For most of the last 12 months, Paul Smith’s life at his retirement community has been intensely restrictive. Ever since nursing homes and long-term care facilities became ground zero for the COVID-19 pandemic, the wide range of amenities offered at Buckner Parkway Place in Houston have been severely curtailed.
Swimming pools, recreation and exercise programs were shut down. The on-site cinema shuttered. Interaction with other residents was limited to small tables in the cafeteria, separated by plastic. One of the only activities permitted was solitary hours in the community’s wood shop, where Smith could tinker with small chairs and toys.
“We’ve been able to go there and work,” Smith said. “We feel good about that.”
But after receiving the second and final dose of the COVID-19 vaccine in February, Smith, 86, and his wife, Virginia, 90, will soon be able to reclaim some of the comforts and freedom of retirement they were accustomed to.
No longer will the Smiths have to share meals with other couples at Buckner separated by a plastic screen at their table. They can even go out to the grocery store, as long as they check in and provide a detailed account of where they’ve gone after leaving the facility.
“We were very happy to get the vaccination and to get the doors open a little bit for us,” Smith said.
While Texas has lagged behind most states in getting its eligible population vaccinated, senior residents of long-term care facilities have, by some metrics, proved to be a notable exception.
As of, only 9.2 percent of Texans were fully vaccinated, while 18 percent of the state has received at least one dose — the fifth- and sixth-lowest rates in the country, according to a Hearst Newspapers analysis. But only two states, California and Pennsylvania, have more fully vaccinated long-term care residents than Texas, with 171,839, according to the U.S. Centers for Disease Control and Prevention.
State data, however, paints a less rosy picture. The Texas Health and Human Services Commission, which regulates all of the state’s registered long-term care facilities, reported only 75,574 residents have been fully vaccinated out of 271,813 long-term care residents across the state in nearly 2,600 facilities — a 28 percent rate. The numbers are slightly better for residents who have received one vaccine dose — 89,419 as of Thursday.
The gulf between the state and federal data can likely be attributed to the CDC’s much broader definition of a long-term care facility. While the HHSC relased data only for nursing homes and assisted living facilities, the CDC includes a plethora of senior housing in its vaccination numbers: skilled nursing facilities, continuing care retirement communities, residential care communities, adult family homes, federal supportive housing for seniors, state-run veterans homes, and any senior housing where individuals receive care or supervision.
Advocates were disappointed the HHSC didn’t include the broader definition of long-term care facilities after delaying the release of data for months. Without a clear census of how many residents and staff are in each facility, they say, it’s difficult to get an accurate read on how high the vaccination rate is.
“We’re hearing that (the vaccination) rate among residents is pretty high,” said Amanda Frederiksen, state director of outreach and advocacy for AARP Texas. “But until you see the numbers, it’s really hard to confirm that. The (long-term care) staff numbers, we’re hearing a lot like 50 percent, which is concerning.”
The accuracy of comprehensive data on long-term care facilities has implications for whether the state will issue revised COVID-19 guidance for long-term care residents, now that Gov. Greg Abbott has rescinded the state’s mask mandate and ended restrictions on businesses.
“The percentage of (long-term care residents) getting vaccinated, I really expect will be influential in policymaking for long-term care facilities,” said Patricia Ducayet, the state’s long-term care ombudsman. “If (seniors) are highly vaccinated, that should have an effect on their rights being restored.”
The federal Pharmacy Partnership for Long-Term Care Program, which is tasked with facilitating on-site vaccination of residents and staff has reduced the burden on long-term care facilities to manage the vaccination process.
The program allows large chain pharmacies like CVS and Walgreens to enroll directly with CDC and receive shipment of the vaccine at multiple locations across the state. Those pharmacies can then partner with local long-term care facilities — defined by the expansive federal criteria — to set up clinics for their residents.
The pharmacy partnership guarantees three vaccine clinics for long-term care providers, enough for residents and staff to get the required two doses of the Pfizer or Moderna vaccines. Though with most of those clinics now complete, providers are now wondering how to get continued access for residents and staff who might have been initially hesitant to get vaccinated.
“How are we going to get these vaccines for staff who did not get it, new employees that will be starting with us, new patients and residents and seniors that will be moving in?” said Abraham Matthew, executive director of Buckner Parkway Place in Houston. “CVS, and Walgreens said we only can have three clinics on your site, which we’ve done. So we really need some help on how we can have access to these vaccines on an ongoing basis.”
Advocates worry that some seniors and long-term care staff and residents are falling through the cracks as the state opens up its priority list to all Texans over the age of 50 this week. State legislators have raised the issue that some facilities missed the registration window for the federal pharmacy partnership.
State Rep. Steve Toth (R-Woodlands) said roughly one-quarter of long-term care facilities in Montgomery County failed to sign up for vaccines.
“Regulated facilities needed to just simply reach out to the county health department and get put on a list and, you know, get in line,” Toth said. “And they just never did it.”
The Department of State Health Services is still allowing facilities to register for the pharmacy partnership, Toth said, and would still be “at the front of the line” to get vaccinated.
Vaccine data provided by DSHS show significant racial disparities among seniors as well. As of Thursday, 637,459 White seniors have been fully vaccinated, compared to 175,067 Hispanic seniors; 65,479 Black seniors; and 57,816 Asian seniors.
Homebound seniors, who are not clearly accounted for in any state data, also may be having trouble gaining access to vaccines, particularly when waiting lists require some level of fluency with technology.
“How do we get home-bound seniors outside of these (retirement) communities access to vaccine, low-income senior affordable housing access to this vaccine?” said Alyse Meyer, vice president of advocacy for LeadingAge Texas, a nonprofit representing aging services providers.
In the meantime, long-term care facilities with large numbers of vaccinated residents and staff are still awaiting updated guidance from the state as to whether they, too, can loosen restrictions.
Abbott’s ending of the state mask mandate notably did not include long-term care facilities. A previous executive order signed by Abbott in September allowed residents at facilities that meet certain standards — such as not having a recent COVID-19 outbreak — to have indoor visits from up to two designated “essential caregivers” who have tested negative for the virus.
Ducayet, Texas’s long-term care ombudsman, said she is concerned that the state has created two separate sets of rules for seniors and the general population. Specifically, long-term care staffers have freedoms not granted to the people they care for, which could put seniors at risk.
“People who work in (long-term care) facilities and go home, that level of risk is elevated by policies changing or orders changing by the state government,” Ducayet said. “What may be the outcome is, we’ll see new cases in our facilities, and that’ll mean, facilities get locked down again, where most visitation isn’t allowed. It does seem unfair to me.”
nick.powell@chron.com
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