Ashton Gardens in Portland on Friday Shawn Patrick Ouellette/Staff Photographer

Retirement communities for Maine seniors who live independently are scrambling to get COVID-19 vaccine to their residents after they were dropped suddenly from the federal pharmacy partnership that is providing inoculation clinics at long-term care facilities.

The federal contract with CVS, Walgreens and selected community pharmacies now targets only nursing homes and assisted-living facilities as top-priority groups identified by the U.S. Centers for Disease Control and Prevention.

Initially, however, federal officials said the contract would cover independent-living facilities, which typically house people over age 55 and offer various types of outside assistance for a fee. The scope of the partnership shifted within the last two months, after it became apparent that the vaccine supply couldn’t meet demand.

Pharmacist Corinn Martineau prepares vaccines before the opening of a mass COVID-19 vaccination clinic at the Scarborough Downs racetrack. Derek Davis/Staff Photographer Buy this Photo

But many residents of retirement communities are well over age 55 and face mobility and health challenges similar to residents of assisted-living facilities, including underlying medical conditions that increase their risk of serious illness and death from COVID-19. They also have similar congregate lifestyles that can promote disease transmission, including communal dining and shuttle transportation.

It’s a problem affecting thousands of retirement communities across the United States, including The Cedars and Ashton Gardens, both in Portland. But while The Cedars was able to arrange on-site clinics after weeks of searching, Ashton Gardens is still struggling to get vaccine to its 158 residents, whose average age is 85.

Left in the lurch are untold residents of independent-living facilities and their families, who are frustrated and fearful that they won’t get the vaccine in time. At Ashton Gardens, the threat became imminent last week when a staff member tested positive for COVID-19. All residents and employees are being tested to prevent an outbreak.

Anne Harris, a New York resident whose 89-year-old mother, Mary Salamone, lives at Ashton Gardens, said she called every state and local agency in Maine she could think of, trying to bring a clinic to the facility. She was told her mother, who doesn’t drive, would have to get her shot from a provider outside the facility.

Mary Salamone, 89, sits in her apartment at Ashton Gardens in Portland. Photo by Chris Salamone

Harris wonders why health officials in Maine missed an opportunity to deliver vaccine to a concentrated population of people at highest risk of experiencing the greatest suffering from COVID-19.

“This is a tragedy waiting to happen and it could be avoided,” Harris said. “Logistically, it makes no sense. The risk factors for these facilities are the same. The only difference is Ashton Gardens doesn’t have medical staff on the premises. I’m pretty sure (health officials) didn’t know what to do about this situation, so they decided not to deal with it.”

There are more than 100 independent-living facilities in Maine, with monthly costs ranging from $1,760 to $4,422, according to seniorliving.org. The exact number is unclear because they vary widely in design and amenities, and they operate without direct oversight by federal and state health agencies, unlike skilled-nursing and assisted-living facilities. Some are part of so-called continuing care retirement communities, which include nursing homes and assisted-living facilities.

Also unclear is how many independent-living facilities have been dropped from the federal pharmacy program. Maine CDC officials said they are working with “dozens” of these facilities to arrange vaccinations, but they didn’t respond to questions seeking details about which facilities have been affected and what the state is doing to help them.

Independent-living facilities usually consist of apartments, condos or cottages, with housekeeping, personal care and medical assistance available for a fee. As a result, the independence of their residents is relative, said Rick Erb, head of the Maine Health Care Association, which represents nursing homes and assisted-living facilities.

Community Pharmacy of Gorham received one of the boxes of Moderna COVID-19 vaccine that had a tag alert that showed temperatures had exceeded proper shipping temperatures. Derek Davis/Staff Photographer

“I think people might be attaching too much meaning to the word ‘independent,’ ” Erb said. “The lines are not as distinct as all that, and requiring residents of a retirement community to seek vaccine on their own probably isn’t the most efficient way to vaccinate more than 100 seniors.”

Ashton Gardens is one of 66 independent-living facilities operated by Hawthorn Senior Living, a company based in Vancouver, Washington. Hawthorn also owns 10 assisted-living facilities, including Birchwoods at Canco in Portland and Winterberry Heights in Bangor.

Hawthorn registered all of its facilities with the federal pharmacy program in October, and its assisted-living facilities began receiving vaccines in December, said spokesman Adam Bryan. CVS pharmacists inoculated residents and employees at Birchwoods and Bangor Drug Co. held clinics at Winterberry Heights.

However, by mid-January, when none of Hawthorn’s independent-living facilities had heard from a pharmacy, the company checked with federal officials and learned that retirement communities no longer qualified for the pharmacy partnership.

Hawthorn reached out to several state and local officials here, including managers at the Maine Immunization Program of the Maine Center for Disease Control and Prevention, and at the Public Health Division of Portland’s Department of Health and Human Services. City officials didn’t respond, Bryan said. State officials said Ashton Gardens residents should seek vaccination appointments outside the facility.

Vials of the Moderna COVID-19 vaccine at the Northern Light Homecare and Hospice vaccine clinic on Jan. 13. The clinic was vaccinating mostly school nurses and other independent medical providers. Brianna Soukup/Staff Photographer

“We were shocked,” Bryan said. “We’ve been coming in at 5 or 6 every morning and calling everyone and anyone who could help us. There are a lot of vulnerable folks living at Ashton Gardens and we still haven’t been able to schedule (an on-site) clinic for them.”

The U.S. CDC had announced in October that independent-living communities were included in the agreement, but by mid-December the status of both assisted- and independent-living facilities was unclear and causing confusion, according to McKnight’s Senior Living News.

