The start of a mass coronavirus vaccination campaign at U.S. nursing homes has brought hope to many families. But it may be a while before restrictions loosen. Here are answers to common questions.
By Matt Richtel
A watershed moment has arrived for many families: This week health care workers from CVS and Walgreens, under contract from the federal government, will fan out to nursing homes across the country to begin vaccinating residents against the coronavirus. The shots not only will help protect the nation’s elderly and infirm — and the staff who care for them — but they raise the prospect of ending the devastating isolation many residents have felt for months.
Family members are hopeful that before too long, they will return to visiting parents and grandparents, aunts, uncles and other loved ones regularly again. We checked with experts on some common questions.
Will restrictions on visiting be lifted soon?
Probably not in a big way. Restrictions vary by state, and the federal government’s guidance on what it considers safe stands for now. They already allow visits under certain conditions. The Centers for Medicare & Medicaid Services, or C.M.S., recommended in September that outdoor visits with residents be allowed and indoor visits, too, if the facility has been free of cases for 14 days.
Some medical experts have said that those guidelines are too lax and that visits should be severely restricted, even banned. However, some of these experts are now saying that the vaccine changes the equation, somewhat.
“Once all residents are vaccinated, it opens the door for loosening of restrictions,” said Dr. Michael Wasserman, the immediate past president of the California Association of Long Term Care Medicine, a geriatrician and former executive at nursing home chains.
To allow visits, Dr. Wasserman recommends all residents of a nursing home should be vaccinated (unless they have some condition or allergy that would discourage vaccination on medical grounds); all staff members should be vaccinated; and the nursing home should have the ability to ensure that visitors test negative for the coronavirus and have been disciplined about wearing a mask in public settings.
Is the vaccine safe and effective for old and frail residents of nursing homes?
The clinical trials of the Pfizer and Moderna vaccine included people over 65, and results showed it to be safe and to work as well in older people as in younger ones.
“This vaccine has gone through testing and clinical trials to ensure it meets the highest safety standards. It also is safe to get if you already had the virus,” says a campaign to encourage people to get the shots by the American Health Care Association and National Center for Assisted Living, a combined trade group representing nursing homes and assisted-living communities.
The lead administrator for C.M.S., Seema Verma, reinforced the confidence in the shot for older patients, including those with health conditions, in a statement last week: “I urge states to prioritize nursing homes and vulnerable seniors in their distribution of the vaccine.”
The point is echoed by Dr. Sabine von Preyss-Friedman, chief medical officer of Avalon Health Care Group, which operates nursing homes, who said the new vaccines appear “safe and effective.”
If restrictions are eased, should I visit right away?
The Pfizer and Moderna vaccines both require two injections — the initial shot and a booster three or four weeks later. Dr. von Preyss-Friedman recommends waiting at least two weeks after the second shot to have a visit.
“You hope these vaccines work, but these are elderly patients,” she said. “You want to err on the side of protection.”
She said that, ideally, the visitor would also be vaccinated as well. Since shots won’t be widely available for a few months, it may be best to wait until you get your vaccine. Until then, she believes nursing homes should consider visits on a case-by-case basis.
Would visitors still need to wear a mask?
Absolutely, medical experts said. This is particularly true if they are not vaccinated, but even after they are vaccinated “until rates in the community go down,” said Dr. Joshua Uy, a geriatrician and associate professor at the University of Pennsylvania Medical School and the medical director of Renaissance Healthcare & Rehabilitation Center, a nursing home in Philadelphia.
Dr. Uy said that he hopes that the federal government would supply enough personal protective equipment so that all visitors and residents could be properly gowned for such visits.
What is being done to encourage nursing home residents to get vaccinated?
The combined nursing-home and assisted-living trade group has started a program aimed at helping nursing homes and other care facilities to explain to residents the essential need to get the vaccine. The campaign, #getvaccinated, notes: “The elderly population has a much higher risk for getting very sick, being hospitalized, or dying from Covid-19. The vaccine has been shown to provide a great deal of protection against serious illness due to Covid-19.”
