Michigan's last-minute switch delayed COVID-19 vaccines for nursing home residents

From Michigan's biggest cities to its far rural areas, the state's most vulnerable populations in nursing homes and long-term care facilities are finally starting to get COVID-19 vaccines — with officials hoping to see declines in the number of cases and deaths soon after both doses of the vaccines are administered to residents and staff.

For many, that day can't come fast enough.

It brings the hope of hugging a parent, spouse, daughter, son or grandchild. It brings the anticipation of simply touching and holding a friend's hand.

More than 29,000 coronavirus cases have been reported among nursing home residents and staff, with 3,683 residents (more than 28% of the state's 12,918 deaths) and 34 staff dying so far in the pandemic.

A few facilities said they had a delay in getting shots into arms because the state switched from the Pfizer to the Moderna vaccine for its long-term care facilities, whose populations are being vaccinated through a federal pharmacy program.

More:Michigan working to fix lag in COVID-19 vaccine administration, officials say

The Michigan Department of Health and Human Services said the switch was made to "maximize the use of the doses of both vaccines being made available to Michigan. At the time of the decision, we understood that we would have more doses of Moderna vaccine available than Pfizer and, because of the nursing homes, we made this switch," spokeswoman Lynn Sutfin said.

She said the switch was made to more quickly meet federal pharmacy program requirements for beginning vaccinations and to inoculate as many long-term care residents as quickly as possible.

More:Visiting my mom through glass was supposed to be temporary. Now it feels endless.

"I think it was a very good decision to switch to the Moderna vaccine," said Melissa Samuel, president/CEO of Health Care Association of Michigan, because of the number of vaccines needed without delays for long-term care facilities.

There are more than 300,000 Michiganders living in nursing homes or other long-term care facilities who the state is working to vaccinate.

The Martha T. Berry Medical Care Facility in Mount Clemens initially was preparing to receive the Pfizer vaccine, which must be stored in ultra-cold freezers. Now, it needs to send out new information and get approvals from residents and physicians for the Moderna vaccine, Executive Director Kevin Evans said.

A vaccination clinic for residents and staff is set for Jan. 19, he said, with about half of the population — about 240 staff and residents — looking to get the first vaccines.

Manda Ayoub, chief operating officer at Pomeroy Living, said there was a delay in getting vaccines to residents and staff the week of Dec. 28, but shots started being administered this week and clinics are scheduled through February at its metro Detroit facilities.

Pomeroy Living's corporate team got their vaccines Wednesday live on Facebook, and Ayoub said it "looks like a lot of the residents want to participate" in the vaccine clinics.

More:Michigan ranks 7th worst in nation in administering COVID-19 vaccines

Sutfin said the state health department will transfer more than 300,000 first doses of vaccine to the federal pharmacy program over five weeks, through the week of Jan. 17. The doses go into a bank the federal program can pull from for distribution to CVS and Walgreens pharmacies as they hold clinics in long-term care facilities, she said.

She said 185,100 doses have been transferred. The number is based on estimates of staff and residents in long-term care facilities.

In Michigan, Sutfin said there are 417 skilled nursing facilities, where vaccinations started Dec. 28, and 4,903 additional eligible facilities in the federal program, such as assisted living, where inoculations began Monday.

Some facilities are not enrolled in the program, but residents and staff will be vaccinated through partnerships with local health departments.

Today, the Detroit Health Department will vaccinate residents and staff at Boulevard Manor, the only nursing home in Detroit without an existing vaccination plan, through a private provider, according to the city.

Sutfin said Wednesday that 8,006 vaccinations had been administered by the federal program in Michigan since it began a week ago.

However, CVS said, as of Tuesday, its pharmacists and pharmacy technicians have given 11,385 first doses of the vaccine to residents and staff at nursing homes as well as 470 vaccines in assisted living and other long-term care facilities.

More:CVS vaccinates 12,000 nursing home, assisted living residents for COVID-19 in Michigan

The company said it will be doing vaccinations in more than 1,000 skilled nursing and assisted living facilities in Michigan and could inoculate about 140,000 people statewide during a 12-week time frame, company spokesman Charlie Rice-Minoso said.

Sutfin said during the first week, 176 clinics were conducted statewide with 271 clinics planned by CVS and Walgreens this week. She said more than 1,100 first clinics have been scheduled by the two pharmacies.

"CVS and Walgreens corporate are deciding which individual CVS and Walgreens stores will be responsible for which facilities, and it is our understanding they have chosen to focus on larger facilities first," Sutfin said.

"We know these are the most vulnerable residents and it is incredibly important that they are vaccinated to protect them," she said.

Rural reach

In Luce, Mackinac, Alger and Schoolcraft counties in the Upper Peninsula, there are no CVS or Walgreens pharmacies covered by the state contract for the federal pharmacy program. However, the pharmacies will provide vaccines to nursing homes and other long-term care residents, said Kerry Ott, public information officer for the LMAS District Health Department, which covers the four counties.

She said some of the pharmacy representatives are coming from west of those counties in the Upper Peninsula or from upper Lower Michigan.

Ott said there are four main skilled nursing facilities, one in each of the four counties. She didn't know Wednesday how many facilities had been reached so far with vaccinations, but said some began last week.

