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Elderly, Vulnerable Oregonians In Group Homes Fall Through Cracks In Vaccination Strategy

Three pharmacies in charge of vaccinating congregate care facilities signed up very few adult care homes, leaving staff to scramble to get their residents protected against COVID-19.
Raymond Hare (left), 92, Gina Roberts (middle) and Edith Overstreet, 92, live at A Place to Call Home in Tigard. Roberts has been trying to get residents vaccinated./Courtesy of Gina Roberts
February 23, 2021

Oregon’s adult care homes house some of the state’s most vulnerable residents: People with mobility problems who can’t get out of bed on their own, suffer from dementia or have other severe disabilities.

Multiple health woes put them at grave risk of a severe infection or death from COVID-19. Along with residents in larger long-term care facilities and nursing homes, they’re at the top of Oregon’s vaccine priority list -- in the phase 1a group.

Both adult care homes and larger long-term care facilities were supposed to be included in the federal government’s pharmacy vaccination program that rolled out Dec. 21. 

Yet adult care and other group homes have been left behind. CVS, Walgreens and a Portland-area pharmacy, Consonus, have held vaccination clinics in almost all of Oregon’s nearly 690 nursing homes and larger care facilities. It’s unclear how many clinics have been held in adult care homes. Only a few were able to sign up for the program.

Compared with nursing homes and assisted living facilities, adult care and group homes are small. They’re often run by the owner of the home, and by law most can only have five residents. They don’t have a powerful lobbying group in Salem like the Oregon Heath Care Association that represents long-term care facilities. Instead, these small businesses are Oregon’s mom-and-pop solution to long-term care. They’re run by small staffs and lack the management sophistication of nursing homes and assisted living chains.

Some of the small adult care homes that enrolled in the pharmacy program were stood up when their appointment times came, and many that enrolled got bumped from the program, according to Patrick Allen, director of the Oregon Health Authority. He indicated the state has known about their predicament for at least nine weeks.

During that time, adult care home administrators told The Lund Report, they have spent hours begging and lobbying for just a handful of vaccine doses for their elderly and frail residents. They have watched, stunned, as big nursing homes were treated to in-house vaccination clinics.

Cheryl Eckl, a 74-year-old resident at Sophia’s Home, an adult care home in Tualatin, said she and fellow residents have been distressed knowing that others with similar disabilities and health issues who live in larger facilities are getting vaccinated. A recent television show featuring a “vaccine party” in an assisted living facility drove that point home, she said.

“Our hearts just sank,” Eckl said. “There are the haves, and we are the have nots.”

No single agency has taken responsibility for ensuring that residents and staff in these homes get vaccinated. 

They’re overseen by a fractured regulatory system that involves a web of different programs in the Department of Human Services along with Multnomah County, which licenses homes in its area. The Oregon Health Authority also is involved: It oversees mental health facilities that include small homes and some that house 16 people.

In all, about 3,800 small homes and a few larger residences that house 16,000 elderly, disabled and mentally ill people qualified for the federal pharmacy program. Eighteen of them have had vaccine clinics as part of the program, DHS said Monday.

This failure by federal, state and county authorities to ensure that these residents were vaccinated when doses became available has put the lives of thousands of Oregonians at risk and reflects the state’s broader failure to move quickly to vaccinate seniors, say advocates and scientists. 

“While seniors in most other states have been eligible for vaccination as a priority to preserve life and prevent severe disease, Oregon has not had that same focus and has delayed vaccination of seniors relative to almost all other states,” said Dr. Maureen Hoatlin, a biomedical consultant and recently retired faculty member at Oregon Health & Science University who studied viruses and errors in replication. “For example in Maine, 52% of seniors 70 and older are vaccinated. In contrast, Oregon, seniors have only recently become eligible.”

Gov. Kate Brown put K-12 educators before seniors living in the community. As a result, Oregon was the last state nationwide to open up appointments for these people. On Monday, those aged 70 to 74 became eligible.

Now, the state has hundreds of thousands of people eligible for vaccination, while vulnerable residents in adult care homes still wait.

Caregivers and residents were horrified when Brown declared in late January that everyone in long-term care had had an opportunity to be vaccinated, a statement that her staff later retracted. 

