Nursing homes will have to get creative—and a little lucky—to reach their goal of increasing employees’ Covid-19 vaccination rates from 40% to 75% by the end of June.
The task will get much tougher in the coming weeks when CVS and Walgreens pharmacies wrap up the last of their three on-site vaccination clinics at each facility.
After that, nursing homes will have to fend for themselves. That means convincing reluctant employees to get the shots and establishing new methods to procure them. Those unable to secure enough vaccine for new employees and residents could see Covid infections and deaths start to rise again after several months of dramatic reductions.
That setback would not only tarnish the industry’s ongoing rebound after suffering more than 175,000 Covid deaths, but it could also slow the return of in-person visitation at some facilities after the Biden administration issued new guidance Wednesday that allow nursing homes to resume the activity.
“After the three rounds of on-site clinics, it is unclear how long term care facilities will be able to quickly access vaccines moving forward,” Mark Parkinson, president and CEO of the American Health Care Association, said in a statement. “We need the CDC to ensure the vaccine is readily available for new admissions as well as current residents who have since decided to get the vaccine, so they are able to visit with their families per the new CMS guidance.”
Covid nursing home infections have fallen 82% among residents and 78% among staff since December thanks to the mass vaccination effort that targeted more than 15,000 nursing homes nationwide. Facility deaths fell by 63% over the same period.
The AHCA announced in February a nationwide goal of getting 75% of nursing home staff vaccinated by June 30.
But while 80% to 90% of residents have been vaccinated, roughly three out of five nursing home staff have refused the vaccine. That reluctance has persisted even though more than 1,600 nursing home workers have died from Covid-19, while nearly 552,000 have been infected, federal data show.
Nationally, nursing home employees are a low-paid workforce with high rates of minority, female, and immigrant representation. Many lack health insurance and paid sick days. And their turnover rate is high.
Their low vaccine take-up rates reflect a combination of misinformation about the vaccines, cultural distrust of the medical profession, and a growing anti-vaccine sentiment throughout the nation.
The Service Employees International Union represents certified nursing assistants at nursing homes, along with dietary, housekeeping, maintenance, and laundry workers. The union declined a request for comment about the low inoculation rates, but its website urges members to get vaccinated.
The nursing home industry has launched a public awareness campaign in an effort to boost employee confidence in the vaccines. It’s hoping reluctant workers will have a change of heart—and it wants to make sure vaccines are available to accommodate those who do.
“If someone was offered vaccine in one of these clinics in December or January and wasn’t ready, that should not be the only opportunity they have to get vaccinated,” Amanda Cohn, chief medical officer of the National Center for Immunizations and Respiratory Diseases at the CDC, said during a March 5 online town hall discussion hosted by BlackDoctor.org.
“We need to make sure that anybody who changes their mind or wants to get vaccinated—even if they said ‘no’ the first time—has easy access to vaccine,” she said.
Keeping Shipments Flowing
To keep the vaccine pipeline flowing after CVS and Walgreens exit the picture, nursing homes are counting on states and the federal government to provide steady shipments to the hundreds of long-term care pharmacies that service the prescription needs of most nursing homes.
Those shipments are already going out, but there are problems, said Chad Worz, executive director and CEO of the American Society of Consultant Pharmacists, which represents about 500 long-term care pharmacies.
Some states don’t allow nurses in nursing homes to administer the vaccine on behalf of the long-term pharmacy, Worz said. They require pharmacy personnel to provide the shot. That would be OK if nursing homes still required large numbers of vaccinations, he said.
“But now you might have to send a pharmacist out to vaccinate five people at a facility that’s two hours from the pharmacy and it’s not as efficient,” Worz said.
“Now you’re in a low-frequency, low-volume environment in long-term care where it’s the new admissions you have to vaccinate. It’s those staff members that were hesitant before, that are now willing.
“And that’s what’s creating the demand. But it’s also, kind of, creating these problems.”
Worz has asked the Centers for Disease Control and Prevention to address the issue through guidance.
Changing Minds Called Key
Changing minds will be key to increasing staff vaccine rates, according to a recent study by a team of behavioral science experts.
It recommends facilities focus efforts on the so-called “movable middle” employees who haven’t been vaccinated but who are open to change.
Those who already have been vaccinated should help persuade the movable middle to get their shots, the report recommends. And managers should work to limit the negative influence of vaccine “refusers or detractors” who won’t take the shot.
The report calls for facilities to make it easy for undecided workers to get the vaccine.
Michael Wasserman, a gerontologist, agreed.
‘‘We shouldn’t expect the frontline staff, and certainly not the residents, to have to work to get vaccinated. It should be brought to them,” Wasserman said during the March 5 town hall. “We need to be doing everything in our power to bring the vaccine to the people who have needed it and deserve it the most.”