2023 Winter GAPNA Newsletter Volume 42 Number 4

Long-Term Care Leadership Summit

Office of Pandemic Preparedness and Response Policy, Federal Government Executive Branch
November 18, 2023

Meeting hosted by:

  • Major General (Ret) Paul Friedrichs, MD-Deputy Assistant to the President & Director of Office of Pandemic Preparedness and Response Policy
  • Xavier Becerra, JD-Secretary of the Department of Health and Human Services (HHS)
  • Mandy Cohen, MD, MPH-Director of the Centers for Disease Control and Prevention (CDC)
  • Jonathan Blum-Principal Deputy Administrator & Chief Operating Officer of the Centers for Medicare and Medicaid Services (CMS)

Attendee list was not available: (approximately 24 present):

  • Jennifer Kim, DNP, GNP & Natalie Baker, DNP, GNP-Gerontological Advanced Practice Nurses Association
  • David Gifford, MD, MPH-Chief Medical Officer for the American Health Care Association and National Center for Assisted Living
  • Nikki Romanik, MD- Office of Pandemic Preparedness and Response Policy
  • Megan O’Reilly-American Association of Retired People
  • Ruth Katz-Senior VP for Policy, LeadingAge
  • Kimberly Miller-Tolbert, HHS
  • Veteran’s Administration
  • Several representatives from CMS and CDC

Summary of Meeting:

The Office of Pandemic Preparedness and Response Policy was created two months ago, with nine employees. One of their focus areas is to understand the long-term care landscape better to improve COVID vaccinations uptake in this setting. They are equally concerned about vaccination rates in the residents and employees.

Director Friedrichs outlined three meeting objectives:

  1. Collect information for a Congressional report that will detail the department’s plans.
  2. Explore COVID vaccination distribution and uptake and create opportunities for improvement.
  3. Determine friction points in the current COVID vaccination program.

Known strengths to providing effective infection prevention strategies in LTC (outlined by Friedrichs, Becerra, Cohen, and Blum prior to audience discussion):

  • For the first time in history, we have three vaccinations for respiratory infections-COVID, RSV, Influenza.
  • Masking, testing and treatment saves lives.
  • The Quality Improvement Organizations (QIO) for LTC facilities have been effective.
  • We have evidence-based tools for reporting.

Known obstacles to providing effective infection prevention strategies in LTC (outlined by Friedrichs, Becerra, Cohen, and Blum prior to audience discussion):

  • It can be very difficult to get things done given the complexity of the federal government.
  • We must work together for solutions.
  • Problems with access, operational issues, and trust.

Attendee Conversation:

  • Need to engage nurse leaders (especially NPs) to help build trust and are respected by their peers.
  • Need to look at NP reimbursement to help increase NP utilization.
  • Access to vaccination and testing-CDC bridge program for vaccination access, CDC can provide testing supplies, 40 million vaccines shipped in past 6 weeks.
  • LTC Strike Teams have increased vaccination rates.
  •             Contract pharmacies have workforce shortages despite getting reimbursed for vaccination administration. These pharmacies require a minimum number of residents/employees willing to accept vaccination and it often takes 2-3 months before they visit the facility.
  •             Secretary Becerra stated that the new commercialization of vaccines eliminates the government’s control of distribution and administration. However, there may need to be federal pathways created for this patient population.
  • Workforce issues-trust problems with proposed staffing rules that may eliminate LPNs.
  • Staffing issues across disciples, MD, nursing, pharmacy.
  • VA experiencing problems receiving vaccines.
  • There is friction between commercialization and government framework.
  • Barriers to vaccination reimbursement.
  • Some of these issues may require congressional involvement.
  • David Gifford (AHCA): Nursing homes often blamed for COVID cases, MCR A-problems with billing for the vaccines, frequent staff turnover creating ongoing need to vaccinate employees.
  • AARP: Help build trust with caregivers, build relationships with nurses, look at best practices.
  • 2 recent articles have looked at trust and reasons why people make the choices that are made.

Final remarks by Director Friedrichs & Secretary Becerra:

Categories of concern discussed were:

  • Bureaucratic obstacles.
  • Reimbursement problems.
  • Workforce issues.
  • Access to vaccines, tests.
  • Hospitals need to vaccinate before they transfer to LTC.

Next Steps:

  • Attendees to send any data that might support today’s discussion.
  • Will reconvene at a later date to discuss short/long term goals.