Mary Ann Herbst, a patient at Good Samaritan Nursing Home in Le Mars, Iowa, received her first dose of the COVID-19 vaccine on December 29, 2020. Only 4 in 10 U.S. nursing home residents have received at least one dose of the latest coronavirus vaccine, released last fall, the study found.
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Mollee Loveland, a nursing home assistant who lives outside Pittsburgh, said no one seems to be taking COVID-19 seriously anymore.
Loveland has seen nursing home patients and co-workers die from the virus.
Now, she has a new worry: bringing the coronavirus home and unknowingly infecting her youngest daughter, Maya, who was born in May.
“She’s so little,” said Loveland, whose maternity leave ended in late June. Babies can receive the coronavirus vaccine as early as six months.
Loveland is also concerned that nursing homes could see a surge in coronavirus cases over the summer, as they did last year.
“Respiratory problems are exacerbated because of how humid, hot and muggy the weather is,” she said.
Due to patients’ complex medical needs and close proximity to each other, the coronavirus continues to pose a serious threat to Loveland’s nursing homes and the 15,000 other certified nursing homes in the United States, home to approximately 1.2 million people.
Despite this risk, an April report found that only 4 in 10 U.S. nursing home residents had received the latest coronavirus vaccine, released last fall. The analysis was conducted by the U.S. Centers for Disease Control and Prevention (CDC) and used data from October 16, 2023, to February 11, 2024
The Centers for Disease Control and Prevention report also shows that during the peak of the COVID-19 pandemic in January, hospitalization rates among nursing home residents were more than eight times the rate for all U.S. adults age 70 and older.
Billing Complexity and Patient Skepticism
Dr. Rajiv Kumar, a geriatrician in Chicago, said part of the reason for low vaccination rates is that the federal government no longer covers the cost of the shots.
While the vaccine remains free to patients, clinicians must now bill each person’s insurance company individually. That makes vaccinating entire nursing homes more logistically complicated, Kumar said.
Molly Loveland and her daughter Maya in a park in Washington, Pennsylvania. Loveland works at a nearby nursing home. Loveland is worried about contracting the coronavirus and bringing it home to her children when she returns to work. Only 4 in 10 U.S. nursing home residents have received at least one dose of the latest coronavirus vaccine, released last fall, federal data shows.
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Kumar is president of the Society for Post-Acute and Long-Term Care Medicine, which represents clinicians working in nursing homes and similar settings such as post-acute care, assisted living and hospice facilities.
“The challenges of going through the process, arranging vaccinations, making sure someone pays for services and collects payment are all made more tedious,” he said.
(In April, after the study was released, the CDC recommended that adults 65 or older get an additional dose of a newer vaccine if it has been more than four months since their last vaccination. That means, going forward, most Most nursing home patients who received just one dose in the fall or winter are not considered up to date on the coronavirus vaccine.
Another problem is that Kumar and his colleagues are raising more doubts about the COVID-19 vaccine than when it was first introduced.
“The long-term care population is a microcosm of what is happening across the country, and unfortunately, public resistance to COVID-19 vaccinations continues. This is the most significant challenge we face,” said the group, which represents both for-profit and nonprofit nursing homes. Dr. David Gifford, chief medical officer for AHCA/NCAL, said in an emailed statement.
Nursing assistant Mollee Loveland also sees concerns and misinformation among patients in her job: “It’s the Facebook rabbit hole.”
But there are ways to combat bad messaging, and there is wide variation across states in the proportion of nursing home residents who have been recently vaccinated.
In North Dakota and South Dakota, for example, more than 60% of nursing home residents in these states have received at least one dose of a COVID-19 vaccine since early October.
Build trust through relationships
Sanford Health, the main health system run by the Dakotas, has managed more than two dozen nursing homes since 2019 when it merged with long-term care chain Good Samaritan Society.
At some of these nursing homes, more than 70% of residents have been vaccinated since early October — at Sanford Nursing Home in Canton, South Dakota, the rate is more than 90%.
Sanford achieves this goal by leveraging the scale of the health system to make vaccinations more efficient, said Dr. Jeremy Cowells, Sanford’s chief medical officer. He also praised the close partnership with South Dakota pharmacy chain Lewis Drug.
But the most critical factor is that many Sanford nursing home patients are cared for by doctors employed by the health system.
At most nursing homes in Sanford North and South Dakota, these clinicians provide on-site primary care, which means patients don’t have to leave the facility to see a doctor.
Another benefit of this integration is that both Sanford clinicians and nursing home staff have access to the same patient medical records, which helps them track which patients have been vaccinated and which have not.
Cowells said these employed doctors played a key role in convincing patients to get the COVID-19 vaccine in a timely manner. For example, one of the medical directors who works at Good Samaritan Nursing Home in Canton is a long-time physician with strong ties to the community.
“For us to have a proper one-on-one conversation with someone who cares about you and has a history of doing that in the past is a lot better than the numbers that the rest of the country can achieve,” Cowells said, adding that Santos Forde still needs to work to reach remaining patients who have not recently been vaccinated against COVID-19.
Jodi Eyigor, director of nursing home quality and policy for LeadingAge, which represents nonprofit nursing homes, said Sanford’s success shows that the responsibility for getting patients vaccinated doesn’t end with nursing homes. Primary care providers, hospitalists, pharmacists and other health care stakeholders need to step up, she said.
“What conversations are happening between them and their doctors before they walk through the nursing home door? Because they may often see doctors quit before they enter the nursing home.
Critics: Shootings related to resident dissatisfaction
Still, nursing homes need to educate their patients and staff about the importance of the coronavirus vaccine. Industry critics argue that one-on-one conversations based on a trusting relationship with a clinician are the last thing nursing homes should do.
But many agencies don’t seem to be doing even that, according to Richard Mollot, executive director of the Alliance for Long-term Care Communities, a watchdog group that oversees nursing homes. He said the recent 40% vaccination rate was inexcusable given the danger the virus posed to people in nursing homes.
A study in the Journal of Health Economics estimated that from the start of the pandemic through August 15, 2021, 21% of COVID-19 deaths in the United States were among people living in nursing homes.
Morlot said the alarmingly low rate of COVID-19 vaccinations is actually a symptom of a larger problem across the industry. He learned from family members of patients that the food in some nursing homes was of poor quality and there was a general indifference to residents’ concerns. He also cited high staff turnover and substandard and even dangerous care.
Morlot said these issues have intensified since the outbreak of the coronavirus, putting widespread pressure on the entire industry.
“This has resulted in a much lower level of care and more disrespectful interactions between residents and staff, with a lack of trust,” he added.
Nursing assistant Mollee Loveland agreed there were fundamental problems with the industry when it came to the day-to-day interactions between workers and residents. She said managers at her workplace often ignored patients’ concerns.
“I feel like if these institutions did more for their patients, they would get more respect from their patients,” she said.
As a result, Loveland said, when administrators announce that residents need to be up to date on the latest COVID-19 vaccine, they are often ignored, even if it puts their own health at risk.
This story comes from NPR’s health reporting partnership KFF Health News.
