Inside Consulate’s Vaccine Strategy: Town Halls, Word Of Mouth, And Optimism At A Nursing Home Giant

January 21, 2021, Maggie Flynn, Skilled Nursing News - As vaccine rollouts continue at long-term care facilities, Consulate Health Care has found staff word-of-mouth critical to getting more uptake along the front lines.  And like other operators, it’s seeing significant buy-in from residents.

With a multi-state footprint, however, Consulate has also seen variations in how fast clinics are progressing in different parts of the country, with Florida standing out for a quick rollout in long-term care facilities.

The Maitland, Fla.-based Consulate, which has 140 skilled nursing and assisted living centers — 81 of which are in Florida — had optimistic words for the overall vaccination process so far, though it was unable to provide specific numbers or estimates of residents and staff vaccinated, citing an ongoing corporate data-gathering effort. 

“I can tell you that we are very pleased with resident participation and really encouraged by the big uptick in staff participation during our 2nd round of clinics,” Consulate spokesperson Jennifer Trapp told Skilled Nursing News on January 21.  “Many of our centers have already been scheduled for their third clinics and we expect to see that participation continue.”

Skilled Nursing News caught up with several executives at Consulate to discuss the vaccine rollout and its experiences and lessons on January 14.  The interviewees were: Jeron Walker, mid-Atlantic division president who works with centers in Pennsylvania, Virginia, North Carolina, northern Florida, Mississippi and Louisiana; Mikki Meer, the Florida division president who oversees 61 of the 81 centers there; Maria Heinlein, vice president of quality assurance and clinical practice; and Andi Clark, chief nursing officer.

When it comes to the vaccination process, how did Consulate think about incentives as the rollout went underway?  Do you offer any incentives for vaccination?

Clark: From the very beginning, which started for us March 13, [2020] when we started to see the CMS and CDC guidance, we were getting a lot of information.  We decided that we needed to be very transparent and that we needed to over-communicate.  That’s what helped us prepare for the vaccines and everything else that came along.

At first, we were having daily calls with all of our teams: Our EDs [executive directors] and directors of nursing and their teams in the centers, our regional teams, our division teams, our corporate teams.  Every day, seven days a week, at 2:30 in the afternoon, I had a call and we talked about what was new, because things were changing rapidly.  We were getting: “Do this, now do that.”  There was just so much information.

So as we started to approach testing, and then as we approached the pharmacy partnerships and getting ready for the vaccine, I think we were well-positioned as a team and with our buildings, our communication systems.  We just rolled right into the next phase of the COVID-19 pandemic.  And our teams have been amazing.

Meer: Florida was probably one of the first states that once the COVID vaccine received its emergency use, really rolled.  Our governor’s office and our state and local health partners have really pushed very quickly to get those vaccines out.  For instance, of my 61 centers, four of which are assisted living, we have predominantly had our second vaccine clinics.  January 21 was the deadline or the goal in the state of Florida to have those first two clinics for our residents and staff.  It’s really been very fast and furious.

In thinking about incentives, our incentive was not financial, but peace of mind — providing education and facts about the vaccine to our employees, to our residents, to our family members, so that they could make an informed decision about what was best for them.

I think the challenge for our profession, and in our organization has well, is that people were nervous about what they perceived as the quickness of this vaccine coming and getting emergency approval.  Our goal was really to over-educate and over-communicate to all our partners, especially our staff.  [It’s a wide] group of employees, cultural diversity, backgrounds — a lot of questions about the vaccine.

Our goal was to provide as much information as we could so every individual could make their own informed decision about what was best for them, for their family, and ultimately for our Consulate family.

Walker: I don’t know if there’s a whole lot more to add to that.  We had that same strategy and focus when it came to incentivizing our staff.  The fact that the vaccine was made available to us early on, as one of the very first in the nation to be provided the opportunity to receive the vaccine, that alone we feel like was a huge incentive, and we’re really grateful for the staff that have participated and joined us in that.

How have you handled education?  And what have been some of the top concerns, aside from worries about how fast it was developed?

