Nearly 570,000 residents and staff at nursing homes and other long-term care facilities have received their second dose of the Covid-19 vaccine through a federal partnership with
But an estimated 50% of frontline nursing home staff are still refusing to get the shots, which remains a persistent and glaring problem for the national effort to fully vaccinate the facilities.
“It may even be as high as 60% if you include other settings of care, like assisted living facilities,” said Christopher Laxton, executive director of AMDA—the Society for Post-Acute and Long-Term Care Medicine. “It’s probably the biggest issue that we have right now, the hesitancy on the part of staff.”
A new report from the Centers for Disease Control and Prevention found that among nearly 11,500 nursing homes that have conducted one vaccination clinic through the partnership “a median of 77.8% of residents and 37.5% of staff” received a first dose.
“The lower percentage of staff members vaccinated raises concern about low coverage among a population at high risk for occupational exposure to SARS-CoV-2,” the report said.
Nearly 147,000 residents at nursing homes and other long-term care facilities have died from Covid-19 as of Jan. 28, according to the Kaiser Family Foundation. That’s about 37% of all U.S. Covid-19 deaths. But nearly 1,400 nursing home workers have also died from Covid-19, and nearly 500,000 have contracted the virus, federal data shows.
Both CVS and Walgreens provide on-site vaccinations at thousands of long-term care facilities under the federal Pharmacy Partnership for Long-Term Care Program. Of nearly 3.7 million doses administered through the partnership through January, more than 3.1 million were for the first of the two-dose regimen, CDC data shows.
Despite the progress, many frontline nursing home staff are shunning the vaccine, swayed by a barrage of conflicting internet and social media chatter, Laxton said.
‘Swirl of Crazy Theories’
“It’s just like a swirl of crazy theories and misinformation and conspiracies,” Laxton said of unfounded rumors about the vaccine. “‘It’s going to mess with your DNA,’ and ‘It’s a sterilization program,’ and ‘They’re going to microchip you,’ or ‘It’s Tuskegee all over again.’
“We’ve surveyed frontline staff, through colleague organizations and sister societies, and that’s kind of what they’re telling us. They don’t trust the leadership. They don’t trust the government. They aren’t aware of incredible sources of information, so it’s all peer-to-peer” information sharing, said Laxton, whose group represents medical directors, doctors, and other caregivers at long-term care facilities.
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 problem.
Nationally, nursing home staff are a low-paid workforce with high rates of minority, female, and immigrant representation. Many don’t have health coverage or paid sick days. And the turnover rate is high. So nursing homes, generally, don’t have the leverage to require workers to take the shot, said Peter Van Runkle, executive director of the Ohio Health Care Association, which represents the nursing home industry.
If they were required to get vaccinations, many would either leave to collect unemployment benefits, go work at a facility that doesn’t require it, or leave the industry altogether, Van Runkle said.
“We don’t want to do anything that’s going to cause people to quit,” he added. “We’re already struggling to get staff.”
Financial Incentives Ineffective
Financial incentives haven’t helped either, he said. “It’s their body. And what happens to their body, or what they think will happen to their body, is a bigger concern than the dollars,” Van Runkle said.
More than 302,000 long-term care residents, 235,000 staff—and roughly 30,000 others whose status has not been reported—have been fully vaccinated through the federal partnership.
Texas and New York have each provided more than 50,000 second shots at nursing homes and other long-term care facilities, CDC data shows. Ohio and Pennsylvania have each administered more than 48,000. California and Florida are nearing 40,000 second doses, and Massachusetts has provided nearly 30,000.
Van Runkle estimates that in Ohio, 15% more nursing home staff are participating in the second round of on-site vaccination clinics currently underway.
“But we’re still below where we’d like to be, which is 70-75% for staff and 90-95% of residents. Residents are in the 90%-plus range,” Van Runkle said. “With the staff, we’re probably still around the 50% mark, even after the second clinics.”
Jay Slotkin, president of the New York Medical Directors Association, said nursing homes must provide counseling and outreach and apply peer pressure among staffers to increase vaccination rates. Laxton agreed that nursing aides who get the shots are the best recruiting tool to get others to do the same.
“When you have homes with a robust education program for employees, and the aides are treated with respect, then you may have a higher rate of people who take it,” Slotkin said. “Because aides are underpaid and not very respected. And they don’t trust people.”