“COVID is terrible in nursing homes,” said Deb Witich, a 70-year-old retired massage therapist who lives at a facility called Spurgeon Manor in rural Iowa. She wants to get the newly approved vaccine because she has had the disease twice and has chronic leukemia, which weakens her immune system.
New vaccines have been made available to the general public in the past week or so, with the Centers for Disease Control and Prevention approving the latest vaccines two weeks ago. But many nursing homes won’t start vaccinations until October or November, when the number of infections among this vulnerable population has fallen by nearly 1% from a mid-September low of 2.2 per 1,000 residents. In other words, the number has increased to 9.7 per 1,000 residents. June.
“The distribution of the coronavirus vaccine is not going smoothly,” said Chad Wards, CEO of the American Society of Consultant Pharmacists. “Older people in such settings are certainly the most vulnerable and should have been prioritized.”
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When the official public health emergency was lifted in May, the federal government halted the purchase and distribution of coronavirus vaccines. This adds new complications for nursing home operators, who have faced resistance throughout the pandemic in persuading people, especially employees, to get vaccinated again.
The coronavirus devastated nursing homes during the first two years of the pandemic, killing more than 200,000 residents and staff. Elisabeth Sopchik, project director of Moving Needles, a CDC-funded initiative to improve adult immunization rates in long-term care facilities, said that without a government agreement to purchase vaccines, vaccine manufacturers will The company said it would only manufacture the product in large quantities if experts recommend approval. .
“Then it has to be inspected by the FDA. We want a safe vaccine. Then there will be contracting and deployment,” Sobchik said. “So we understand not only the frustration, but also why it wasn’t available sooner.”
Even as vaccinations become available, nursing homes face continued resistance to vaccines among nurses and aides. Without state mandates for workers to be vaccinated, most nursing homes rely on persuasion, which is often difficult.
“People want COVID-19 to be in the rearview mirror,” said Leslie Eber, medical director at Orchard Park Healthcare Center in Centennial, Colorado. “This year, I think we need to remind people more often that COVID-19 is not benign. Maybe it’s a cold for some people, but for those I care about… You won’t catch a cold.”
According to federal data from mid-September, only 62% of nursing home residents are up to date with vaccinations, meaning they will have received the last booster shots available before new vaccinations this month. . This is an improvement compared to 38% at the beginning of October 2022.
However, only 25% of nursing home staff are up to date, which is close to the rate last October.
In a written statement, the Department of Health and Human Services said it would work to identify long-term care facilities with low vaccination rates and ensure “proven infection prevention and control measures are in place to protect older adults.” Stated.
This year, more nurses and assistants will have to get vaccinated at drug stores and health centers on their personal time rather than on the job. Many homes are operating clinics and long-term care pharmacies are still supplying vaccines, but with the added complexity of billing insurance companies for vaccines for both residents and employees. confronting.
In addition, households are rolling out a new vaccine against another dangerous virus, respiratory syncytial virus (RSV), which for many residents is the third time they have received it, along with COVID-19 and influenza vaccines. This will be the inoculation.
The three vaccines will be even more complex for nursing homes to administer, as they will have to claim reimbursement from Medicare for the shots. The coronavirus vaccine is billed to Medicare Part B, which covers outpatient and physician services, while the RSV vaccine must be billed to Medicare Part D, which is the prescription drug benefit.
“The United States is phenomenal in terms of screwing up vaccinations,” said David Nace, chief medical officer at UPMC Senior Community in Pittsburgh. “Who in the name of God came up with this idea that some things fall under Part B, some fall under Part D, and some can be claimed at a pharmacy?”
Medicare will cover the cost of vaccines for most nursing home residents, but employees may have to fill out paperwork for private insurance or, in a small number of cases, pay out of pocket.
Leslie Fran, executive vice president of the Service Employees International Union, which represents more than 134,000 workers in 1,465 nursing homes, said many facilities have stopped operating on-site clinics. He said he is directing employees to go to the drugstore to get vaccinated. This will lead to more workers skipping the shot, she said.
“Given that many nursing home workers work multiple jobs, they have very little time,” she says.