Heinlein: Education has always been a top priority, since the beginning of the pandemic, for our staff and residents and families.  We knew that there were going to be concerns, and so we really tried to get out ahead of that as quick as we could.  As we were learning about the vaccines, even before the EUA came through, one of the things that I think was very helpful was the polling of our staff to really understand their willingness to take the vaccine, but also some of their concerns around that, so we could focus and really tailor additional facts and resources around those concerns.

The top one that we heard was how quickly this vaccine came to market and their concerns around that.  We’ve tried to address that with really trusting the science, and using all the resources to provide to our teams so they can make that very personal choice about taking the vaccine.

We’ve used so many different platforms — social media platforms, printed materials, posters in our centers, our weekly calls, the weekly CNO calls, which started at the beginning of the pandemic.  It was a great avenue to just continue with the vaccines.  It was a perfect way to be able to get so much information — it did happen very quickly, so we were able to use that to take the information, the resources, and get that to the center leadership, so they could take that information back to the teams at the local level.

There’s been videos; we’ve used text messages and e-mails to our staff so they had multiple ways to read about the vaccine, to read about the science behind the vaccine as well, and really I think that helped in making that decision.

Walker: One thing I would add that has been very successful for us in a few of our markets is really involving the medical directors and having physician-led town hall meetings with our centers in those markets, and hearing from a physician the really good stuff that comes from the vaccine.  Those have proven in those markets to be very, very successful in encouraging staff and educating staff and the residents on the benefits of the vaccine.

Meer: I think what was very interesting in our profession is we predominantly have females employed in most of our positions; probably 80% of our staff is female.  And some of the concerns especially for our younger females are about the side effects or potential impact if they’re of childbearing years.  I think it’s very interesting to think about that, and think about our population.

Again, we just relied on science and redirected to very trustworthy sites, whether that was CDC guidance, whether that was Department of Health guidance, whether that was CVS Health/Omnicare — which was our pharmacy provider already prior to this pandemic, so we have a really great relationship with Omnicare.  Relying on information direct from Pfizer or Moderna and allowing staff to really be able to digest some of that information, ask questions and really have an open forum about the vaccine.

You mentioned earlier that many of the Florida facilities had had their second vaccine clinic — do you know how many?

Meer: Of my 61, percentage-wise, we’re probably up into 80% of my buildings at this point [January 14] that have received their second clinic, with a very large portion of residents and staff who took the first dose getting the second, so there weren’t a lot of people getting one dose and going, “Oh, you know what, I don’t want the next one, it didn’t make me feel good.”  We really had a very high percentage of residents and staff who got their first dose come back and get their second.

And then on the second clinic, a large number of residents and staff who chose not to do it the first time signed up and did it on the second visit.  I think those are the people that were a little nervous on the front end about side effects, and I think when they looked around and saw their fellow coworkers and residents and families and they saw very limited side effects — we had very little staff callout or illness or resident negative outcomes from the vaccines — I think once people saw that first round was going pretty good, we had more people decide to take advantage.

In terms of residents opting for vaccination versus staff members, I came across a webinar for New York providers where the speakers noted that residents were more open to it than staff.  Is that something you’re seeing?

Meer: In Florida, I think what you just stated was accurate.  I think we have a higher portion of residents taking the vaccine than we do staff.  Again, a larger older population: very willing and very excited about the vaccine being made available.  I think staff — younger, a little bit more apprehensive potentially about the vaccine, but with additional education and even with the passage of a couple weeks, we’ve seen really great participation.

Walker: I would concur, for the other centers outside of Florida and even within the Florida buildings that I cover as well; it’s very similar with that.

Jeron, in the facilities that you deal with, is it a similar percentage that have had the second vaccine clinic, or does the rollout vary for states?

Walker: It’s a little slower in some of the different states; Florida is ahead of the game.  The bulk of our Florida centers will have their second vaccine clinic completed before the end of the month — actually all of them will have that completed.  Whereas you start getting into some of the other states — Virginia was pretty far ahead of the game, they were doing pretty good and by the first part of February, we’ll have the second clinics completed for Virginia.

Pennsylvania, we’re kind [looking at] mid-February, Mississippi and Louisiana are lagging a little behind.  But again, by mid-February, we should have all of our centers having gone through their second clinic.

