Low vaccination rates among nursing home staff imperil elderly

Health care advocates and industry groups are raising the alarm over lagging vaccination rates in nursing home staff, threatening the progress the nation has made in protecting the vulnerable elderly. 

More than seven months after becoming eligible, only about 59 percent of staff in nursing homes and long term care facilities nationwide are partially or fully vaccinated, according to federal data compiled by the Centers for Medicare and Medicaid Services (CMS).

The numbers for staff vary by state, but reflect the nationwide rate for fully vaccinated adults. However, the figures are significantly lower than the nationwide average vaccination rate — 81 percent — for nursing home residents. 

States like California and Vermont are reporting close to 80 percent fully vaccinated staff. 

Louisiana, meanwhile, has the lowest statewide average: Just 43.2 percent of the staff at its long-term care facilities have been vaccinated, according to CMS data released last week.

In Florida, which has over 700 nursing homes, only 42 percent of workers are fully vaccinated. 

Health experts are concerned low vaccine uptake among staff could leave residents vulnerable to a resurgence of the virus, despite their relatively high vaccination rates. 

“We know that the main way that COVID gets into nursing homes is via the staff who live in the community. And may be exposed to the virus in the community. And so the fewer staff that are vaccinated, the more potential there is for a staff member to become infected, and … bring the virus into the nursing home,” said Ari Houser, a senior analyst at the AARP Public Policy Institute.

The authorized vaccines have been shown to greatly reduce serious illness and death in elderly people, but the rapid spread of the delta variant is fueling new concerns.

“In general we know that elderly individuals who are frail often do not respond as robustly to vaccines. Many of these individuals live in nursing homes and even if fully vaccinated have some degree of risk of a breakthrough infection if exposed to the virus,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

Two industry trade groups set a goal of vaccinating 75 percent of the staff in their facilities by the end of June; an analysis by AARP released last week showed that only one in five of the nation’s more than 15,000 nursing homes were able to meet it.

Nursing homes have been devastated by COVID-19. Residents make up only about 1 percent of the U.S. population, but account for more than 20 percent of all deaths nationwide.

According to Medicare data, the disease has killed more than 133,000 residents and nearly 2,000 staff members. That’s also likely an undercounted figure, since facilities only began reporting at the end of May 2020. 

Industry groups are scrambling to find ways to increase vaccination rates among staff, but are finding that misinformation is widespread. 

“Like with many members of the public and other health care workers, we believe widespread misinformation circulating online and distrust of institutions are at the core of many of the concerns raised by caregivers,” a spokesperson for the American Health Care Association/National Center for Assisted Living said in an email.

The trade group is running an education campaign for its members, and is encouraging providers to address specific concerns and dispel myths. 

But sometimes the resistance is political.

According to the Kaiser Family Foundation, the stark political divide among the vaccine hesitant has grown more prominent in recent months. The vaccination gap between counties that voted for former President Trump in the 2020 election and those that voted for Biden has nearly doubled in less than two months.  

Conservative areas of the country have been particularly hard-hit by the delta strain; White House COVID-19 response coordinator Jeff Zients on Thursday said Texas, Missouri and Florida alone accounted for more than 40 percent of all new cases this week. 

“People who work in skilled nursing facilities, they’re members of the general population, they’re members of their communities and they tend to reflect the perceptions and values of their communities,” said Peter Van Runkle, executive director of the Ohio Health Care Association.

“So if you’ve got a rural part of the state or a conservative area … you are going to see lower vaccination rates,” Van Runkle said.

Some experts are pushing for nursing home administrators to impose a vaccine mandate as a condition of employment. 

While some health systems have imposed such a requirement, the idea is controversial and far from an industry standard.

One roadblock is the fact that COVID-19 vaccines have not yet received full approval from the Food and Drug Administration.

But guidelines issued in May from the Equal Employment Opportunity Commission said employers are allowed to require workers to be vaccinated, so long as there are religious and medical exemptions.

The bigger problem for companies is the threat of a staff revolt. Van Runkle said unless the entire industry requires vaccinations, mandates won’t work on a piecemeal basis. 

“As much as [facilities] want people to be vaccinated, they’re not going to take that step of mandating, unless it’s something that applies to everyone throughout healthcare,” Van Runkle said. “If you’re the only provider in town who’s mandating, guess where the staff are going? To the ones that aren’t. It’s got to be an all or none thing.”