Hospices are facing a flurry of challenges as the first wave of coronavirus vaccines rolls out across the United States. With distribution processes varying from state to state, hospices nationwide are implementing diverse methodologies as the impacts of COVID-19 vaccination processes reach into operations and bottom lines.
Vaccinations began Dec. 14 across the country as health care workers were among those that received the 11.9 million doses issued so far, according to a recent Bloomberg report of state-by-state data from the U.S. Centers for Disease Control and Prevention (CDC). At least 1.46 million people have completed the two-dose vaccination regimen with billions more to go, representing the “biggest vaccination campaign in history,” per the report’s authors.
The initial vaccination roll out has been lacking, with national advocates such as the National Partnership for Hospice Innovation (NPHI) already calling on state and federal policymakers for a new approach to address supply chain issues and inconsistencies in vaccine distribution to hospice and other health care providers.
An inconsistent distribution process had hospices nationwide taking varied approaches as they prepared to vaccinate staff, anticipating operational disruptions and associated costs.
“Vaccinations are rolled out as they become available from local health departments and patient-facing clinical staff are prioritized,” said Mandy Cogswell, chief clinical officer of Minnesota-based St. Croix, a portfolio company of the private equity firm H.I.G. Capital. “Distribution models vary by state and county [and] roll-out strategies have varied.”
Cogswell, who is also a Hospice News Class of 2020 Future Leader, told Hospice News that St. Croix Hospice has been in regular contact with local health departments to ensure patient-facing staff receive prioritization for vaccination throughout each of its service regions in Iowa, Kansas, Minnesota, Missouri, Nebraska and Wisconsin.
St. Croix Hospice staff in Eau Claire, Wisc., were among the first to receive COVID-19 vaccinations, along with those in other Midwest locations such as Nebraska and Iowa. Employees were vaccinated at a local high school in collaboration with the Eau Claire City-County Health Department. Staff in Grand Island, Neb., were vaccinated onsite at the Central District Health Department. In other instances, St. Croix Hospice employees were invited by partnering skilled nursing or assisted living facilities to receive the vaccination when it became available to their own staff.
Limited supply and high demand have strained the COVID-19 vaccine distribution process thus far, with many hospice providers vying for access to vaccinations among employees.
“This was the first time any of us has experienced a vaccination roll out of this magnitude,” said Monte Hanks, assisted living facility administrator for The INN Between, a medical respite center for homeless adults in Salt Lake City. “We knew there would be bumps in the road; however, the community was committed to working together to figure out the process and make it as seamless as possible.”
Utah prioritized vaccinations to hospital workers, long-term care facility workers and residents, teachers and adults 65 and older, according to executive director Kimberlin Correa, who told Hospice News that The INN Between falls in the assisted living facility category, or the second tranche of the state’s vaccine roll out. The center serves adults in the community who are experiencing homelessness and suffering from terminal illness or an acute medical condition that does not require hospitalization but makes them too ill to be on the streets or in shelters.
The facility partnered with CVS pharmacy as the clinic provider to distribute vaccinations among staff and fragile residents who have been in isolation since the pandemic’s onset.
“We had gone on a strict lockdown in March and our residents were looking forward to returning to some semblance of normalcy,” said Correa. “For the [CVS] clinics, people could receive their first dose during the first or second clinic, but no first doses would be administered on the last clinic date. We were told that this was a one-time offer. If a person were to pass it up now, they would go into the general population tranche.”
COVID-19 vaccinations for hospice staff can reopen doors to patients in facility settings that have been on lockdown since the outbreak first hit the nation. Limited access to referral sources and patients in both facility- and community-based settings has ruffled bottom lines for many hospices.
While vaccines represent an opportunity to regain from some of the COVID-19 headwinds, hospices will risk taking on financial hits and impacts to operations in the distribution process.
“The cost involved more than 200 hours that our nurse supervisor and administrator had to invest in learning about and preparing for the [vaccine] clinic,” Correa said. “This was a strain on our budget as a nonprofit serving no- and low-income clients who cannot afford to pay for their stay. We must raise our annual operating budget through charitable donations. The time investment for the vaccine clinic was a strain on our resources. I hope that the learning curve on this process becomes well documented to streamline future situations.”
Grappling with hesitance among staff is another concern for hospice providers, as some have not made the vaccine a requirement. Nearly 30% of health care worker respondents in a December survey from the Kaiser Family Foundation said they “definitely or probably would not” get vaccinated. Main reasons for hesitancy included worries about possible side effects (59%), lack of trust in the government to ensure the vaccines’ safety and effectiveness (55%), and concerns that the vaccine is too new (53%).
Concerns about efficacy proliferated among hospice providers, along with the impacts of these concerns on the ability to distribute a vaccine among staff. Regular contact with local health departments to improve understanding and education about the vaccinations could be beneficial for hospices working to raise awareness and ease employee concerns.
Andrew Mayo, M.D., chief medical officer of St. Croix Hospice stated that he felt “very comfortable” and “worry free” about getting the vaccine during a Wisconsin news broadcast, citing that the science behind development of vaccine technologies is solid. Mayo said many things came together to make staff vaccinations possible, including development, distribution and approval for the vaccine.
“Vaccination is encouraged but not required, and we are proud that staff has been incredibly supportive of, and confident in, vaccination,” Cogswell told Hospice News. “The COVID-19 Vaccine Champions is our way of celebrating and thanking staff for their championship of the vaccine and acknowledging why they personally wanted to receive it.”