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Efforts to Vaccinate N.H.'s Long-Term Care Community Haven't Been Easy, For Facilities or Families

Karen Collman and Jamie Cunningham, during a pre-pandemic visit with their sister, Erica, who lives at Lafayette Center in Franconia.
Courtesy of Jamie Cunningham and Karen Collman
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Karen Collman and Jamie Cunningham, during a pre-pandemic visit with their sister, Erica, who lives at Lafayette Center in Franconia.

This time last month, Karen Collman was feeling cautiously optimistic. She knew that the first COVID-19 vaccines were coming to New Hampshire and, like many, saw the moment as a turning point — a sign that help was coming soon, at least to those most at risk.

“Everything seemed on track,” she recalled thinking at the time.

Karen has spent the better part of her life as the chief caretaker for her sister, Erica Cunningham, who lives at Lafayette Center, a nursing home in Franconia. Erica has schizophrenia, and she’s spent most of her life in institutional care.

“It’s been a very long road,” said Jamie Cunningham, Karen and Erica’s brother. “Try and imagine being stuck in a room since the beginning of this pandemic, not being able to get outside of a room. And for someone who knows confinement, to have that even more intense, she has done incredibly well.”

The pandemic has, understandably, upended the siblings’ ability to connect with each other. Still, they’ve tried their best to make sure their sister knows they’re there for her.

“The last Zoom call we had with her last Saturday, we were saying how strong and courageous she was,” Jamie said. “And she responded that, ‘I wish other people could see my strength.’”

Through the spring, summer and fall, as other nursing homes across the state struggled against COVID-19, Lafayette Center somehow managed to evade an outbreak. But Karen and Jamie were acutely aware that could change at any time. That’s why they were so relieved at the news that vaccines were on their way.

'Even though they were giving lots of reassurance that it's under control ... I know well enough to know that in most cases, when you have this happen, it starts to snowball.'

“You know, 20/20 hindsight,” Karen said, “I wish I'd been more concerned at that time.”

The siblings’ concerns grew when they realized their sister — and others at Lafayette Center — wouldn’t get vaccinated as quickly as they thought. First, the facility had trouble getting a clinic date, period. Then, they were told they wouldn’t get their first doses until Jan. 28, more than a month after New Hampshire’s long-term care vaccination program began.

And then, at the end of December, came even more troubling news: A resident at Lafayette Center tested positive for COVID-19.

“Even though they were giving lots of reassurance that it's under control, that we're putting special PPE practices in place, I know well enough to know that in most cases, when you have this happen, it starts to snowball,” Karen said.

They weren’t the only ones feeling this pressure. Most of New Hampshire’s long-term care facilities are relying on the federal government and large pharmacy chains, CVS and Walgreens, to administer coronavirus vaccines through a program called the Pharmacy Partnership for Long-Term Care.

CVS, which says it's managing clinics at Lafayette and more than 150 other facilities across the state, says it’s going according to plan and there haven’t been any substantial delays.

“As expected, COVID-19 vaccination clinics are operating much like the thousands of vaccinations clinics (e.g., seasonal flu) we operate in long-term care facilities every year,” Tara Burke, with CVS/Aetna, wrote in an email. “We’ve encountered no substantive delays, save for some difficulties in getting confirmation from facilities on clinic dates.”

Those on the ground say the program has, in fact, seen substantive delays and other significant challenges.

“I have a lot of worries about how this has been handled,” said Brendan Williams, who leads the New Hampshire Healthcare Association, the statewide advocacy group for long-term care facilities. “I'm sure it's been a great boondoggle for CVS and Walgreens, and good for them, and I know that the pharmacists who have arrived at facilities for the most part have been great to work with. But, you know, at the corporate level, I think this has obviously been an unprecedented undertaking, but I'm not sure it was the right way to go.”

'Days matter when it comes to getting these vaccinations into people's arms.'

