Hospitals Pressured on Covid Shots as Nursing Homes Fear Surge

Nursing homes—facing labor shortages, limited bed space, and faltering Covid-19 vaccination rates—want hospitals to provide seniors with updated booster shots before discharging them to their facilities.

About 90% of new nursing home arrivals come directly from hospitals. It’s unclear, however, what percentage have received Covid boosters or vaccinations because hospitals aren’t required to track the information. But “anecdotally, talking to our members, the majority have not gotten a vaccination during their hospital stay,” said David Gifford, chief medical officer for the American Health Care Association and National Counsel of Assisted Living.

With rising national infection rates pointing toward a winter Covid surge in the US, fragile residents in nursing homes—where Covid has already killed nearly 161,000 people—remain at greater risk for severe illness and death if infected. Heightened flu and respiratory illnesses and increased visitation, travel, and indoor activity during the holiday season only add to the risk.

So the nursing home industry has adopted an “all hands on deck” approach to keep residents safe.

As part of the effort, it has asked the federal government to loosen requirements that restrict the availability of the vaccine. It wants to mobilize the National Guard to administer the vaccine at facilities when others can’t, and it’s reaching out to state and local public health agencies to conduct on-site vaccine clinics when needed.

The Covid death rate for nursing homes jumped from 35 deaths per 100,000 in mid-November 2021 to 131 deaths per 100,000 in mid-January 2022, according to the Kaiser Family Foundation. “That spike raises concerns about the potential for a similar spike in preventable deaths among nursing home residents in the upcoming post-holiday season,” the foundation reported.

More than 200,000 residents and staff at nursing homes and other long-term care facilities have died from Covid-19, according to the foundation. Experts say infected direct-care staff likely spread the disease to vulnerable residents.

More than 86% of nursing home staff and residents have completed their primary Covid vaccinations. But fewer than 47% of residents per facility—and just over 22% of staff—have updated their vaccines with bivalent boosters, or received their second primary dose in the last 60 days, according to the latest government figures.

Leaning on Hospitals

The nursing home industry wants to increase those numbers. It says hospitals are the preferred vaccine provider for incoming residents because they can store large amounts of vaccine on-site. Only about 10% of nursing homes can retain the vaccine long term, according to LeadingAge, which represents nonprofit aging services providers, including nursing homes.

This week, HHS okayed the waiver of federal reporting requirements to allow the vaccine to be administered by staff at facilities that apply to become vaccinators and meet CDC requirements for the storage, preparation, and administration of the vaccine. This should improve vaccine access in these facilities. But vaccinating residents before their hospital discharge remains the better option for the vast majority of nursing homes that can’t get this waiver.

“What we want hospitals to do is make sure that they encourage patients before they discharge them. Give them the opportunity to get vaccinated prior to discharge. And that’s not happening consistently, at all, based on what we hear from our members,” Katie Smith Sloan, CEO of LeadingAge, said.

While hospitals and nursing homes both need patient consent to provide the shots, “we absolutely share the same goal as our nursing home colleagues in terms of getting as many patients protected against Covid-19 as possible,” Akin Demehin, senior director of quality and patient safety policy at the American Hospital Association, said.

Hospitals have made shots available through vaccination clinics, in urgent care and emergency departments, and even during primary care visits, Demehin said.

But hesitancy remains a problem, so hospital officials “try to work with patients to answer questions in a nonjudgmental way and really sort of create” an environment that encourages them to get the shot. “But patients always have the option of declining it,” he added.

That reluctance—as well as fatigue from three years of Covid precautions—carries over to nursing homes where residents’ families have also been less insistent about having their loved ones further immunized.

Vaccines ‘Prime’ Immune System

“The No. 1 cause that we hear is people don’t want to get the vaccine,” Gifford said. “They don’t think it works because they see everyone getting breakthrough cases.”

Instead, the vaccines “prime your immune system so that when you do get infected, you react much faster to it, so you don’t get seriously ill and hospitalized,” Gifford said.

That messaging has been harder to instill, but it couldn’t be more true.

“Early surveillance shows that people who received their updated Covid-19 vaccine this year were nearly 15 times less likely to die from Covid-19 compared to people who are not vaccinated,“ Rochelle Walensky, director of the Centers for Disease Control and Prevention, said during a recent press briefing.

People who’ve only had their primary Covid vaccine series without the bivalent booster may be “considered fully vaccinated, but you are not considered fully protected,” Walensky added.