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Despite the apparent success of vaccination, the COVID-19 danger is by no means over. People are still contracting the virus and at risk; some people can’t be vaccinated or missed getting vaccinated; occasionally, someone doesn’t develop immunity.

What was true at the beginning of the pandemic is still true more than a year later: Older adults are at a far greater risk of hospitalization and death as a result of coronavirus.

But there’s a treatment that has had lifesaving effects: Monoclonal antibody treatments, or mAb. Studies show that when administered early in the course of infection, these outpatient infusions are 87 percent effective in impeding disease progression and preventing hospitalizations. It’s not a cure, but it far minimizes the complications and seriousness of a case of COVID-19 and helps lead the body to recovery.

“Preventing hospitalizations”—that’s a top goal for senior living, particularly during the pandemic, when a hospitalization can leave a resident at risk of further infections, isolated, stressed, and worse.

Another key phrase is “administered early”—treatment should be administered as soon as possible after symptoms start in order to be successful. This requires a test with a short turn-around time.

Antibodies cannot be given more than 10 days after symptoms start.

But mAb treatment requires specialized procedures, training, knowledge, and access to the medication itself. These are not typically available in a senior living community. And a senior living staff handling highly demanding work during a pandemic simply doesn’t have the capacity to stretch that far.

That’s where public-private partnerships leapt in to fill the gap. The goal was to have trained assistance, pharmacies, and community capabilities converge ASAP to deliver treatments—riding to the rescue, so to speak.

I think something we do quite well is partner very closely with the medical entities around us and coordinate resources. I encourage other senior living providers to not think they can do it all on their own,” says Meredith Mills, senior vice president and COO at Country Meadows.

What is mAb treatment?

Monoclonal antibodies are antibodies made in the lab. They’re modeled after natural antibodies, then customized to attack specific threats. When mAbs made to attack COVID-19 are given to a person testing positive for COVID-19, they home in on the spike proteins on the virus—those spiky bumps you see on the pictures of enlarged viruses posted seemingly everywhere—and wipe them out.

Different types of monoclonal antibodies target different spikes; recently, using a combination of types was found to be more effective. Changes in the types of antibodies and combinations used are ongoing with the emergence of variants and new research. Before senior living residents could benefit from mAb treatment, several obstacles needed to be overcome.

It’s new. In November 2020, mAb treatments were authorized by the U.S. Food and Drug Administration, under an emergency use authorization (EUA). But an EUA status requires significant documentation—proving eligibility and consents—and preparation that must be followed to the letter.

It requires special handling. Obviously, lab-made products need special handling to be used safely. The mAb treatments themselves had to get to pharmacies serving long-term care communities, and then to communities, all according to procedures.

It requires special skills. The treatment is done by infusion, and infusion requires training and expertise, usually from a registered nurse. The professional administering the treatment needs to be able to insert an IV and observe and assist as needed during the one-hour infusion time.

The professional also must monitor the patient for an hour after the infusion. But assisted living settings often don’t have infusion professionals. And if a patient has to go to the hospital to receive mAb treatment, it defeats the purpose.

It sometimes requires education. As with all action around COVID-19, using these treatments means helping residents and families get a clear and accurate understanding. Getting permissions and handling billing and reimbursement can be complicated as well.

But with lives at stake, solutions soon abounded.

Building the bridges

The obstacles are being overcome by several providers, including Chelsea Senior Living, Sunrise Senior Living, and Country Meadows Retirement Communities, through partnership with federal programs and other organizations.

When Country Meadows was offered treatments through a relationship with Penn State University, “we took the opportunity and ran with it,” says Dr. John Hopkins, DO, Country Meadows corporate medical director and president and founder of CCS Healthcare.

“Because of the large number of infections at that time, in December and January, we were doing sometimes 10 a day, for three days in a row…. it’s been a wonder drug of sorts for us.”

The provider kept a traveling team of two nurses and an advanced practice clinician on call, paying a retainer through grant funding. They expanded the program, training nurses in its skilled nursing facility to administer treatments. Country Meadows itself has a strong clinical support team; recognizing that demographics were leading to rising acuity in senior living, it had already begun a strategy to build capability and leadership to meet such needs.

“The families, in the beginning, had a lot of questions,” says Meredith Mills, MHA, PCHA, senior vice president and chief operating officer at Country Meadows. “So over time, we’ve transferred that task from the medical teams to the executive directors, providing them with a FAQ list.”

Sending information about the positive results to residents and families also made a big difference. Staff and families alike were particularly heartened by the recoveries and “thriving” residents in memory care, where physical illness can precipitate a steep decline.

“I think something we do quite well is partner very closely with the medical entities around us and coordinate resources. I encourage other senior living providers to not think they can do it all on their own, because I do think it seems daunting,” says Mills. “Like Dr. Hopkins says, leverage your resources.”

It takes a network

Indispensable to many mAb efforts was the work from two mAb champions: the National Home Infusion Association (NHIA) and the U.S. Health and Human Services Department, particularly Project ECHO for monoclonal antibodies.

To get more treatments to more people, HHS and Dr. David Wong, Chief Medical Officer in the HHS Office of Minority Health, developed the SPEED program, which targeted long-term care first, providing the antibodies to pharmacies, and helping to get infusion nurses. Also through this program, a coalition including Argentum and five other associations for older adults have established the Long-Term Care Infusion Support Activity, or LISA, through which communities and neighborhoods can tap into specifically trained and vetted Medical Reserve Corps members for infusions.

For NHIA, helping get the lifesaving treatments out was a passion project on the part of its CEO, Connie Sullivan, BSPharm, and senior director of clinical services Ryan Garst, PharmD, MBA, BCSCP.

Home and specialty infusion pharmacies can provide the skills and experience to perform a variety of infusions, from hydration to specialized medications such as mAbs, as well as the knowledge to coordinate care across a multi-disciplinary care team. As Garst says, home infusion providers are a “one-stop shop,” and used to working with a variety of patients and physicians to provide care.

In partnership with HHS and organizations such as Argentum, they got the word out about what they could do: provide a turnkey solution with the speed and expertise necessary to make the treatments work. In addition to the safe prep, infusions, and monitoring, they help educate staff and families and bill for reimbursement.

As Argentum’s vice president of quality improvement John Schulte puts it: “This program checks all the boxes.”

The participants of the NHIA SPEED program provided monoclonal antibody therapy while continuing to service their current patients to keep them at home and out of the hospitals, which provided relief to health systems. NHIA is still working to increase reimbursement for these therapies in the outpatient setting, which will allow for even greater access to these efficacious products.


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