“We have fallen through the cracks,” said Maryanne Cassera, a registered nurse and advocate for Sophia’s Home in Tualatin and Wilsonville. “Teachers and prisoners have been vaccinated. What about the frail and vulnerable?”

Advocates for seniors have pressed state lawmakers for action. So, too, has the state’s long-term care ombudsman, Fred Steele. In letters to a state legislative committee last month, AARP said the state faces “a crisis” due to the lack of vaccinations in adult care homes. Steele decried the lack of “any coordinated plan to distribute vaccines to state-licensed settings” such as adult care homes.

The federal government failed them. State officials have deferred responsibility to counties. Many rural counties with fewer adult care homes have managed to get many residents vaccinated, while larger, urban counties have floundered.

“The people who were always in the highest risk category continue to be at the highest risk,” said Dr. Sharon Meieran, an emergency room physician and Multnomah County commissioner. “I find this unconscionable.”

Program Announced Last Fall

Last October, the federal government announced it had contracted with CVS, Walgreens and some local pharmacies to vaccinate residents of long-term care facilities across the country. About 40% of the deaths nationwide have been among residents in long-term care facilities, according to a Kaiser Family Foundation study. In Oregon, that figure is higher -- 55%, according to a health authority spokesman -- or 1,180 deaths. The large majority have been in long-term care facilities, judging from the state’s weekly COVID-19 report. Last Thursday’s report lists just over 980 deaths in nursing homes and other long-term care facilities. It does not show deaths or cases in adult care and group homes, which presumably would account for the difference between the two figures. 

But there’s no way to confirm the exact figure. The health authority refused to release the number of deaths in care homes to The Lund Report. The agency’s public records official cited a state law that says that information obtained by state or local health officials in an outbreak investigation is confidential. 

“There is no exception under ORS 433.008(2) that would permit Oregon Health Authority, in its discretion, to provide you with the information you are seeking,” OHA’s Jeanne Windham, who handles records requests, said in an email.

State officials declined to explain why they list deaths and cases for the larger facilities and refused to release an aggregate figure for the care homes.

Steele, the long-term care ombudsman, said only about 10% of adult foster homes have had one or more COVID-19 positive cases. 

The federal pharmacy program clearly includes adult care homes: In the eligibility list, it includes “residential care communities/adult family homes.”

On Oct. 22, the Oregon Health Authority and state Department of Human Services informed county health care officials, long-term care facilities and adult foster homes about the program. Initially, they only had a week to sign up. On Oct. 30, DHS issued another alert, saying the enrollment period had been extended about a week. DHS issued a third signup alert on the last day, Nov. 6.

All of the state’s nearly 690 nursing homes and long-term care facilities, which house nearly 32,000 people, got signed up. The pharmacies are supposed to hold three clinics in each facility. One for first doses, one for second and any remaining first doses, and the third for the remaining second doses.

Vaccinations started Dec. 21, and by the end of January first-dose clinics had been scheduled in all of the state’s nursing homes. As of Monday, a DHS spokeswoman said that clinics had taken place in 95% of all facilities enrolled in the program -- totally nearly 46,900 residents and just over 38,300 staff members. All of the state's nursing home residents have now had access to the second dose. She said that since the big outbreaks took place in long-term care facilities -- and not small group homes -- they were the agency's top priority.

Mike Mike McCormick, interim director of DHS’ Aging and People with Disabilities program, told a state Senate committee at the end of January that the pharmacy program was a great success.

“This is really exciting, great progress, good momentum,” McCormick told the Senate Committee on Human Services, Mental Health and Recovery. “While there have been some bumps in the road, we’re overall very pleased with how this is proceeding.”

He called the situation in adult care homes “more challenging.”

State authorities have not released comprehensive vaccination figures of small group homes. The Oregon Health Authority has yet not responded to a request from The Lund Report. DHS said residents in 300 of 1,400 adult foster homes had been vaccinated. That leaves 3,500 homes to scramble for vaccinations. 

In Multnomah County, which oversees 620 adult care homes for people with a range of disabilities and other problems, only a dozen homes signed up, said Lee Girard, interim deputy director of the county’s Department of County Human Services.

Officials Point Blame 

It’s unclear why so few enrolled. 

”I’m not sure that we actually  know,” Girard said.

Annie Neal, supervisor of ‎Multnomah County’s adult care home program, speculated that group home administrators had been waiting for more information.

