In Illinois nursing homes, tens of thousands still waiting for COVID-19 vaccinations: ‘This is beyond an emergency’
Robert Schur said he isn’t the kind of guy to write letters to elected leaders, but he feels his mom’s life is at stake.
Schur’s mother lives in a long-term care facility and has yet to be vaccinated against COVID-19, more than a month after doses began to be distributed. State data suggests most people in long-term care have yet to get their first dose of vaccine.
“This is one of the few times in my life I’ve really needed the government to step up and do something,” said Schur, a Northbrook attorney who’s written to several legislators for assistance without much response. “And I feel like it’s a failure of America.”
Illinois Department of Public Health data shows that, as of Thursday, roughly 90,000 shots had been administered in Illinois as part of a special federal program that sends Walgreens and CVS Health pharmacists into long-term care facilities to vaccinate residents and staff against the disease.
But the state vaccination administration plan estimates that about 360,000 people qualify for early vaccinations because of ties to long-term care — meaning far less than half have received a shot.
Gov. J.B. Pritzker told reporters Friday that he was “very troubled to see the slow pace,” which now isn’t expected to reach all facilities with a first round of vaccinations until mid-February.
“They must accelerate the pace of vaccines to our most vulnerable residents,” he said.
The delays, compounded by a lack of clarity, frustrate families and senior advocates who have watched as the virus tore through facilities across the state, accounting for roughly half of the nearly 19,000 COVID-19 deaths in Illinois. With nearly a thousand outbreaks still considered active in Illinois facilities, and a more contagious virus strain invading the country, they argue that every day missed can fuel more misery.
“This is beyond an emergency situation to get this done,” said AARP Illinois’ state director, Bob Gallo.
The delays are happening amid a delicate debate over how much to parse which groups of people should get top priority for the vaccines.
Researchers say giving doses first to the oldest, most frail residents would reduce deaths the fastest. On the other hand, trying to micromanage the process might slow it down, leaving vials sitting idle as officials fret over who exactly should get the next shots.
Indeed, state data shows that a sizable number of doses — 430,000 as of Friday — are waiting to be administered under the special federal program for long-term care. It’s unclear just why that is the case, with agencies and pharmacies offering varying explanations and declining to answer some key questions.
In limbo
Citing the carnage that COVID-19 has wreaked in long-term care, the Centers for Disease Control and Prevention last fall set up what it billed as an innovative program to ensure these vulnerable residents could get swift relief.
While leaving most vaccine distribution to state and local governments to figure out, the CDC contracted with Walgreens and CVS to administer doses to long-term care residents and staff members, starting as early as Dec. 21 with those in skilled nursing facilities (considered the most frail), then moving to assisted living, memory care and other congregate care locations. In all about 75,000 facilities are enrolled in the federal program.
Delivering and administering doses at the homes has created some logistical headaches that can slow the process. Pharmacy workers have to collect batches of vaccine, then drive to facilities, where they may need to go room to room to administer shots. People being approached in long-term care facilities also may want extra time to discuss whether they should get vaccinated.
What limited data is available reflects some of these difficulties. Illinois has gotten 900,000 doses so far from the federal government for its general vaccination effort, with more than half already injected into arms, most of them belonging to health care workers in hospitals and other settings. Meanwhile, less than a fifth of the long-term care program’s roughly 520,000 doses have been administered.
It’s unclear how that disparity in Illinois compares with other states. The CDC has set up a website to track vaccine distribution by state, but it doesn’t provide each state’s progress on administering the vaccinations in the long-term care program. An agency spokeswoman told the Tribune it would begin reporting that data Thursday, but as of Friday evening it was not available.
The challenges with the program are perhaps unsurprising for a new, large-scale undertaking that has fueled a mix of relief and frustration across the country.
The Health Care Council of Illinois, an industry trade group, noted in a statement from its executive director, Matt Pickering, that “the rollout hasn’t been perfect” in what has been a “huge logistical operation.” At the same time, he said the state, which encouraged facilities to enroll in the program, “has been responsive to the issues we have raised.”
Jonathan Aaron, who runs 13 Illinois long-term care facilities as part of Citadel Health Care, said one of them got the first round of vaccination Dec. 29 and the last one — the only one that isn’t a skilled-nursing facility — was set to get its first shots Saturday.
He said that at times his facilities didn’t get much advance notice about which type of vaccine would be administered and that twice the type was switched just before visits. That made it harder to educate residents and staff members on what to expect, he said, which is key to reassuring people skeptical of the new vaccines. But broadly speaking, he said he’s relieved the shots are happening.
“I am so grateful that our residents and staff have received the vaccinations,” he said. “However, I long for a more transparent and uniform process.”
Deborah Shalowitz Cowans, of Glencoe, said her 89-year-old mother is in an independent living facility called Vi at the Glen in Glenview, where she has been confined mostly alone for nearly 10 months as she battles breast cancer.
Her mother, Phyllis, is allowed visitors and can go to a common living room, but her daughter doesn’t feel it’s safe to visit now that the new, more contagious variant of the virus has emerged. Shalowitz Cowans said Vi residents in skilled nursing and memory care units have received their first vaccinations but her mother was still waiting.