She said local hospitals handled vaccinations at two adult foster care homes that were not included in the state list.

Ott said officials weren't worried about not getting vaccines at long-term care facilities, but "it did puzzle us a little bit since none of those pharmacies are in our counties."

Sutfin said CVS and Walgreens are committed to serving any facility within 75 miles of one of their stores.

Planning process

The vaccination process at nursing homes and other long-term care facilities is different than at hospitals and health systems. It involves many moving parts.

"With record-breaking cases in nursing homes right now due to soaring community spread, no one could wish for a swifter delivery of the vaccine than those living and working in long term care facilities," said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, which represents more than 14,000 nursing homes and assisted living communities in the U.S.

He and others in the industry said they knew the rollout would take time, but the plan was to start the program the last two weeks of December. He said it is operating within its intended time line without widespread issues or delays.

Facilities had to apply to be on the federal program list. Then, they had to be matched with a pharmacy.

Paperwork, including consent and decline forms, FAQs and information about side effects, had to be given to residents or their families. If a facility distributed paperwork on the Pfizer vaccine, it had to then distribute paperwork about the Moderna vaccine when the state made the switch.

More:Michigan to allow more indoor visits at nursing homes

Three vaccination clinics have to be scheduled in each facility, with the second clinic not only providing second doses but also first shots to those who didn't receive them in the first round.

Pharmacy staff come to the long-term care facilities to administer the vaccine either in a clinic setting or by going room to room. Each resident and staff member is monitored for 15 minutes after receiving the vaccine for allergic reactions.

"There's a lot of planning pieces that have to go into this because we don't want to waste vaccines in any way," Ott said.

Nursing home residents appear more inclined to roll up their sleeves for the vaccine.

They haven't been able to see loved ones in person, except in very specific circumstances, wearing masks and being 6 feet apart. For months, they were in their rooms and couldn't participate in communal meals and activities in an effort to protect them from the virus.

But "there's definitely a lot of fear among the staff," said Kevin Lignell, communications specialist for SEIU Michigan Healthcare, the union representing many of the workers.

He said two of the biggest, "very reasonable" fears the union is hearing from its members is how could a vaccine that has been developed this fast be safe and concerns that its long-term effects are unknown.

"I think the more people that get the vaccine and it's proven to be safe, the more these people will be won over," Lignell said. "There's a lot who want to take it, but they don't want to be the first people to take it."

Health departments help

Oakland County Health Division is administering vaccines in more than 100 long-term care facilities that were not matched with CVS or Walgreen pharmacies in the county, said Bill Mullan, spokesman for County Executive Dave Coulter.

The health division is administering the Pfizer vaccine at those locations, which are non-skilled nursing facilities, such as assisted living and independent living locations.

More:TCF Center to be primary COVID-19 vaccination site in Detroit, counties preparing sites

Mullan said residents and staff at Samaritas Senior Living of Bloomfield Hills were the first of the long-term care facilities in the county to receive vaccines from the health division last week, with more locations planned this week and in the weeks ahead.

Facility Administrator Ashley Coley said 53 residents in independent living, 15 residents in assisted living and 27 staff members were inoculated. The location does not have skilled nursing. Only five residents in independent living did not receive the first dose of the vaccine, for a variety of different reasons.

Coley said the location applied to get into the pharmacy partnership, but for an unknown reason it was not matched. So Coley collaborated with the county health division.

"We were really excited and we felt super fortunate. We want to see our residents feel safe," she said. "The residents are walking around, counting down the days til dose two. Waiting for some normalcy."

More:Fact check: How Michigan ranks in giving first doses of COVID-19 vaccines

As residents at the Bloomfield Hills location were getting vaccines, others at four other Samaritas sites, including skilled nursing facilities, in Michigan were waiting their turns.

"We have an interesting hodgepodge of things happening. Different providers and different vaccines," said Kim Thompson, COO-Senior Living of Samaritas.

For example, she said, a similar Samaritas site in Traverse City that has assisted and independent living did get matched with a pharmacy and some residents there should get their first doses by the end of the month.

Thompson said residents and staff at Samaritas' skilled nursing locations in Cadillac and Grand Rapids got their first shots this week by pharmacy teams. She said the skilled nursing location in Saginaw is set for a vaccination clinic next week by the county health department after it didn't get on the pharmacy list.

Thompson said at the clinics in the skilled nursing facilities, full personal protective equipment was worn and coronavirus tests were administered before entering the building.

But even the best-laid plans can encounter glitches.

At one site, Thompson said, pharmacy personnel were there in advance for the clinic, but the vaccine didn't arrive on time. When it did, it was still frozen and they had to wait an hour for it to thaw.

Thompson said 95% to 99% of residents who can get the vaccine are expected to receive it. Staff is "a little more inquisitive, cautious" with about 50% to 60% expected to get it in the first round.

"The expectation is the second clinic is actually going to be larger than the first," she said.

Staff writer Georgea Kovanis contributed to this report.

Contact Christina Hall: chall@freepress.com. Follow her on Twitter: @challreporter.

Support local journalism. Subscribe to the Free Press.