For the 25 million to 30 million people who do not have health insurance or whose insurance does not cover the full cost of vaccines, the CDC is offering vaccinations at select pharmacies, health centers, and clinics listed on www.vaccines.gov. Arranged to receive free COVID-19 vaccination. Frein said the program is not well known among workers, and Wards said distribution favors large pharmacy chains, lagging access in rural areas. Federal officials say 627 of the nation’s 19,400 independent pharmacies, many in rural areas, have enrolled in the program, with 100 more expected to be added.
However, a major hurdle remains the reluctance among nurses and assistants to get vaccinated. Like many facility owners, Avalon Healthcare Group, which owns or operates more than a dozen nursing homes in Western states, is not requiring its employees to be vaccinated. Dr. Sabine von Preis-Friedman, Avalon’s chief medical officer, said the company is trying to address each employee and their reasons and has no intention of abandoning the push.
“We’re not going to just say, ‘Okay, everyone get vaccinated’ and forget about it,” she said.
The House of Avalon has been using modest financial incentives to encourage staff to get vaccinated. Contests have been organized between several units, with winners receiving prizes such as pizza parties and a raffle for department store gift certificates, an initiative that will be resumed this year.
Jim Wright, medical director of Our Lady of Hope Health Center and two other nursing homes in Richmond, Virginia, says rewards and respectful persuasion alone are not enough to motivate facility workers. said it was not enough. They tend to be in their 20s and 30s and aren’t worried about contracting the coronavirus, which many people have already overcome, he said.
“Maybe they’re not doing it to protect the population or to protect themselves,” he says. “I don’t know the answer.”
Sheena Bumpass, a nursing assistant in Duncan, Oklahoma, and vice president of the American Association of Medical Assistants, said she had planned to get vaccinated this season, but some of her co-workers won’t.
“Now that the public health emergency is over, I think people are done with it,” she said.
Edenwald Senior Living, a nursing home in a senior living community in Towson, Maryland, is requiring its employees to be vaccinated unless they can justify an exemption for medical or religious reasons.
As of Sept. 10, about three-quarters of the facility’s employees had received a previous COVID-19 vaccination, according to federal records, which is three-quarters of the vaccination rate for nursing home workers nationwide. It has doubled.
Edenwald relies on Giant Supermarket pharmacies to administer the shots in an auditorium in the independent living section. Registration forms have already been distributed to clinics later this month. The facility charges workers’ compensation for vaccinations, but managers said they will pay premiums for employees who do not have health insurance.
“This is our seventh COVID-19 clinic,” said Megan Curtis, director of care management at Edenwald. “We were able to resolve it somehow.”
Swati Gaur, medical director of three nursing homes affiliated with Northeast Georgia Health System, said some facilities may offer the Novavax vaccine to defiant employees. It relies on more traditional virus-blocking technology than the Moderna and Pfizer shots, which use messenger RNA.
“We’re basically saying, ‘Why not get the vaccine?’ Have you thought about Novavax? It’s manufactured just like the flu vaccine,” Gaul said.
For the first time, the respiratory syncytial virus vaccine will be offered to nursing home residents. The virus causes 160,000 people over the age of 65 to be hospitalized and up to 10,000 deaths each year. Most nursing homes are combining the flu vaccine with the coronavirus or respiratory syncytial virus vaccine, but they don’t try to give all three at the same time.
Gaur said given the vaccine’s novelty and people’s relative unfamiliarity with RSV, clinicians need to spend more time explaining the reasons for vaccination.
Spurgeon Manor, the nursing home where Witik lives, partnered with a pharmacy at a nearby Hy-Vee grocery store to treat 85 residents of the home and adjacent assisted living center with the coronavirus, likely in early October. Vaccinations will be provided. As an employee.
Alana Marian, assistant director of nursing, said she would encourage employees to get vaccinated, but she estimated fewer than half would get vaccinated. “There’s a lot of prejudice out there about it,” she said.
Lee Gies, 95, a former truck driver who lives in the home, said he was looking forward to his latest shot after contracting the coronavirus last winter. He said he believed previous vaccinations helped protect him from more severe symptoms.
He said he expects most residents at the facility will be vaccinated, but a small number will decline. “Some people just want to die,” he says.
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Jordan Lau and Tony Reese are reporters for KFF Health News, a nonprofit news organization. Reese reported from Dallas Center, Iowa, and Lau reported from Washington, DC.
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