In mid-December, Health and Human Services Secretary Alex Azar suggested that most nursing homes would receive the coronavirus vaccine by Christmas. In fact, most vaccinations of nursing homes and other long-term care facilities didn’t begin until after the holiday.

While Azar’s prediction was surely far too rosy, it highlights a process that has been delayed due to poor planning and bureaucratic red tape.

Most states have joined with the federal Pharmacy Partnership for Long-Term Care Program to distribute the vaccine. Under the program, two large chain pharmacies, CVS and Walgreens, are tasked with getting the vaccines to long-term care facilities.

“It’s taken longer than anybody expected or hoped to get that program really going,” said Josh Michaud, an associate director for Global Health Policy at the Henry J. Kaiser Family Foundation. “In many states, there have been hiccups and roadblocks along the way that have slowed things up compared to vaccinating healthcare workers.”

Michaud said that a lack of coordination among federal and state agencies and private pharmacies led to confusion.

“It’s hard to see how this program works from the outside – it’s rather opaque,” Michaud said. “A lot of nursing homes have had a hard time getting information from state-level officials and Walgreens and CVS. Administrators have often complained about lack of communication on how the process was supposed to roll out.”

Other experts say that the federal government has failed to maximize available resources.

About 40,000 independent pharmacies have entered into agreements with the federal government to distribute vaccines. However, they were not supposed to receive vaccines until the supply increased. That may have been a mistake.

“I think we would have benefited from using those pharmacies to vaccinate long-term care facilities,” Rothholz said. “We had a lot of pharmacies that were already serving nursing homes, and if they were allowed to, they could have helped.”

The state of West Virginia decided to forgo the federal program and instead partnered with many independent pharmacies in the state. As a result, all nursing homes in the state received their first dose by the end of December.

Another factor in slowing the vaccination of long-term care facilities was bureaucratic paperwork.

Residents have to sign informed consent forms to get a vaccine, forms that are often long and cumbersome. It can be a serious inconvenience if the resident is mentally impaired.

“If an individual is experiencing dementia or other problems, then you have to get consent from the family or other person who is in a position to make that decision,” said Michaud. That’s an added delay in some cases.

For the federal government, pharmacists have to enter data on who got vaccinated and on how much vaccine supply they have. Some states have additional paperwork requirements.

Jeff Sprinkel thinks he saw the effect of this firsthand.

Sprinkel is the administrator of the Lake Minnetonka Care Center, a skilled nursing home for people with mental illness in Deephaven, Minnesota. The facility houses 21 residents. While Sprinkel is grateful that his facility has received its first dose of the vaccine, he is concerned about how long it took.