key: cord-0941554-6uby7v1x
authors: Gharpure, Radhika; Yi, Sarah H.; Li, Ruoran; Jacobs Slifka, Kara M.; Tippins, Ashley; Jaffe, Aaron; Guo, Angela; Kent, Alyssa G.; Gouin, Katryna A.; Whitworth, J. Carrie; Vlachos, Nicholas; Patel, Anita; Stuckey, Matthew J.; Link-Gelles, Ruth
title: COVID-19 Vaccine Uptake Among Residents and Staff Members of Assisted Living and Residential Care Communities — Pharmacy Partnership for Long-Term Care Program, December 2020–April 2021
date: 2021-08-25
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2021.08.015
sha: 936634b0b4e18d09ae4aa77fba700b9f005297a5
doc_id: 941554
cord_uid: 6uby7v1x

Objectives In December 2020, CDC launched the Pharmacy Partnership for Long-Term Care Program to facilitate COVID-19 vaccination of residents and staff in long-term care facilities (LTCFs), including assisted living (AL) and other residential care (RC) communities. We aimed to assess vaccine uptake in these communities and identify characteristics that might impact uptake. Design Cross-sectional study. Setting and Participants AL/RC communities in the Pharmacy Partnership for Long-Term Care Program that had ≥ 1 on-site vaccination clinic during December 18, 2020 – April 21, 2021. Methods We estimated uptake by using the cumulative number of doses of COVID-19 vaccine administered and normalizing by the number of AL/RC community beds. We estimated the percentage of residents vaccinated in three states using AL census counts. We linked community vaccine administration data with county-level social vulnerability index (SVI) measures to calculate median vaccine uptake by SVI tertile. Results In AL communities, a median of 67 residents (IQR: 48–90) and 32 staff members (IQR: 15–60) per 100 beds received a first dose of COVID-19 vaccine at the first on-site clinic; in RC, a median of 8 residents (IQR: 5–10) and 5 staff members (IQR: 2–12) per 10 beds received a first dose. Among three states with available AL resident census data, median resident first-dose uptake at the first clinic was 93% (IQR: 85–108) in Connecticut, 85% in Georgia (IQR: 70–102), and 78% (IQR: 56–91) in Tennessee. Among both residents and staff, cumulative first-dose vaccine uptake increased with increasing social vulnerability related to housing type and transportation. Conclusions and Implications COVID-19 vaccination of residents and staff in LTCFs is a public health priority. On-site clinics may help to increase vaccine uptake, particularly when transportation may be a barrier. Ensuring steady access to COVID-19 vaccine in LTCFs following the conclusion of the Pharmacy Partnership is critical to maintaining high vaccination coverage among residents and staff.

Following the U.S. Food and Drug Administration's Emergency Use Authorizations of the 30 first vaccines for prevention of coronavirus disease 2019 , the Advisory Committee 31 on Immunization Practices recommended that residents and staff members of long-term care 32 facilities (LTCFs) be prioritized in the first phase of COVID-19 vaccine allocation. 1 As congregate 33 settings, LTCFs pose increased risk for transmission of SARS-CoV-2, the virus that causes COVID- 34 19, 2 and residents are also at increased risk for severe COVID-19 illness due to older age or 35 underlying health conditions. 3 LTCFs include skilled nursing facilities (SNFs) and other nursing 36 homes, assisted living (AL) and other residential care (RC) communities, and residential facilities 37 for persons with intellectual and developmental disabilities. AL/RC communities provide 38 assistance with activities of daily living (e.g., bathing and toileting) and may also provide some 39 healthcare services (e.g., management and administration of medications) in a residential 40 setting; these communities represent approximately 44% of U.S. LTCFs. 4 Data from October 41 2020 indicated that 22% of AL/RC communities with available data reported at least one case of 42 COVID-19 among residents or staff members, and that COVID-19-associated mortality among 43 the resident population was significantly higher than that among the general population (21% Associates, and Walgreens), conducted on-site visits to enrolled LTCFs to provide end-to-49 end management of the COVID-19 vaccination process, including appropriate storage, handling, 50 J o u r n a l P r e -p r o o f and transport of vaccines, vaccine administration, and fulfillment of reporting requirements. 51 Over 62,000 LTCFs across 49 states enrolled in the program and received on-site vaccinations 52 for residents and staff members. Early estimates from the first month of the program indicated 53 that a median of 78% of residents and 38% of staff members in SNFs received at least a first 54 dose of Complementing these results, we aimed to assess vaccine uptake in 55 AL/RC communities participating in the program and identify community and county 56 characteristics that might impact uptake. Specifically, we assessed the association between 57 uptake and county-level social vulnerability, which has been shown to impact COVID-19 vaccine 58 uptake in LTCFs 8 and broader population settings. To estimate uptake, we calculated the cumulative number of first and second doses of 74 vaccine administered to residents and staff members at each clinic and normalized by the 75 reported total bed capacity per community (presented as number vaccinated per 100 reported 76 beds for AL communities and per 10 reported beds for RC communities to account for 77 differences in average community size). Additionally, we estimated the percentage of residents 78 who received a first dose of COVID-19 vaccine in AL communities in three states (Connecticut, 12 79 Georgia, 13 and Tennessee 14 ) that reported resident census counts (number of occupied beds) in 80 publicly available COVID-19 reports obtained via systematic website searches 5 between 81 February 2-4, 2021. AL census counts were not available for additional states; RC census counts 82 were available only for a small number of communities and were not included due to 83 insufficient sample size. We linked community-level vaccination data from these states to AL 84 census data using standardized values of community name and address. We calculated the 85 estimated first-dose uptake per 100 residents by dividing the number of first doses of vaccine administered by the reported census count. Estimated first-dose uptake exceeded 87 100% if reported doses administered were greater than resident census counts. 88 We linked AL/RC communities with county-level social vulnerability index (SVI) *"Unlinked" indicates communities not matched to publicly available resident census data; "linked" indicates communities matched to resident census data. Uptake per 100 residents was calculated only for linked communities. Census data were available for AL communities in three states; RC census data were available only for a small number of facilities and are not presented. †Occupancy-to-capacity ratio was calculated as resident census (dated January 27-February 2, 2021) divided by total number of reported beds. ‡Uptake for clinics 2 and 3 is cumulative vaccine uptake inclusive of previous clinics. §First-dose uptake per 100 beds was calculated as number of first doses of COVID-19 vaccine administered normalized per 100 reported beds (total bed capacity). First-dose uptake per 100 residents was calculated as number of first doses of COVID-19 vaccine administered normalized per 100 residents in census counts (occupied beds).

