “life plan communities” – where residents of skilled nursing, supportive livelihoods and independent livelihoods can live nearby?
That’s the case in Seattle’s Bayview, which houses 210 occupants in a 10-story building. For the moment, independent living residents are not on the priority list but “I know there will be a team of residents and staff who will not want to be vaccinated and we will see if we can use those vaccines for our independent lives.” “Joel Smith, Beau’s health services administrator.
Rational challenges are bound to arise, but many tors operators have a keen understanding of the mission. “It’s critical that we move in the direction of getting out of this crisis,” Fifer said of Genesis. “Nursing houses need to be the first to address vaccine shrinkage and succeed in achieving a high level of acceptance. There is no alternative right now, Plan B is not. We have to succeed.”
KHN (Kaiser Health News) is a non-profit news service covering health issues. It is an editorially independent program KFF (Kaiser Family Foundation) which is not affiliated with Kaiser Permanent.
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