To protect elderly, advocacy group wants boosters mandated in Oregon long-term care facilities

The advocacy group Disability Rights Oregon is asking leaders of the Oregon Health Authority and the state Human Services Department to mandate booster doses for employees in nursing homes and long-term care facilities in Oregon.

The state’s nearly 700 long-term care facilities with approximately 40,000 residents accounted for the highest share of deaths from Covid-19 the first year of the pandemic. State figures show that more than 50 facilities are still grappling with outbreaks as the highly infectious omicron variant is expected to spread rapidly in the state in the next month.

The lethal impact of the variant isn’t clear to health authorities yet, but state officials last week declared they were most worried about vulnerable Oregonians, including seniors. The health authority told the Capital Chronicle that arranging boosters for seniors is a priority though it hasn’t established a plan.

“Roughly one in every three Oregonians who have died from Covid-19 resided in a long-term care facility at the time of their fatal infection,” wrote Thomas Stenson, deputy legal director of  Disability Rights Oregon, in a letter obtained by the Capital Chronicle. “A new variant arising just at the time the efficacy of an early 2021 vaccine course begins to wane poses a very serious threat, especially in these facilities. For these reasons, the prospect of the omicron variant spreading in long-term care settings at this time is extremely troubling.”

The letter said the two agencies should mandate boosters or ask Gov. Kate Brown to do so.

Brown’s staff said in a statement Wednesday a mandate wasn’t coming – at least now.

Stenson said a mandate was the next logical move.

“If that policy change requires an order from the governor to do so, we would ask you to approach the governor jointly for such an order,” Stenson wrote.

“Given that the danger of further infections, hospitalizations, and death in long-term care facilities is already enormous, mandating boosters for long-term care facility staff should be an easy policy choice,” Stenson wrote. “Health care providers, including long-term care staff, are already required to be vaccinated. Vaccine is currently plentiful with minimal logistical challenges in distribution relative to 10 or 12 months ago. Staff who are already vaccinated are not likely to have new religious or medical objections to a booster.”

The letter, sent Tuesday, was addressed to Patrick Allen, director of the Oregon Health Authority and Mike McCormick, acting director of the Aging and People with Disabilities program in DHS.

The Oregon Health Authority said in a statement Wednesday to the Capital Chronicle: “We know vaccination requirements dramatically increased the number of staff and patients who were protected in a wide range of health care and other settings. Public health officials at OHA continue to evaluate the emerging science about boosters and variants to determine whether Oregon should revise how many vaccinations it takes to be up-to-date and fully protected.”

At a news conference Friday, Allen and Brown said that Oregonians have about two weeks before omicron hits, and they urged residents to get vaccinated and boosted. 

Brown’s office indicated Wednesday that a mandate is out of the question, at least for now. 

“While the governor has stated that all options are on the table as we face a projected surge in omicron cases and hospitalizations, her focus right now is on making sure our most vulnerable Oregonians have access to booster shots and ensuring we are ready to support our hospital systems,” Liz Merah, Brown’s press secretary, said in an email. “She is encouraged by the state’s latest data, which shows that nearly 100,000 Oregonians have stepped up to get boosted since her call to action last Friday. If this pace keeps up, we are well on our way to meeting the governor’s goal of an additional 1 million Oregonians getting boosted by the end of January.” 

Representatives of the Human Services Department didn’t respond by the end of day Wednesday with its reaction to the mandate request.

Officals say state’s message is not strong enough

Employees in residential facilities are required to have two doses of a Pfizer or Moderna vaccine or one dose of Johnson & Johnson or otherwise must be determined to be exempt. State data show that 87% of staff – about 29,000 people – are vaccinated and 63% qualify for a booster shot. Only 20% of long-term care employees have a booster dose.

Among the 40,000 residents in long-term care facilities, 90% have had two shots but only 44% have gotten a booster.

Fred Steele, the state ombudsman for long-term care, worries about new waves of outbreaks just as those from delta are starting to wane. He said that besides making long-term care centers a priority, the state needs to do a better job of emphasizing the need to get a booster shot.

“The messaging hasn’t been strong enough about the need for boosters and the waning effectiveness of the original vaccinations,” Steele told the Capital Chronicle. 

Initial studies in Britain indicate that two doses of Pfizer or the AstraZeneca vaccine, which is not available in the United States, protects about 30% of people against omicron. A booster dose increases that to about 80%. One study still being evaluated by experts found that the Johnson & Johnson vaccine was useless against omicron. 

State data show that a quarter of a million people in Oregon have been vaccinated with the Johnson & Johnson vaccine compared with 3.9 million for Pfizer and 2.5 million for Moderna.

The state’s webpage on boosters does not draw any distinctions among the three vaccines, and it doesn’t explain the new urgency. Instead, the site explains that boosters are an extra shot and that they’re recommended by the federal Centers for Disease Control and Prevention, especially for people who are immunocompromised.

“A booster is a vaccine dose that may be given to someone whose immune response from the primary vaccine series begins to wane over time or to those at higher risk of severe disease or infection due to working or living conditions,” the webpage says.

Hope for a laser focus by the state

Steele said he hopes that the state’s plan to get 1 million more Oregonians boosted by the end of January will lead to a laser-tight focus on vaccinations of employees and residents in long-term care centers.

“Beyond messaging, the actual approach of getting vaccinations in the arms needs to occur within the next couple of weeks,” Steele said.

On Dec. 17, the Human Services Department alerted all long-term care providers and nursing homes that they need to be “actively and urgently implementing Covid-19 vaccination opportunities for residents and staff, including booster shots and third doses.” The state directed them to detail what they need to get residents vaccinated on an online form.

“Any long-term care facility that needs help with a pharmacy relationship to receive vaccine, including boosters, can ask the state for help,” the state said. “The state is also actively offering vaccine assistance with a high degree of urgency.” 

A Human Services Department spokesperson, Elisa Williams, said that the health care and human services agencies have stepped up “outreach efforts” to long-term care facilities. Since mid-December, DHS employees have been calling every nursing home and residential care facility to confirm that it has given residents access to booster shots. 

“The outreach and assistance includes providing mobile vaccine clinics for facilities that the state determined have not yet provided residents with a booster shot opportunity,” Williams said in an email. “Scheduling of these mobile clinics is underway with the goal of ensuring all licensed facilities have either provided booster shot opportunities or have a booster shot opportunity scheduled by mid-January.”

As of this week, about 30 long-term care facilities had requested a mobile clinic to help with their vaccinations.

More than 530 facilities are obtaining booster doses through a pharmacy, a DHS Williams said. 

The Oregon Health Care Association, the trade group representing long-term care facilities, told the Capital Chronicle that it is coordinating with the governor’s office, DHS, the Oregon Health Authority and pharmacies to help nursing home and long-term care facilities step up booster doses for residents.

“Boosters and ongoing vaccinations in long-term care facilities are not coordinated by the federal government like the initial vaccine clinics were a year ago,” the association said. “Those vaccine clinics took months to plan and several months to complete. They were supported with large-scale staffing resources from the pharmacies who had contracted with the federal government.” 

This time, each facility is responsible for ensuring to vaccines and boosters, the association said.