In early January, CVS predicted a long wait for retirement community residents because vaccine was in short supply. Now, the CDC’s description of the pharmacy agreement pointedly says it applies to skilled-nursing and assisted-living facilities, and it excludes independent-living facilities.

States are reacting differently to the need for vaccine among retirement communities.

In the last two weeks, Hawthorn has been able to arrange vaccination clinics at more than half of its retirement communities, including facilities in Oregon, California, New Mexico, Idaho, Kansas, Texas, Georgia, Florida, Ohio, Massachusetts and Indiana. The company has cobbled together responses with help from independent pharmacies, emergency management agencies, municipal fire departments and county health offices, Bryan said.

Hawthorn was able to schedule vaccination clinics at its four retirement communities in North Carolina, after state health officials said the facilities were ineligible for the pharmacy program and county health officials said they didn’t have enough vaccine to share with Hawthorn residents. Local pharmacies are delivering the vaccine, Bryan said.

Firefighter paramedic Steve Higgins draws up a dose of the Moderna COVID-19 vaccine at Scarborough Public Safety on Monday. The Scarborough first responders are vaccinating themselves for the next few days and then they will travel to smaller stations to administer the vaccine to their fellow emergency medicine providers. Brianna Soukup/Staff Photographer

In contrast, Maryland announced Jan. 31 that it will vaccinate independent-living facilities previously registered with the federal pharmacy partnership through clinics coordinated by local agencies on aging and overseen by the state Health and Aging departments.

Maine’s response to the need for vaccine at independent-living facilities has been spotty.

The Cedars in Portland was forced to seek an alternative a few weeks ago, when Walgreens refused to hold vaccination clinics for residents and employees of its assisted- and independent-living facilities. Since late December, Walgreens pharmacists have fully inoculated more than 100 skilled-nursing patients at The Cedars and the employees who care for them.

“We were super pleased initially with Walgreens,” said Katharine O’Neill, spokeswoman for The Cedars. “But when we asked about our assisted- and independent-living residents, we were told the contract was strictly for long-term care facilities.”

O’Neill said Walgreens advised The Cedars staff to contact the state Department of Health and Human Services for assistance. They reached out to state and local officials and found a solution with the Maine CDC’s Public Health Nursing program.

“We had to get out there and call and push and beg,” O’Neill said. “The public health nurses have been so willing and so glad to help.”

Mary Salamone, 89, resident of Ashton Gardens in Portland, receives her first COVID-19 vaccine Friday from nurse Jaclyn Janis at the MaineHealth vaccination clinic in Westbrook. Salamone said she felt like she hit the jackpot when she was able to schedule a vaccination appointment because so many of her neighbors are scrambling after independent-living facilities were dropped from the federal pharmacy partnership. Photo courtesy of Chris Salamone

Public health nurses held an initial vaccination clinic at The Cedars on Jan. 28 for about 30 residents of The Osher Inn assisted-living facility and its staff. A second clinic will be held there later this month to administer second doses. The nurses returned Friday to vaccinate about 60 residents of The Atrium independent-living community, with booster shots to be given March 5.

“I am so relieved that we have gotten the first dose of the vaccine,” said Bev Baker, a resident of The Atrium. “It gives me hope for the future.”

For its part, the Maine CDC said the Maine Immunization Program is working with dozens of independent-living facilities and low-income senior housing communities to help arrange vaccination of residents.

“Given the inadequate supply of vaccine to Maine from the federal government, the program may inform ILF administrators that some residents could be able to access the vaccine more rapidly through a hospital or their primary care providers,” said spokesman Robert Long.

The Maine CDC has been exploring and pursuing numerous ways to vaccinate the most at-risk older individuals across Maine, including via the retail pharmacy program, independent pharmacies, partnerships with local health care partners, and Public Health Nursing clinics, Long said in a written statement.

As a result, Long noted, more than 20 percent of Maine residents age 70 and older had been vaccinated as of Friday.

“Maine is making best use of all available resources to vaccinate as many at-risk Maine residents as quickly as possible using all available resources in ways that ensure that no doses go unused,” Long said.

Portland officials said it wasn’t a case of deciding to help The Cedars and not help Ashton Gardens.

“When we received an inquiry from Hawthorn, our Public Health staff enlisted help from their Maine CDC counterparts and the CDC has been in touch with Hawthorn,” said Jessica Grondin, city spokeswoman.

Grondin said independent-living facilities are considered different from nursing homes and assisted-living facilities because “there is an expectation the individuals residing in them should be independent enough to access vaccine resources on their own. In actuality, we know that isn’t always the case.”

Maine CDC is working to connect these organizations with vaccination opportunities, Grondin said in a prepared statement.

Mary Salamone, 89, a resident of Ashton Gardens in Portland, receives her first COVID-19 vaccine Friday from nurse Jaclyn Janis at the MaineHealth vaccination clinic in Westbrook. Photo by Chris Salamone

“The ability to do this is limited due to supply, but this process will become simpler as greater vaccine supply becomes available,” she said.

Mary Salamone, who lives at Ashton Gardens, finally got a vaccination appointment Friday afternoon at the MaineHealth clinic in Westbrook. After several family members made numerous calls on her behalf, she called MaineHealth’s automated registration line Thursday afternoon at the urging of her physical therapist.

She was surprised when a person answered and scheduled her right away. Chris Salamone, who lives in South Portland, gave his mother a ride. Her second shot is in three weeks. Still, she remains concerned, especially since a staff member at Ashton Gardens recently tested positive for COVID-19.

“I just hit the jackpot,” Salamone said after getting her first shot. “I’m very relieved. There was so much build-up, I’m glad to have it over with. But I’m worried about other residents here who haven’t been vaccinated yet because we’re kind of behind the eight ball now.”