Long-Term Care Program, December 2020-April 2021 *Includes cumulative first-dose vaccine uptake as of April 21, 2021. †SVI ranks counties according to 15 social factors (indicators): 1) percentage of persons with incomes below poverty threshold, 2) percentage of civilian population (aged ≥16 years) that is unemployed, 3) per capita income, 4) percentage of persons aged ≥25 years with no high school diploma, 5) percentage of persons aged ≥65 years, 6) percentage of persons aged ≤17 years, 7) percentage of civilian noninstitutionalized population with a disability, 8) percentage of single-parent households with children aged <18 years, 9) percentage of persons who are racial/ethnic minorities (all persons except non-Hispanic White), 10) percentage of persons aged ≥5 years who speak English "less than well," 11) percentage of housing in structures with ≥10 units (multiunit housing), 12) percentage of housing structures that are mobile homes, 13) percentage households with more persons than rooms (crowding), 14) percentage of households with no vehicle available, and 15) percentage of persons in group quarters. Estimates are created using 2014-2018 (5-year) data from the American Community Survey. The 15 indicators are categorized into four themes: 1) socioeconomic status (indicators 1-4), 2) household composition and disability (indicators 5-8), 3) racial/ethnic minority status and

The Advisory Committee on Immunization 212

Practices' Interim Recommendation for Allocating Initial Supplies of COVID-19 Vaccine -United 213

214 2. Centers for Medicare & Medicaid Services. COVID-19 nursing home data

Severe Outcomes Among Patients with Coronavirus Disease 218 2019 (COVID-19) -United States

Long-Term Care Providers and services users in 221 the United States: data from the National Study of Long-Term Care Providers

Characterization of COVID-19 in Assisted Living Facilities -39 States

Term Care Program

Early COVID-19 First-Dose Vaccination Coverage Among 229 Residents and Staff Members of Skilled Nursing Facilities Participating in the Pharmacy 230

Disparities in COVID-19 Vaccination Coverage Among 233

Health Care Personnel Working in Long-Term Care Facilities, by Job Category

MMWR Morbidity and mortality weekly 235 report 2021

County-Level COVID-19 Vaccination Coverage and 237 Social Vulnerability -United States

Patterns in COVID-19 Vaccination Coverage, by Social 240 Vulnerability and Urbanicity -United States

Demographic and Social Factors Associated with COVID-243

Vaccination Initiation Among Adults Aged ≥65 Years -United States

Nursing Homes and Assisted Living Facilities Data

Data/20210128-Assisted-Living-Facilities-with-COVID-19.pdf. Accessed

Tennessee Department of Health. Long Term Care Facility Data

Centers for Disease Control and Prevention/ Agency for Toxic Substances and Disease Registry/ 254

Department of Housing and Urban Development. HUD USPS ZIP CODE CROSSWALK FILES

Vaccine Among Residents of Two Skilled Nursing Facilities Experiencing COVID-19 Outbreaks -262

Programs; COVID-19 Vaccine 267 Requirements for Long-Term Care (LTC) Facilities and Intermediate Care Facilities for Individuals 268

National Institute of Environmental Health Sciences. Key Elements of a Model Workplace Safety 271 and Health COVID-19 Vaccination Program

Workplace Vaccination Program

Mobile Vaccination Resources

State Regulatory Provisions for Residential Care Settings: 280 An Overview of Staffing Requirements

Variation in Residential Care Community Nurse and Aide Staffing 282 Levels: United States