I will say, I think as the first clinics have proven to be successful, I think that’s bred a lot of confidence into the second clinics, people willing to participate.  I think as people watch the news around the nation, and they can see that really there aren’t any side effects to this, for the most part, I think they’re gaining more confidence with that as well.  I think some of the hesitancy maybe from the first clinic was just that; they wanted to wait and see.  I think they’re seeing that now.  I’m very confident that clinic two and clinic three are going to be very, very successful, even more so than clinic one.

Clark: The clinic that I was at last week to get the vaccination was interesting, because it was a first clinic, and CNAs [certified nursing assistants] were lined up to get theirs.  What I noticed as the morning wore on is the CNAs who received the vaccine were saying to other CNAs in the hall: “Are you going to get the vaccine?”  “Oh, I don’t know.”  “Oh, you should do it. I barely felt it.”

That particular building, they started out with — I think 15 staff had signed up, and by the end of the day there were 30.  I think a lot of it was our younger staff; they just did not want to have a shot, and once someone said, “You know, it really doesn’t hurt,” they started rethinking it.

Do you think that’s something that will be incorporated into future education efforts?

Clark: Yes, and we actually did that [recently] when we talked again about vaccinations and exactly that fact.  And as leaders in the company have received the vaccines, Jen has been really active in cataloguing that and saying to our teams in the building: The leadership in the company believes in the vaccine.  Chris Bryson, our CEO, did a video for everyone in our company about the safety of the vaccine and how we want to protect our patients and our staff.

And I can’t really say enough about the CVS Pharmacy partnership; the nurses that were there, the organization of their clinics, has been excellent.

When it comes to the resident vaccinations, can you talk about the communication that was involved there, and how that went?

Heinlein: I think it was making sure that we had all of the information and resources available so we could get that out to the residents, and utilizing the good information that CVS provided to us, being able to use some different methods to communicate.  Sending out a message, letting the families know: “Hey, this is coming.  Get ready.”  They were prepared when we started to do those phone calls of: “These are the dates,” and making sure we got all the consent processes correct.

It was utilizing all the resources, all the different areas that we could grab information to provide to the residents, to their families.  The process I think went really, really smoothly.  I think they were open to it and ready for it, and I think they were happy to get the consent done to understand what the process was going to be, and I think CVS did a nice job of making that as seamless as possible.

When did that process have to start?  Was it when the vaccines were authorized?

Heinlein: That was pretty early in December, as soon as we knew that the EUA was underway.  We sent out a quick notification to the families to let them know it was coming.  I mean, everybody was seeing it, right?  It was all over the news, so everybody was waiting for that.

Because we were getting our information and facts and process from CVS, so we kind of knew what that was going to look like before the authorization was actually done.  We knew what their clinics were going to look like; we just needed some of the final pieces of paper.

Were there any surprises or lessons learned over the course of the rollout?

Clark: All of our daily phone calls, it was every day at 2:30, seven days a week, and we had such huge attendance.  For three or four months it was a daily call, then we went to three days a week, and now we’re down to one day a week.  But the attendance on the calls was amazing.  I think what I have learned is the resilience, the diligence and the compassion that our center teams have for their staff and for their families.

What I’ve told the nurses in the company is that this will be defining in their career, and probably defining for all of us.  Because years from now, people are going to talk about the COIVD pandemic, and there’ll be stories — and I’ve said to them, think about what you’re doing now and the difference you’ve all made.

We’ve learned so much as we’ve gone, not only about the vaccines, but infection control will be with us forever.  We feel like we’re experts in infection control now.  It’s been as challenging as it’s been, but it’s also very gratifying to see the compassion from everybody’s that touched our patients.

Walker: From a surprise standpoint for me, when we involve an endeavor this large, working with CVS and the federal government, for it to go off as smoothly as it has has been refreshing and surprising all at once.  We’re so proud of our CVS partners and what they’ve done.  The large, large measure of clinics have been very successful, and we certainly could not have done it without them and we’re grateful for that.

Meer: Considering all the media frenzy and some misinformation out there, I’m just humbled that every single day, we have amazing caregivers walking into our centers to provide care and love and compassion to our most frail and most needy in our country.  It’s just humbling.  It’s just amazing.