URGENT - New Initiative and Long-term Care Supports

Dear Partners:

The Washington State Department of Health (DOH) continues to support enhanced efforts to protect those in long term care (LTC) as the flu, COVID-19 and RSV outbreaks continue. Data continues to show vaccines reduce the rates and severity of illness for seniors and staff who may get ill.

Please offer COVID bivalent and influenza vaccines now to all residents and staff who are not up to date or already vaccinated. Immunity from initial COVID vaccination series is known to have decreased over time and does not sufficiently protect individuals from new viral strains. Please see additional information below on the Centers for Disease Control and Prevention (CDC) and DOH vaccine program supports and resources to help meet current immunization needs. 

The CDC has provided a new opportunity for LTC providers to access single dose vials of COVID 19 vaccine for use in any setting. Interested LTC COVID-19 Vaccine Providers must have access to a prescribing authority, staff available on-site for COVID-19 vaccine administration, and the ability to meet proper vaccine storage and handling, along with cold chain requirements.  More information about enrollment can be found Long Term Care Facilities Enrolling in CDC COVID-19 Vaccination Program | CDC. 

A provider who meets the new CDC program requirements may apply to become a COVID-19 vaccine provider as a federal government step-down partner. They will then directly receive vaccines through their local pharmacy from federal government stock. The LTC COVID-19 provider using this process is required to ensure facility level data entry into WA Immunization Information System within 90 days of vaccine administration. Vaccines require special storage and monitoring as well as qualified and trained staff to administer.  We encourage facilities that have these capabilities and resources to apply.  Even without registering as a provider with CDC, facilities working directly with a pharmacy may be able to obtain single dose vials if onsite staff are qualified to administer vaccinations.  Additional resources for onsite vaccination support is also available in most areas by: contacting your LTC pharmacy partner; Local Health Jurisdiction or the Department of Health through this survey link: https://www.surveymonkey.com/r/DQ5K9WV. 

The Washington State Department of Health remains committed to ensuring vaccine equity for all LTC providers.

Resources for LTC Vaccine Assistance:

Vaccine in a Minute - December 19, 2022 (DOH)

LTC Bivalent Booster and Flu Tool Kit Resources (DOH)

LTCF Bivalent Booster Flyer (DOH)

Sample letter for Residents (CDC)

In partnership, 

COVID-19 Vaccine Program & the Office of Immunization 
Washington State Department of Health 
COVID.vaccine@doh.wa.gov  
www.doh.wa.gov 

Read below for message from our partners at the Centers for Disease Control and Prevention:

Dear Partner/Awardee:

As we enter the winter months with increasing cases of respiratory diseases, including COVID-19, we need your help to encourage older adults to receive the updated (bivalent) COVID-19 boosters, especially those living in long-term care settings (LTC). The data tell us why.

A recent CDC report showed: 

• Adults ages 65 years and older: 

• Continue to have the highest COVID-19-related mortality rates.
• The COVID-19-related death rate among unvaccinated people who are 65 years and older has consistently been higher than the rate among vaccinated people.

• Adults ages 85 years and older:

• Remain at particularly high risk of dying of COVID-19.
• The proportion of COVID-19–related deaths accounted for by adults in this age group increasing during April–September 2022 from 28% to around 40% of COVID-19–related deaths.

 

CDC data on nursing homes showed:

• COVID-19 case rates:

• Are higher in nursing home residents who have not received all recommended doses than those who are up to date.

• COVID-19 vaccination rates, as of December 11:

• 43% of nursing home residents in the United States are up to date with COVID-19 vaccination.
• 10% of nursing home staff in the United States are up to date with COVID-19 vaccination.
•  

The updated (bivalent) COVID-19 boosters are the best protection against COVID-19 variants causing illness right now. CDC, HHS, and partner organizations are reducing barriers to vaccination for residents of LTC facilities by providing flexibilities in vaccination administration, increasing communications, and encouraging jurisdictions to utilize “strike teams” for intensive facility level efforts. 

 

Specific actions under this approach include: 

 

• CDC is creating COVID-19 vaccine sub-provider agreements to allow LTC facilities that are not directly enrolled as providers in the CDC COVID-19 Vaccination Program to access COVID-19 vaccine doses through enrolled pharmacy providers for direct administration by the LTC facilities to their residents and staff. See Long Term Care Facilities Enrolling in CDC COVID-19 Vaccination Program | CDC for more information.  
• Use of single-dose vials: HHS has approved the use of single-dose vials of Pfizer vaccine for the core LTC pharmacy partners in order to improve access.  LTC may now order COVID-19 vaccine doses in single dose vials.  CDC will work with HHS (HCORE) and pharmacy partners to strengthen this option, which should help with maintaining safety and effectiveness of vaccine in the field and limit the risk for potential damage to vaccine product.  
• Data reporting flexibilities: HHS will move forward and grant a 90-day temporary waiver of data reporting requirements to the state/local immunization information system (IIS), unless required by state laws.   While reporting of administrative data to IIS remains important, CDC hopes this temporary waiver will assist in increasing vaccine access in these specific facilities. Facilities can still report to IIS voluntarily if they choose and facilities should continue to report to IIS during this period if their state law requires it. CMS-certified nursing homes are still required to report resident and staff vaccination data to CDC’s National Healthcare Safety Network each week.  More information related to this reporting can be found at: LTCF | Weekly HCP & Resident COVID-19 Vaccination |NHSN | CDC.
• Alternative vaccine providers: Working with LTC facilities and partners to consider emergency medical technicians (EMTs) or home health agencies, who are COVID-19 providers, to provide onsite vaccinations 
• Strike Teams: Engaging with interested state health officials to develop “Strike Team” efforts in LTC facilities. 
• Communications: CDC and HHS will accelerate and saturate messaging, data, and communications towards these facilities.  

 

Here is how you can support as more health care providers and LTC facilities reach out to state and local health departments for vaccine assistance:

 

• Share this sample letter with LTC facilities so that they can share it with residents and their families. This letter provides information about COVID-19 vaccination and language to communicate and promote the facility’s efforts to provide access to the vaccine (e.g., onsite vaccination or driving residents to a vaccination site).
• Advocate for a strong and clear recommendation from the patient’s healthcare provider to help increase the likelihood that a patient will agree to be vaccinated.
• Ensure providers and facilities know that vaccinators such as emergency medical technicians (EMTs) or home health agencies, who are COVID-19 providers, may be available to provide onsite vaccinations at LTC facilities. The Centers for Medicare and Medicaid Services (CMS) will allow Medicare-enrolled immunizers, including but not limited to pharmacies working within the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare SNF residents.  This means that vaccinators such as EMTs or home health agencies may be available to provide onsite vaccinations at LTC facilities, helping provide much needed access to residents.
• Stay up to date on the latest COVID-19 data in your state or county, using CDC’s COVID-19 Data Tracker. This quick reference tracker provides information on COVID-19 cases, deaths, hospitalizations, testing, and vaccination.

Thank you for all of your efforts to increase vaccination among this critical population who are at great risk of severe illness and death from COVID-19.