An industry effort to vaccinate 75% of nursing home staff against Covid-19 by July 1 appears to be faltering as continued employee hesitancy, declining infection and death rates, and general pandemic fatigue are making it tough to sustain the urgency necessary to meet the lofty goal.
Only 1,133 nursing homes—less than 10% of the roughly 15,000 Medicaid- and Medicare-certified facilities—had reached or surpassed the 75% staff vaccination threshold by the end of May, new federal data shows. And only 50% of staff have been inoculated at nursing homes that have provided the recently required vaccination data.
“These preliminary results indicate that while we have made considerable progress in the past few months, we still have farther to go,” said a statement from the American Health Care Association, which launched the staff vaccination effort.
The underwhelming numbers thus far, help explain why more nursing homes are requiring employees to get vaccinated as increased summer travel and new Covid variants spark concerns about potential new outbreaks.
Nursing homes and other long-term care facilities have been the epicenter of the Covid-19 outbreak, accounting for nearly 184,000 deaths and more than 1.4 million infections as of May 10, according to the Kaiser Family Foundation. Infected staffers are believed to be the cause of much of the carnage.
In March, an unvaccinated employee in a Kentucky nursing home is believed to have spurred an outbreak involving a variant that killed three residents and infected 26 others along with 20 facility staff. Only four of the infected staffers were fully vaccinated, the Centers for Disease Control and Prevention reported.
“This is a race against variants at this point,” said Chris Laxton, executive director of AMDA—the Society for Post-Acute and Long-Term Care Medicine. “As each new variant comes online, our fear is that the vaccines will be less and less effective. So we really want to get as many of the staff as we possibly can to a place of being fully vaccinated.”
That won’t be easy, said Laxton, whose organization represents nursing home medical directors.
“We’ve persuaded those who are persuadable,” he said. “Now we’re dealing with people who are just flat-out resistant. They don’t want to take it. They don’t trust it. They don’t like it.”
“So these are the folks you have to really sit down with one-on-one and say, ‘Tell me what worries you about this, and let me see if I can get you to move off of this position, which is not based on evidence.’ It’s always something else.”
‘Condition of Employment’
Some operators, like Lynne Katzmann, founder and CEO of Juniper Communities, took action before the situation reached that point.
In December 2020, Juniper, in Bloomfield, N.J., announced that staff vaccinations would be “a condition of employment” at all its senior living locations, including six nursing homes in three states. McLean, Va.-based Sunrise Senior Living did the same in March for all its U.S. properties, including 10 nursing homes in six states.
Earlier this month, the nonprofit Jewish Family Home gave the 500-plus employees at its assisted living facility and nursing home in northern New Jersey until July 1 to begin their vaccine doses.
And Continuing Healthcare Solutions, which operates 31 assisted living and nursing homes in Ohio, will require employee vaccinations when the Food and Drug Administration lifts its emergency use authorization and grants full approval to the
“We’re charged in our industry with the responsibility of providing a safe environment for the nation’s most vulnerable population. We take it very seriously, and we believe it’s our moral obligation to expect our staff to be vaccinated,” said Mark Morley, CHS’s vice president of operations.
Carol Silver Elliott, president and CEO of Jewish Family Home, said its two facilities already have over 85% of staff vaccinated. But they decided mandatory vaccines were in everyone’s best interest.
“When a family member is bringing someone here and they say, legitimately, ‘Are all the staff caring for my loved one vaccinated?’ don’t you want to be able to say yes? I think it really matters,” she said.
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Misinformation, Cultural Distrust
Nationally, nursing home employees are a low-paid workforce with high rates of minority, female, and immigrant representation. That includes certified nursing assistants, or CNAs, who provide much of the hands-on patient care, Many lack health insurance and paid sick days. Their turnover rate is high.
Along with concerns about the vaccines’ rapid development and potential side effects, their reluctance to get the shots reflects a combination of misinformation, cultural distrust of the medical profession, and a growing anti-vaccine sentiment that’s taken hold across the country.
That hesitancy has persisted even though more than 1,900 nursing home workers have died from Covid-19, while nearly 585,000 have been infected, federal data shows.
Mandating Covid shots for nursing home and other health-care workers is sound policy, said Emily Largent, professor of medical ethics and health policy at the University of Pennsylvania.
“This is consistent with other norms that are enforced in the workplace,” Largent said. “And they’re taking care of an incredibly vulnerable population, so I think they have a particular ethical responsibility to take care of those vulnerable adults, and being vaccinated is part of that responsibility.”
No Mass Exodus
At Juniper, nearly 97% of staff have been vaccinated with exceptions granted only for medical and religious reasons, said Katzmann. Of the company’s 2,000 employees, only 30 have left their jobs over the vaccine requirement, Katzmann said. The industry has long feared that vaccine mandates would spur a mass exodus of workers.
“We never used the word ‘mandatory.’ And that’s important,” Katzmann said. “Everyone has a choice whether they get vaccinated or not. But we wanted to make clear that your choice to be vaccinated is your own.”
CHS delayed its original staff vaccine mandate, slated to begin June 1, after some employees expressed hesitation about the drugs’ FDA status, Morley said. After the last of three vaccination clinics earlier this year, about 30% of CHS employees were vaccinated, Morley said. It’s roughly 60% today.
“We’re not to where we want to be, but our staff is listening. And through that open dialogue, we are making progress,” Morley said.
Laxton “generously” estimated that 60% of nursing home staff nationwide have been vaccinated. That would be up from 37.5% in January, according to the CDC. As of June 14, about 2,000 nursing homes haven’t yet reported staff vaccination data as required to the Centers for Medicare & Medicaid Services. Those that don’t could face civil monetary penalties beginning the week of June 21.
The Agency for Healthcare Research and Quality has produced a how-to, best practices guide to building vaccine confidence among CNAs.
Elliott of Jewish Family Home said her organization considered offering incentives, like gift cards or paid time off, to encourage more staff to get their shots, but decided otherwise.
“If I’m a staff person who’s reluctant, I look at the organization offering me a $25 gift card and I say ‘That’s what my life is worth to you, $25? That’s what my life is worth to you, a day off?’ It just felt wrong to us,” Elliott said.