Maryland SILC OPERATIONS COVID-19 UPDATE – March 9, 2021
ACL Policy Update: What ACL’s networks need to know about CMS’ new COVID-19 vaccine rule
By Alison Barkoff, Acting ACL Administrator and Assistant Secretary for Aging
Educate residents, clients, and staff about COVID-19 vaccinations;
Offer vaccines to all residents, clients, and staff (when vaccines are available); and
Report vaccination of residents and staff to the CDC’s National Health Care Safety Network (NHSN) database.
The new rule also recognizes the high risks – and importance of vaccines – in other types of congregate settings. The rule requires Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IIDs) to provide vaccine education to residents and staff and to offer them vaccines. Because ICF-IIDs do not yet have the infrastructure to report into CDC’s database (unlike LTC facilities), the rule encourages ICF-IIDs to report vaccinations to CDC and seeks public comment on mandating this requirement.
Finally, the rule seeks public comment on applying the vaccine education, access, and reporting requirements to other congregate settings, like assisted living and group homes that are funded through Medicaid home and community-based services (HCBS) programs, and psychiatric residential treatment facilities. In the interim, the rule encourages these congregate settings to voluntarily adopt culturally and linguistically appropriate and accessible vaccination education and to support individuals in accessing vaccines.
What barriers exist to the implementation of a COVID-19 vaccination policy for residents and staff of all congregate living facilities?
How can equitable access to COVID-19 vaccines be ensured for residents of congregate settings?
How can regulations be revised to ensure that congregate settings are able to reduce the spread of COVID-19?
Whether your state or county has included residential and adult day health or day habilitation staff on the vaccine-eligible list of health care providers? What other impediments do staff face in getting access to vaccines?
ACL is pleased to have worked with our colleagues at CMS on this important new rule. This rule reflects the strong advocacy by the disability and aging communities about the need to protect the lives of people with disabilities and older adults in all congregate settings. This new policy is an important step in our fight together against COVID-19, in ensuring that the people most at risk have access to vaccines, and in putting systems in place to protect that the health and safety of people in congregate settings moving forward.
(Washington Post). We are reaching a point where most of the people who want to be vaccinated are able to do so, and many of the people who remain unvaccinated are undecided or have no intention of getting vaccinated. A recent survey of people with disabilities conducted by the American Association on Health & Disability (AAHD) found that people with disabilities who were hesitant or refused to be vaccinated were most concerned with vaccine safety than with access to the vaccine. In other words, most of the individuals responding to the survey could access the vaccine, but did not want to take it or were still unsure. Many of the individuals responding to the survey – and people with disabilities in general – have legitimate concerns about the impact of the vaccines on their disabilities and underlying health conditions. Those concerns are valid and should not be minimized. However, a majority of survey respondents who refused to be vaccinated said that they were motivated by a distrust of the federal government, government officials, or vaccine producers. There are still millions of undecided individuals who could help us move towards herd immunity to make things safer for all of us, and especially individuals who cannot be vaccinated because of disability or other underlying health conditions.
Centers for Independent Living (CILs) can and should help promote the vaccines and encourage consumers to be vaccinated. We need to respect the expertise and lived experience of people who are concerned that their disabilities or underlying health issues might react unfavorably to the vaccines. But for others, CILs are trusted community organizations who can change minds and assist people with disabilities to access vaccines. These activities are allowable with CARES Act funds and likely the forthcoming vaccine funding Part C funded CILs will receive from the Centers for Disease Control and Prevention (CDC). Consider how you can use meetings, videos, social media, and other avenues to get the word out about getting vaccinated and about vaccine safety. Studies are showing that political leaders and research are not changing minds for people who are vaccine hesitant. Information from friends, and local, trusted individuals, and seeing those trusted individuals talk about their experiences getting vaccinated are convincing people that they should get vaccinated. CILs are in a great position to be that source.
CILs and partnering organizations across the country are working together to eliminate some of the barriers people with disabilities and those who are aging experience in gaining access to vaccines. One of the major barriers for people in rural settings is transportation.
To address barriers of getting to the vaccine sites, many CILs are utilizing creative partnerships for transportation. There are CILs who have used CARES Act funding to contract with transportation companies in their communities such as Uber, Lyft, and taxis to provide free rides for people with disabilities to any of the vaccination sites. A few CILs have their own transportation companies to address rural shortages and were able to provide rides. These companies vary in size and scope. For example, one rural CIL in Wisconsin, coordinates a volunteer ride share program supplemented by accessible vans the CIL owns. At a rural CIL in Colorado, the CIL owns accessible vehicles that blends funding from the Area Agencies on Aging (AAA) with CIL funds to enhance their operation. Other communities are using this opportunity to advocate with their local Department of Transportation to expand hours and routes to get folks to the vaccination sites.
For folks who can’t leave home, there are many creative solutions happening. Some CILs are partnering with local public health departments and Meals on Wheels to help identify folks who are not able to get to a site and connect them with a public health nurse who can go to their homes to administer vaccines. In Idaho, the SILC partnered with allied organizations to implement a pop-up vaccine site in a rural community that was having difficulty physically getting to the other sites and to address apprehension around getting the vaccine. It included education, vaccines, and fun giveaways. A few CILs chose to become vaccine sites themselves since they are already a location and organization that many people with disabilities know and trust.
There are CILs like the one in Michigan that used some of their CARES Act funds to train and coordinate volunteers to accompany and support individuals through the vaccine process who might be anxious because of their disability or for other reasons to get the vaccine. There are also advocacy initiatives around ensuring proper access at vaccine sites including physical, American Sign Language (ASL), and plain language information that can also help address reluctance. There is advocacy around expanding the vaccine time slots to give more room in the day for problems, such as late transportation which CILs report helps lower consumer anxiety. Many CILs are also offering support to individuals in navigating the vaccine registration system and assisting with educating on misconceptions around the vaccine.
We know that CILs are on the front lines when it comes to making sure our community gets the vaccines that they need. The IL-NET operated by ILRU with support from APRIL, NCIL, and the University of Montana Rural Institute and RTC: Rural thank you for the commitment and creativity that you have dedicated to the cause. We are here if you need us to brainstorm, offer potential solutions, assist with finding resources, or to just give you our thanks and support to keep up the good work.