COVID-19 Long-Term Care Vaccination

Board of Health  - Emergency Rule

On December 15, 2021 the State Board of Health unanimously voted to extend an emergency rule requiring health care workers to get vaccinated for COVID-19. The rule impacts all licensed health care entities, requiring them to mandate their personnel -- including employees, direct contractors, and support staff-- who interact with individuals receiving or seeking medical care to receive the COVID-19 vaccine. The Board of Health passed the first emergency rule on August 30, 2021 after an appeal from Governor Polis to consider mandating vaccination.The emergency rule states each facility shall develop and implement a policy and procedure to ensure 100% of employees, direct contractors, and support staff have obtained full COVID-19 vaccination status in accordance with the schedule below: 

  • All employees, direct contractors, and support staff must have received their first dose of the COVID-19 vaccination no later than September 30, 2021.
     
  • All employees, direct contractors, and support staff must have received their second dose of the COVID-19 vaccination (if applicable) no later than October 31, 2021. 
     
  • An employee, direct contractor, and support staff member who was diagnosed with COVID-19, who received monoclonal antibody treatment or convalescent plasma treatment, shall obtain their vaccination in a timeframe that is in accordance with the recommendations of CDC, ACIP, and the individual’s licensed independent practitioner. 
    • These individuals shall obtain a medical exemption from their licensed independent practitioner that clearly states the timeframe of the medical exemption.
       
  • On or after October 31, 2021, each facility shall ensure all newly hired employees, direct contractors, or support staff members are fully vaccinated at the time of hire, or receive their first dose of a two-dose protocol, or a single-dose vaccination, prior to providing any care, treatment, or other services for the facility and/or its clients.
     
    • The facility shall verify that these individuals have proof of a COVID-19 vaccination approved for emergency use, or fully authorized, by the World Health Organization (WHO) or FDA. Alternatively, individuals may request a medical or religious exemption, in accordance with facility policy.
       
    • The facility shall ensure individuals who have received their first dose of a two-dose protocol shall complete the second dose of the protocol in accordance with the full dosing schedule of the vaccine product.
       
    • The facility shall ensure individuals awaiting their second dose of a two-dose protocol, or who have not yet reached fourteen (14) days after receiving a one-dose protocol, and all unvaccinated individuals shall comply with the requirements of Part 12.2.6.
       
  • Beginning October 1, 2021, each facility shall report its COVID-19 vaccination rate to the department two times during each calendar month.
     
    • The first report shall occur during reporting period one, which is defined as the first (1st) day through the fourteenth (14th) day of the month.
       
    • The second report shall occur during reporting period two, which is defined as the fifteenth (15th) day through the last day of the month.
       
    • Multiple reports received during a reporting period shall be counted for that reporting period only.
       
  • This information shall be reported in the form and manner specified by the Department.
     
  • Information reported to the Department under this Part 12 shall be made publicly available on the Department’s website.
Vaccination Reporting Systems
  1. Colorado Health Facilities Interactive (COHFI)

    As a part of the health facility COVID-19 vaccine dashboard, where you can check staff vaccination information for all licensed health care facilities, we’ve developed a vaccination reporting self check tool. You can search for your facility to see date and timestamps for each submission. The data found in the tool is updated every four hours. The time is in the upper left corner. 

    This data can still be accessed through your facility’s COHFI account. Information on COHFI can be found in the user manual. A step-by-step overview of COVID-19 vaccine reporting can be found in the manual

    AND
     
  2. Juvare/EMResource

    Reporting into Juvare/EMResource is required. The EMResource Access form can be completed here for first-time users in EMResource. Training/support materials by facility type is outlined in th EMResource Guidance Document. Facilities are required to report resident and staff COVID-19 vaccine doses into Juvare/EMResource weekly and as soon as possible after vaccine clinics are completed.
CDC and FDA Booster Dose Guidelines

CDC endorsed the Advisory Committee on Immunization Practices’ (ACIP) recommendation for a third (first booster) dose of COVID-19 vaccines in certain populations. The Food and Drug Administration’s (FDA) authorization and CDC’s recommendation for use are important steps forward as we work to stay ahead of the virus and keep Americans safe.


Public Health Order 21-01 includes a provision requiring providers to administer second doses and any additional or third (first booster) doses regardless of where the individual received prior vaccinations. It also requires providers to administer vaccine to any individual who self-attests that they meet the criteria approved by the FDA and recommended by CDC. Finally, it requires vaccine administrators to submit vaccination and demographic data to CDPHE within 48 hours of administration.

There are third (first booster) dose recommendations for all three available COVID-19 vaccines in the United States. Eligible individuals may choose which vaccine they receive for their third dose, though mRNA vaccines (Pfizer and Moderna) are clinically preferred. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different third (first booster) dose. CDC’s recommendations now allow for this type of mix and match dosing.

