Boosters Lag, Covid Infections Rise Among Nursing Home Staffers

The push to get Covid-19 booster shots for nursing home staff is proving a tough sell.

While over 72 million Americans have received Covid booster shots, including 62% of nursing home residents, only 27.6% of nursing home staff nationwide have received a booster shot, said Janell Routh, co-lead of the Covid-19 Vaccine Task Force at the Centers for Disease Control and Prevention.

Infected staff have been the main cause of virus transmission in nursing homes and other long-term care facilities. At least 187,000 residents have died from Covid-19, according to the Kaiser Family Foundation.

“As you can see, we all still have a lot to do to promote confidence in these vaccines in order to keep both staff and residents safe,” Routh said this week during a national webinar with nursing home industry officials.

While infection rates were about the same for nursing home staff and residents several weeks ago, that has changed.

“We are seeing a much larger increase in staff cases than resident cases, so we are concerned that staff are leading to more of the spread,” said webinar speaker Evan Shulman, director of the division of nursing homes at the Centers for Medicare & Medicaid Services.

New infections jumped nearly 79% nationally among nursing home staff, from 5,822 for the week ending Dec. 19 to 10,421 on Dec. 26, CMS data shows. Resident infections increased more than 20% from 4,285 to 5,155 over the same period.

No Pause in Visitation

But in spite of rising infections and hospitalizations due to the highly transmissible omicron variant, Shulman said no pause in nursing home visitations is needed at this time.

“We at CMS and CDC believe visitation can still occur,” Shulman said, if visitors and families follow the new, updated visitation guidance that CMS issued in response to concerns raised by industry trade groups and state health officials. They asserted that previous CMS rules forbid “any restriction on visitation, regardless of staffing levels, community positivity rates, or severity of facility outbreak.”

The revised guidance maintains residents’ rights to receive visitors at any time, but acknowledges that “there may be times when the scope and severity of an outbreak warrants the health department to intervene with the facility’s operations.

“We expect these situations to be extremely rare and only occur after the facility has been working with the health department to manage and prevent escalation of the outbreak,” the guidance said. We also expect that if the outbreak is severe enough to warrant pausing visitation, it would also warrant a pause on accepting new admissions,” if adequate alternative care for hospital discharges is available.

But a leading nursing home trade group said more than half of nursing homes are already limiting new admissions “at a time when overwhelmed hospitals need our assistance to free up precious beds due to the Omicron surge.”

The American Health Care Association and the National Center for Assisted Living in a letter Thursday also urged Health and Human Services Secretary Xavier Becerra to extend the public health emergency beyond its current Jan. 16 expiration date. The AHCA/NCAL also called on the HHS to prioritize long-term care facilities in the distribution of vaccines, testing kits, and Covid treatments.

Recommendations on Masks

The new nursing home visitation guidance also calls for all visitors to wear a mask and to physically distance when in communal areas of the facility.

“While we strongly recommend that visitors wear face coverings or masks when visiting residents in a private setting, such as a resident’s room when the roommate isn’t present, they may choose not to,” the guidance said. “Also, while not recommended, if a resident (or responsible party) is aware of the risks of close contact and/or not wearing a face covering during a visit, and they choose to not wear a face covering and choose to engage in close contact, the facility cannot deny the resident their right to choose, as long as the residents’ choice does not put other residents at risk. This would occur only while not in a communal area.”

“Visitors and families, we need you to mask up and make sure that you’re following these principles of infection control so that we can keep visitation going,” Shulman told webinar participants.