“The time frame was short and the information was scant,” Neal said.

She said the county later unsuccessfully submitted the names of adult homes to DHS to get them signed up “through different channels.” 

“At some point, somewhere, it was determined they wouldn’t get into that program,” Neal said.

It’s been nine weeks since the federal pharmacy program launched: Only 200 of the homes in Multnomah County have had staff and residents fully vaccinated, Girard said.

While county officials point to the state, state officials blame the failure on federal authorities.  

“Since the program was federal, there was a general lack of understanding as to what an (adult foster home) is,” wrote Lynette Caldwell, adult foster home manager at DHS, to care providers in a Feb. 18 email obtained by The Lund Report.

Allen, Oregon Health Authority director, said on Friday that state officials spent three weeks arguing with CDC officials trying to get adult care homes into the program. 

“These were facilities we were led to believe by CDC were eligible for the federal pharmacy partnership program and in fact had been signed up,” Allen said.

CDC officials declined to answer questions about the program in Oregon, referring The Lund Report back to the state.

Although the program is run by the federal government, Steele blamed the state.

“We in Oregon have intentionally built a home- and community-based care system for long-term care services,” Steele said. “It is very much the state’s responsibility to ensure that every person in every one of those licensed care settings has access to a vaccine or any other applicable service, whether it’s one of our smaller adult foster care homes or one of our larger institutional nursing homes.”

He said it was clear that the state’s reliance on sending out email alerts was not enough to get the adult care homes on board.

 “We absolutely as a state should have recognized before the vaccine started rolling out that we needed a more coordinated plan for distribution in those homes,” Steele said. “We should have recognized that the typical standard communication through things like an administrative alert and otherwise wasn’t going to be sufficient around the need to mobilize around a vaccine clinic.”

Frustration Mounts

Cassera, the registered nurse, tried to get Sofia’s Home in Tualatin and Wilsonville into the federal pharmacy program last fall. She said she filled out the required survey three times to ensure the homes were accepted.     

The CDC never responded, she said.

Eckl, the resident at Sofia’s Home in Tualatin, who suffers myriad health problems, said it’s been difficult to be cooped up during the pandemic. She said she’s not been to the dentist in a year and hasn’t seen her grandchildren.

“I hope I remember what they look like,” Eckl said.

She said all five residents at the Tualatin home want the vaccine.

“We didn’t ask to be first,” Eckl said. “We knew the teachers should go first. But 

when they didn’t put us side by side with the prisoners that was a disappointment.”

This month the state started vaccinating inmates. 

An administrator of two homes in Southwest Portland, who requested anonymity over fears of backlash from the state, also tried to sign up last fall. She said she spent hours on the computer trying to get her homes registered. Her 10 residents are frail, have dementia and all of them are over 90, putting them at very high risk of severe disease or death from COVID.

Her homes did not get into the pharmacy program. 

“The big long-term care companies have lobbyists, so (those residents) had the opportunity to be vaccinated onsite in a safe environment,” the administrator said. Residents of small adult care homes are “in the same priority group, but they were not given that luxury. That’s something that doesn’t sit well with me.”

Since January, she has been emailing and calling state and county officials, trying to get her residents vaccinated. The state offered her appointments at the mass vaccination clinic at the Oregon Convention Center, but she was horrified at the prospect of exposing them to the public. 

“I’ve spent a year keeping them safe,” she said. “I run a really tight ship.”

In the end, four of her residents got vaccinated there. She also recently got the rest of her residents vaccinated by calling a nearby Albertsons and asking to talk to the pharmacy manager. He called back and offered eight extra doses. He visited her homes that night and vaccinated everyone.

“He was a godsend,” she said.

Another owner of an adult care home, Gina Roberts, thought she was one of the lucky ones. A registered nurse, she enrolled her home, A Place to Call Home, in the pharmacy program. She picked CVS, which scheduled three clinics at the Tigard home -- for February, March and July.

She said CVS sent her information about the vaccines, links to videos by pharmacists who explained the process and a stack of consent forms for families. She obtained all the necessary signatures and had copies of the residents’ insurance cards. 

“It seemed totally legit and great,” Roberts said.