“I want to keep her alive,” she said. “She’s my best friend in the entire world. I can’t tell you how upsetting it is for me on a daily basis that she hasn’t gotten the vaccine.”
A spokeswoman for the Vi said CVS had not set a date to vaccinate the residents in independent living. When nursing home administrators learned Jewel Osco Pharmacy could provide the shots, the spokeswoman said they arranged to do so starting Wednesday.
Finger-pointing
On Friday the state, for the first time, offered a date by which all facilities should have gotten at least their first round of vaccinations: Feb. 15.
Second shots are set to be given three to four weeks later after the first shots, and, under the program, pharmacies also are making a third visit, to catch any people who may have missed either earlier opportunity.
But it’s difficult to track progress at individual homes. Neither Walgreens nor CVS publicizes a list of specific places they will visit and when. Nor has the state released specific data on vaccinations at long-term care facilities.
The Tribune asked IDPH on Jan. 8 for a list of all facilities and a running tally of the number of people vaccinated at each one. The state has not responded to that request or subsequent queries; officials face a Monday deadline to respond to a separate request made under the Freedom of Information Act.
Some insight into the delays is available via data posted by CVS and Walgreens, which show daily updates on the number of facilities the companies are working with in 53 jurisdictions. Most of the jurisdictions cover entire states, but Chicago and some other cities have their own jurisdiction.
As of Friday, the figures showed both pharmacy companies have visited the vast majority, if not all, of the skilled nursing facilities in Illinois. But most of the state’s 1,800 long-term care facilities are of other types, such as assisting living and memory care.
The firms’ postings also show that CVS has visited all of its assigned Chicago facilities that do not provide skilled nursing care, while Walgreens has yet to visit most on its list.
But for nonskilled nursing facilities in the rest of the state, there are many delays. Walgreens reported it has conducted 170 clinics at the 463 facilities it’s been assigned, with 118 more visits set in the next week. CVS reported it had visited only 17 of the 516 facilities it’s responsible for, and has plans to visit 88 more in the coming week.
Those rates are among the worst in the country.
According to both firms, they started vaccinating nonskilled nursing facilities in Chicago on Dec. 28, about the time they started in much of the rest of the country. But CVS and Walgreens didn’t launch the same program for the rest of Illinois until weeks later. Both list their formal “activation” date as Monday, Jan. 25. Across the entire country, CVS’ activation date was that late in only two other places: in Wisconsin and in Philadelphia, which has its own jurisdiction. For Walgreens, only Wisconsin was that delayed.
Walgreens didn’t respond to questions about the delays. CVS said the timing was set by each jurisdiction’s health officials.
“States and jurisdictions established their timelines with the CDC and made them clear at the beginning of the program, and many states prioritized facilities with patients requiring medical care. We are following the state’s program as outlined, which has been successful to date,” according to a CVS statement.
However, the Illinois Department of Public Health said pharmacies set the timing, not the state. Asked about CVS, an IDPH spokeswoman said the company told the state it wouldn’t be done with skilled nursing facilities until Jan. 25. “If they could have made it through the (skilled nursing facilities) sooner, they could begin vaccination clinics at other (long-term care) facilities sooner,” she said.
In the meantime, facilities like Northbrook Inn, a memory care facility where Schur’s mother lives, were kept waiting.
Frustrated at the information void, Schur said he emailed a congressman, a state senator and a state representative this month. One aide advised him to sign up his mom via Lake County’s health department system, even though she lives in Cook County — and, regardless, she can’t leave her facility without being quarantined. Nobody else responded, he said.
On Tuesday, he and other families got an email from a Northbrook Inn administrator saying they were continuing to push for shots. “As I’m sure you’re aware,” the email said, “Illinois has had somewhat of a mess in rolling out the vaccines, even to assisted-care communities like ours.”
Chase Salyers is the director of operational support for Koelsch Senior Communities, the parent firm that operates the Northbrook facility. Salyers said that Koelsch, which runs 34 facilities in eight states, followed directives to sign up all facilities in November. Each facility was assigned a pharmacy that would follow up to schedule shots.
On Wednesday, he said, the firm learned that two Illinois facilities that had been under CVS had been transferred to Walgreens, which would visit in the coming days to vaccinate. The other two, including Northbrook, remained with CVS. Salyers said CVS just told him his remaining facilities would be scheduled soon.
“They said we fell through the cracks,” he said.
Schur and another resident’s daughter, Jan Caron, said they didn’t blame the facility administrators, who they said were frantically trying to arrange shots. But it’s been hard to see other older adults successfully schedule vaccination appointments online while their loved ones are still waiting.
“My personal frustration is that there are people in their late 60s who have gotten it or are about to, and a lot of nursing homes haven’t gotten it,” said Caron, whose father is 89. “There’s a big difference between 65 and 90.”
On Thursday, residents and their families got the good news they’d been waiting for. CVS said it would be coming to deliver the first shot in 12 days, on Feb. 2, or about six weeks after the program began.
