As we enter winter, the cooler months in many parts of the United States, infectious disease experts estimate that 50,000 people in the country will die of COVID over the next five months, between now and the end of March. One of every five of these individuals who die- 20% – will be nursing home residents. Ashish Jha, White House COVID Coordinator, told this to representatives from the LeadingAge Policy team and a handful of others (AHCA, AARP, and HHS) when Dr. Jha and his senior team met with us on Tuesday, November 1.
“All or most of these deaths are preventable with the proper use of vaccines, boosters and treatments,” Jha observed. “We can save ourselves and potentially prevent 50,000 deaths.” Nursing home and assisted living providers play an important role in encouraging the use of these measures and Dr. Jha asserted that the White House has a strong commitment to partnering with aging services providers to prevent this dire outcome.
The issues Jha wanted to discuss and work together on were:
Boosters – how can we get more residents of nursing homes and assisted living to take the bivalent booster?
Therapeutics – the use of therapeutics is still much lower than it should be. How can we increase use of covid treatments?
Indoor air quality – what messages do we need to get out there about mitigation measures related to indoor air quality?
Regarding boosters and therapeutics, Dr. Jha suggested this conversation focus on residents because the numbers, issues, and concerns regarding staff are quite another topic.
The White House team made it abundantly clear that providers are partners in this effort; they are not seeking to lay blame on providers for low booster and therapeutics use rates. In fact, CMS colleagues in the meeting noted that nursing homes are required to offer boosters to residents – and they do so consistently.
Tone and words matter.
It’s important to add that LeadingAge participants in the meeting pointed out that tone is going to contribute to making the partnership work. Although the White House COVID team does not write White House press material, they heard the LeadingAge concern that some recent White House releases have been unnecessarily negative, damaging, and hurtful to committed long-term care providers. They promised to look into this.
Promoting acceptance of bivalent boosters.
On bivalent boosters, Dr. Jha said that approximately 25% of nursing home residents have pulled up a sleeve since bivalent boosting started in September. Importantly, for comparison, the rate for all eligible individuals in the U.S. is around 8.5%; 25% is commendable and headed in the right direction. In conversations with individual nursing home providers, we consistently hear that up to 90% of residents have received the bivalent booster.
The White House team was very curious to understand what providers are doing to achieve such high acceptance of the new booster by residents. They also asked why rates are so low in some nursing homes, including some in the same community as those with exceptionally high rates.
Some of the reasons offered by LeadingAge and others in the meeting were weariness and pandemic burnout or a belief that it is over, having not heard of the new booster, worrying about the newness of it, family members advising residents not to take it, the idea that they’ve already had a booster, assuming super immunity because they have had COVID, seeking a specific brand, inability to deliver the vaccine on demand at the bedside, and lack of trust of the messenger suggesting the booster.
LeadingAge representatives suggested that some providers might appreciate help with vaccine clinics. CMS leaders who were on the call mentioned that QIOs have funding to help providers with boosters, including some support for onsite clinics. LeadingAge is reaching out to CMS to learn more about these potential clinics.
Increasing rates of treatment.
Dr. Jha started the conversation on treatments saying that as far as he’s concerned every person over age 50 who tests positive for COVID and has symptoms should start oral treatment as quickly as possible. It the symptoms aren’t severe at first, they should still start oral therapeutics because “you don’t know how the person will feel in the next few days and by day 8 it’s too late.” The issue that older people are not accessing therapeutics for COVID is across the board, no matter where people live.
There’s a lot of misinformation or lack of knowledge about covid therapeutics among prescribers and patients. The White House COVID team is connecting with providers, medical records companies, pharmacies, medical associations, and others to promote the message that we have treatments, providers should be prescribing them, and there is not a supply or access problem. One of the things the administration is developing is an explainer for prescribers on Paxlovid and other oral therapeutics. It will have a simple red, yellow, green system to help prescribers make quicker decisions when time is of the essence.
Everyone breathes air. Addressing air quality can start low-cost.
The conversation was so robust that the group had time for only a cursory discussion of the air quality issue. The White House team said that the most important thing providers can do is make sure their HVAC system is working as it was originally intended to work. The staff noted that while many air quality companies and products are excellent, there is a lot of misinformation. They understand that it is difficult to separate the wheat from the chaff and are working on ways to support providers in doing that.
One important take home message was that there are low-cost steps anyone can take. As the point person on the team said: we regulate everything else that comes into your home. “Why do we have standards for water but not for the air? We all breathe air.”
Communication and trust.
The key themes that have been with us since the beginning of the pandemic – communication and trust – endure. These themes apply in all the relevant relationships between residents, providers, staff, family members, the government, local health departments, pharmacies, and others. LeadingAge members continue to lead the way, but much work remains to be done.
A note about the rest of the continuum of services.
Although the November 1 meeting focused on nursing homes and assisted living settings, the COVID team expressed interest in talking about non-nursing home settings, such as adult day, affordable senior housing, peoples’ own homes, and others. LeadingAge will continue to follow up with the White House team on these discussions.