On March 29, 2022, CDC updated its recommendation to allow certain people to receive a fourth/fifth/sixth (second booster) dose of the Pfizer or Moderna COVID-19 vaccine. Which dose this is depends on which vaccine was originally received and whether or not the person is immunocompromised. 

COVID-19 vaccine follow-Up (second booster) dose recommendations 

  • A fifth (second booster) dose  of the Pfizer COVID-19 Vaccine may be administered to individuals aged 12 years and older with certain kinds of immunocompromise at least four months after receipt of a fourth (first booster) dose of any authorized or approved COVID-19 vaccine.
     
  • A fifth (second booster) dose of the Moderna COVID-19 Vaccine may be administered to individuals aged 18 years and older with certain kinds of immunocompromise at least four months after receipt of a fourth (first booster) dose  of any authorized or approved COVID-19 vaccine.
     
  • A fourth (second booster) dose of the Pfizer or Moderna COVID-19 vaccine may be administered to individuals aged 50 years and older at least four months after receipt of a third (first booster) dose of any authorized or approved COVID-19 vaccine.
     
  • A third (second booster) dose of the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine may be administered to individuals aged 18 years and older who received a first and second (first booster) dose  of Johnson & Johnson’s Janssen COVID-19 vaccine at least four months ago.

Learn more about CDC’s updated recommendations.

These updated recommendations acknowledge the increased risk of severe disease in certain populations, including those who are elderly or aged 50 years and older  with multiple underlying conditions.

Find out how many follow-up doses you will need for the highest level of protection with these resources:

CDPHE COVID-19 Vaccine Follow-up Dose Calculator
CDPHE Adult Follow-up Dose Flowcharts

Long-Term Care Facility Vaccine Clinic Toolkit

This toolkit has been assembled to provide:

  • Guidance for vaccination.
  • Vaccine clinic fact sheet, preparation checklist, and flyer.
  • Vaccine administration forms.
  • Vaccine provider information.
  • What to do after your COVID-19 vaccine clinic.
  • Reporting information.

We also created COVID-19 vaccination and treatment materials in English and Spanish, including posters/flyers to provide messaging at your facilities. 

Ongoing Vaccination Plans

With the eighth amended Public Health Order 20-20, each facility must establish and maintain a COVID-19 mitigation plan that promotes vaccine confidence and acceptance and must continue to offer vaccinations to all consenting staff and residents. Each facility shall submit to CDPHE a plan which details how the facility ensures vaccinations are offered and provided to all consenting staff and residents. A template for this plan is available here. Minimally, this information must include:

  1. How the facility assesses and addresses the vaccination status of new staff and residents;

  2. The identification of designated staff who coordinate vaccination information, administration, and tracking of the vaccination status of staff and residents on an ongoing basis,

  3. Ongoing measures to promote vaccine confidence and acceptance, and; 

  4. The vaccination status of all current staff and residents.

Submission of this information may be completed utilizing this form and must be submitted via email to residentialcarestriketeam@state.co.us. Plans were due June 14, 2021. This plan must be kept current by the facility and be presented for review during health facility inspections.

Highly Recommended: Facility COVID-19 Vaccination Coordinator and Backup Coordinator complete Colorado Immunization Information System (CIIS) training and obtain access to the CIIS system by following these start to finish steps and these instructions. Additionally, see the CIIS Enrollment Requirement Presentation.
 

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Continuing Vaccination:

The Residential Care Strike Team has outlined the following next steps for LTC facilities to continue vaccinations:

  • The facility identifies residents and/or staff requiring vaccination (we encourage you to work with other LTC facilities in geographic areas to run coordinated clinic(s), when possible, to meet vaccine minimums).

  • The facility contacts LTC pharmacy or retail pharmacy it typically utilizes for routine resident medications to determine vaccine availability.  

  • If the LTC pharmacy or retail pharmacy the facility typically utilizes is unable to meet the request or the facility does not have a relationship with an LTC pharmacy or retail pharmacy, the facility contacts a LTC pharmacy from this mapped  list of LTC pharmacies willing to service facility location (geographically). Alternatively, here is a list of providers (.pdf). 

  • LTC pharmacy fulfills request and schedules vaccinations with the facility contact (or in some instances LTC pharmacy provides vaccine/vital supplies and facility nurse(s) vaccinates identified residents and/or staff at facility).

  • If LTC pharmacies near a facility location are unable to meet the request, the facility should utilize the following:

  • If unable to locate a vaccinator through available resources provided, the facility should contact residentialcarestriketeam@state.co.us

  • For residents and staff who are able to go to an offsite vaccine clinic, use the Where can I get vaccinated? site to locate available options.

Strike Team Assistance:

If your LTC pharmacy would like to become a COVID-19 vaccine provider, please email: residentialcarestriketeam@state.co.us and cdphe_covidvax@state.co.us to get started.