My stepmother had her hip replaced last week. After the surgery, she woke up in the recovery room and stayed overnight in the hospital. The next day she was lucky enough to be discharged directly back to her home instead of to the other option, a skilled nursing facility (AKA a nursing home) for several weeks of strengthening therapy/rehabilitation.
Each time she moved from one health care setting to another her doctors and nurses needed to communicate any vital information about her to the next person. Each time anyone moves from one care setting to another is called a transition of care.
Medical care is a lot like a relay race. When the nurse or doctor taking care of you goes off shift, a transition occurs. They need to communicate any helpful or important information about you to the next medical professional coming on shift to replace them. This “hand off” is where critical information about you can get lost or misunderstood, which can lead to problems.
That’s what happened to 88 year-old Emma. My friend Sherry has the responsibility of being her widowed elderly aunt Emma’s medical power of attorney, or POA. The role of being someone’s medical POA includes helping them make decisions about their health care, especially when or if they are unable to understand or choose between various options. When Emma fell in early January 2021, she broke her hip, requiring surgery and several weeks of rehabilitation. Unlike my stepmother, Emma was discharged from the hospital to a local nursing home.
Emma received her first COVID vaccine in mid-January while residing at that nursing facility. She was discharged back to her own home two weeks later, before she would have been due for a booster.
Sherry called me yesterday morning and asked, “How do I get Emma her booster shot of COVID vaccine? The nursing home says she’ll have to go somewhere else.”
When we called the nursing facility to find out who gave her the initial COVID vaccine, they explained that the vaccine shots were given by CVS, a pharmacy chain with a federal contract to immunize nursing home residents. CVS came and gave every resident their first COVID vaccination in mid-January. Then, CVS had been given contact information for anyone who had been discharged so they could register them for a booster vaccine dose. They had completed the last scheduled COVID vaccinations the previous day.
There are no CVS pharmacies in our area, so I asked the nursing home for contact information to find out if CVS would be in any other nursing facilities in our area. Unfortunately, when I called them, no one could connect me with whomever was administering the COVID vaccine. They couldn’t even tell me who I could contact to find out more. It was like CVS swooped into town, gave the vaccine to those nursing home residents, then left without a trace.
When I asked for a copy of Emma’s COVID vaccine card, the nursing home said they didn’t have it anymore. They explained that it had been mailed to Emma’s POA, my friend Sherry. Unfortunately, Sherry never received it, so we recreated one from the nursing home records on a blank COVID vaccine card, documenting the date, manufacturer, and site where Emma received her COVID vaccine.
Emma had received the Pfizer COVID vaccine for her first dose. Unfortunately, our local pharmacies have only received Moderna vaccine. What were we going to do? Would it be okay if Emma got a Moderna vaccine for her booster dose, instead of Pfizer’s vaccine?
Luckily, the answer is Yes. The Centers for Disease Control and Prevention (CDC) states that if someone residing in an assisted living or a nursing facility has moved, it is OKAY to get a booster with the Moderna vaccine even if the initial vaccine dose was from Pfizer and vice versa. Since they are both mRNA vaccines, the CDC states that it is acceptable to mix them.
What about the 3 week window recommended for the Pfizer COVID vaccine booster dose? Would she have to start all over again?
No. The CDC states you can delay getting the booster beyond the 3 weeks recommended by the manufacturer for the Pfizer COVID vaccine or the 4-week booster recommended for the Moderna vaccine. Up to 6 weeks is considered acceptable, especially in light of the recent weather-related delays in shipping the vaccines.
Here are 4 Ways to Protect Yourself or Your Loved One During Transitions of Care
1. Make a current list of all your medications, and keep it updated.
This is especially important when coming home from the hospital or nursing home. The doctors may have adjusted the dose of one or more of your medications, or in some cases stopped or changed the medication entirely during your hospital or nursing home stay.
2. Bring your discharge summary paperwork to your next medical appointment.
Doctor’s offices are not always kept informed of what happens to you during a recent hospitalization or stay at a nursing home . Bringing the latest information with you helps to keep everyone in the loop, and avoids confusion and accidental duplications.
3. Ask.
With COVID restrictions making face-to-face discussions less common, making misunderstandings much more common. In addition, many medical providers are stretched for time and may not always take the time to explain the plan of care completely.
4. Be a Squeaky Wheel.
Speak up whenever something doesn’t seem right to you. Please don’t make the assumption that “the doctor always knows best.” You may be the only one who notices an omission or discrepancy.