The first clinic was scheduled for Feb. 10 at 2 p.m. Roberts ensured the residents, who include a 300 pound woman, a resident with advanced dementia and a man suffering from two broken thigh bones, were ready. 

“They were really excited about it,” Roberts said.

She also asked her caregivers to be there, including one who drove from her home in Clatskanie.

But CVS never showed up.

“I did everything that they told me to do for the vaccine clinic,” Roberts said. “But they didn’t do their part.”

She received an email the next day from Ashley Butcher, an account representative at Omnicare, a CVS affiliate that provides pharmacy services to long-term care facilities. The email said: ”Unfortunately the clinic will not be able to take place as we cannot service based on not having a common area outside the home and/or oversight coordinator. ... I encourage you to work with your local health department at this time. I do apologize.”

Butcher did not respond to a request for comment from The Lund Report.

Adult Care Homes In Limbo

Many rural counties have been fairly successful in getting adult care home residents vaccinated, Steele said.

With fewer adult care homes, smaller counties are more nimble. Klamath County, with about 50 adult foster homes, is one example.

Valeree Lane, the county’s health equity coordinator, said only two of the homes were enrolled in the pharmacy program. But one had an outbreak, so a local doctor went to the facility and vaccinated those who had not contracted COVID-19. For the other homes, she said the county worked with local emergency medical services and supervised nursing students to get appointments at Sky Lakes Medical Center in Klamath Falls for residents who could travel. On-site vaccination clinics were organized for the rest.

Cassera, the nurse advocate for Sofia’s Home in Tualatin and Wilsonville, told state and county officials they should let trained medical personnel, like herself, organize vaccine clinics in the homes.

“I proposed it to OHA, and mentioned it several times to the county,” Cassera said, referring to Clackamas County. “They said it sounds like a great idea, but nobody is willing to run it up the chain of command and get approval.”

An agency spokesman said OHA is not opposed to the idea

“If the adult foster home has someone who is trained to administer vaccines, and is registered as a COVID vaccine provider, they can administer vaccines to residents,” said Jonathan Modie, an OHA spokesman.

But Cassera has not made any headway. She also said DHS has not been much help. It sent her links to sign up for drive-through vaccine events organized by Oregon Health & Science University at the Portland airport. With a crush of demand, she could never find slots available for those who could make it, like caregivers. And for the residents, those events are inappropriate, she said.

“Some of these folks are bedbound,” Cassera said. “It would require an act of God to get them to a vaccine event.”

Nevertheless, OHA told her to coordinate with the insurers for Medicaid patients to arrange medical transport. 

After getting the “runaround'' from OHA and DHS, she said she met with staff from U.S. Sen. Ron Wyden’s office and solicited the help of state Rep. Rachel Prusak, chair of the House Health Care Committee.

“I want accountability and transparency,” she said. 

McCormick, the interim DHS manager, said in his Senate testimony that state officials had given the list of adult care homes needing vaccinations to local public health authorities and Medicaid insurers and asked them to carry the torch. He said the Department of Human Services and the Oregon Health Authority were “coordinating mobile vaccine clinics.”

Multnomah County officials acknowledged the need for on-site visits to adult group homes. Girard said about 150 adult care homes in the county need a mobile clinic. She said the county is trying to organize them. State officials have also echoed the need for mobile clinics.

But no one seems to be in charge of organizing them.

It’s unclear how many residents and caregivers in adult care and group homes remain to be vaccinated. Less than 20% of people aged 65 and over have been vaccinated, giving Oregon the third lowest percentage of vaccinated seniors among 31 states with comparable data, according to a report by The Oregonian/OregonLive.

On Monday, Oregon added another 206,000 thousand seniors aged 70 to 74 to the eligibility list, and next week appointments will be open to the 258,000 Oregonians between 65 and 69 years old.

Allen, the director of the health authority, acknowledged on Friday the state has known for a while that adult care home residents had fallen through the cracks, but he said the state is trying to rectify that.

“It has been a scramble to try to cover these folks, not having expected to have to plan to at the beginning,” Allen said at the news conference. “But they will get vaccinated. We will make sure that every one of these foster care facilities gets a visit and is able to schedule vaccinations.”

Adult care home administrators who’ve spent weeks trying to navigate the system as they compete with educators and seniors, just want to know when.

You can reach Lynne Terry at [email protected] or on Twitter @LynnePDX.