While some facilities have been able to get their first doses with relative ease, and New Hampshire is farther along in its vaccination efforts than other states, Williams says the process for lots of others has been plagued by poor communication, scheduling problems and a lack of transparency. He says New Hampshire might’ve been better off taking the same route as West Virginia, which eschewed the federal pharmacy partnership in favor of a state-run vaccine distribution program

According to data from the New Hampshire Department of Health and Human Services, a little less than one-quarter of available doses had been administered to residents and staff at long-term care facilities as of last week. Data from CVS suggests that their clinics in New Hampshire are farther along than many other states: Their records indicate that 56 of 56 clinics at nursing homes, and 45 of 126 clinics at assisted living or other long-term care facilities, were completed as of Thursday. It’s not clear why CVS’s records reflect 100 percent completion of the first round of clinics at New Hampshire nursing homes as of Jan. 13 when Lafayette Center, which is licensed as a nursing home, did not have its first clinic as of that date. 

While vaccine distribution efforts have lagged, New Hampshire’s seen an explosion of COVID cases and deaths in long-term care facilities over the last month. State officials are currently monitoring more than 40 active outbreaks in institutional settings, most of them at nursing homes or residential care facilities.

“Days matter when it comes to getting these vaccinations into people's arms,” Williams said. “And the fact that it took so long to vaccinate an entirely place-bound population does not seem like a great harbinger of things to come when they need to vaccinate the general public.”

That sense that days matter has been all too acute lately for Karen and Jamie. They kept asking the staff at Lafayette Center whether it was possible to move up the date of the clinic, and the facility said they tried all they could. Meanwhile, in the last week, a few more people at the nursing home tested positive.

The siblings felt they had no choice but to take matters into their own hands. So they came up with a plan. They started sharing their story, making calls and writing letters: to the media (including NHPR), to the governor’s office, to anyone who would listen. All the while, they were trying to strike a careful balance between highlighting the urgency of the situation without placing blame on Lafayette Center, which they say has gone to great lengths to take care of Erica so far.

“I was feeling very anxious because one of the things that's most important to me is to continue to have really positive relationships with the people who are taking care of my sister,” Karen said.

But it didn’t seem like they were getting anywhere. Last Saturday, Karen woke up worrying that it was all getting away from her — that her sister wouldn’t get vaccinated before she got COVID.

“Having been in this position of being an advocate for my sister for years, and I think other family members would understand this, you're always questioning, have you done enough?” she said.

Then she realized there was one person she hadn’t yet contacted: Perry Plummer, a retired state emergency management director who’d been tapped to oversee New Hampshire’s vaccine rollout. After a bit of internet sleuthing, Karen tracked down his cellphone number and sent him a text message, asking him to help. To her surprise, she heard back within half an hour: Plummer assured her his team was working on it.

“We are definitely inserting ourselves where we need to, to make sure that the facilities are getting done in a timely manner,” Plummer later told NHPR.

After hearing about the situation at Lafayette Center, Plummer said it was apparent that the original date of their vaccine clinic “was later than what we think is in the best interest of the facility.” He said his team worked with CVS to reschedule for today, Jan. 15.

'To have some bumps and to try to work through them is expected — you know, disappointing, but expected.'

This wasn’t the only time state officials have had to intervene to fix problems with the federally run pharmacy partnership. Plummer and other state leaders have said the state is capable of stepping in to take over the process if problems persist, or to send in public health “strike teams” to vaccinate residents and staff at long-term care facilities if the pharmacies don’t move quickly enough on future clinics. But thus far, they haven’t taken that step. He says they don’t have a firm set of criteria for when the state would take over the process, because each situation is different.

“This is a response that's unprecedented. So, you know, to have some bumps and to try to work through them is expected — you know, disappointing, but expected,” Plummer said. “The truth is that they're doing this across the country. We wish everybody was vaccinated on day one. It's just not possible.”

While Karen and Jamie wish their sister could’ve been vaccinated on day one, they’re just grateful it’s happening sooner than they first thought. But they know there’s still a lot that can happen in the coming days. Friday’s clinic is just for one dose; their sister won’t get her second dose for three more weeks, and her booster shot three weeks after that.

“Right now, I personally, myself, I'm still scared,” Jamie said. “You know, it's not safe yet … Wow. I hope we cross the finish line.”

At this point, they feel like they’ve done everything they could to keep their sister safe. They just have to hope the other people in charge are doing the same.

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