Long-Term Care Facilities Begin COVID-19 Vaccinations on Older Adults

Although the long-awaited COVID-19 vaccines are here, the Centers for Disease Control and Prevention (CDC) says that the demand will most likely exceed the current supply. On December 11, 2020, the Advisory Committee on Immunization Practices (ACIP), made a recommendation to the CDC that people who live in long-term care facilities (LTCFs), such as nursing homes and assisted living facilities, should be prioritized in the vaccine rollout.

Although LTCF residents make up less than 1% of the U.S. population, they are among the highest risk population. These individuals are often older than 65 years, have preexisting conditions (like diabetes), and live in a group setting—factors that place them at a higher risk of contracting COVID-19 and developing severe illness.

“The distribution guidelines vary by state, with most states following the CDC recommendations of prioritizing nursing homes and assisted living right behind frontline healthcare workers,” Sue Johansen, senior vice president at A Place for Mom, a senior care referral service, tells Verywell. Some facilities have already begun vaccinating their residents.

The ACIP's Recommendations

Since early December 2020, the ACIP has been finetuning its recommendations to ensure that the COVID-19 vaccine quickly reaches those who need it most.

Here are the current recommendations as of the end of 2020:

• Phase 1a: Healthcare workers and long-term care facility residents
• Phase 1b: Persons older than 75 years old and frontline essential workers
• Phase 1c: Persons 65–74 years old, persons 16–64 years old with high-risk medical conditions, and other essential workers
• Phase 2: All persons older than 16 years old

Johansen says that in most states, "only seniors in long-term care facilities (including skilled nursing facilities and assisted living communities) will be prioritized to receive the vaccine."

However, Johansen adds that older adults who live in the general population, such as with family, will need to wait until the vaccine is made more available, likely in mid-February. 

Some states may diverge from the ACIP's recommendations. For example, on December 23, 2020, Florida Gov. Ron DeSantis signed an executive order allowing providers to vaccinate people older than 65 years old before essential workers.

Is the COVID-19 Vaccine Mandatory in LTCFs?

Johansen says that “Most senior communities are strongly encouraging their residents to take the vaccine, but are not making it mandatory.”

“Interestingly, our recent survey also shows that some caregivers were willing to move their senior loved one into senior living specifically to ensure they receive the vaccine as quickly as possible,” Johansen says.

Caregiver Concerns

While some residents and caregivers are eager for the vaccine, others have apprehensions. “The caregiver population in senior living communities is as varied as the population of the United States itself," Johansen says. "Therefore, there is a wide range of feelings about the vaccine.”

Johansen feels that “attitudes will likely shift over time as the vaccine rolls out more broadly." According to the A Place for Mom survey, 61% of caregivers plan to get their older loved ones vaccinated, while 36% of caregivers say that they will decline vaccination for their loved ones. Those who declined cited concerns about safety, side effects, and wanting others to be vaccinated first.

According to the CDC, clinical trials for the vaccine included adults over the age of 65, and researchers did not find any serious safety concerns. However, the CDC, along with the ACIP and the Food and Drug Administration (FDA), will continue to monitor any unexpected vaccine side effects that may warrant a change in current vaccine recommendations.

Continued Safety Precautions

According to the CDC, experts need to learn more about the protection the COVID-19 vaccine provides before deciding to change current safety recommendations such as face mask-wearing and social distancing.

Therefore, it’s likely that most long-term care facilities will continue to use the same precautions they implemented earlier in the pandemic to keep their residents safe. According to Johansen, these prevention measures include:

• On-site COVID-19 testing of residents and staff
• Restricting visitors and non-essential personnel
• Enhanced cleaning protocols (especially in high traffic areas like elevators, hallways, and doorknobs)
• Requiring face masks
• Frequent hand washing and making hand sanitizer available around the community