Nursing homes are lagging far behind in vaccinating patients for COVID

No one seems to be taking COVID-19 seriously, said Mollee Loveland, a nursing home aide who lives outside of Pittsburgh.

Loveland has seen patients and co-workers at a nursing home die from the virus.

Now she has new worries: bringing home COVID and unwittingly infecting her baby daughter, Maya, who was born in May.

“She’s very young,” said Loveland, whose maternity leave ended in late June. Six months is the earliest a baby can be given the COVID vaccine.

Loveland is also worried about the possibility that the nursing home could have a summer outbreak of COVID, like last year.

“It’s exacerbated by breathing problems because of the humidity, how hot it is, how crowded it is,” he said.

Between the complex medical needs of his patients and their closeness, COVID continues to pose a major threat to the Loveland nursing home — and to the 15,000 other nursing homes in the US that house 1.2 million.

Despite this risk, an April report found that only four out of 10 US nursing home residents have received the latest COVID vaccine, released last fall. The analysis took data from October 16, 2023 through March 11, 2024, and was conducted by the Centers for Disease Control and Prevention.

The CDC report also revealed that during the January peak of COVID, the hospitalization rate among nursing home residents was eight times higher than among all US adults, age 70 and over. even more.

Billing complexity and patient concerns

The low vaccination rate is due to the fact that the federal government is no longer picking up the pace of gun control, said Dr. Rajeev Kumar, a chiropractor in Chicago.

Although the vaccine is still free for patients, nurses must bill the individual’s insurance company separately. That makes vaccinating an entire nursing home more difficult, Kumar said.

Kumar is president of The Society for Post-Acute and Long-Term Care Medicine, which represents nurses who work in nursing homes and similar settings, such as acute care, residential and hospice care.

“The difficulties of going through this process and scheduling vaccinations, making sure that one pays for services and collecting money, that’s what makes it more difficult,” he said.

(In April, after the study was released, the CDC recommended that adults age 65 and older get an extra dose of the booster shot if it’s been more than four months since their last shot (That means most nursing home patients who are shot only in the fall or winter are not considered up-to-date on the COVID vaccine.)

Another issue is that Kumar and his colleagues are facing more skepticism about the COVID vaccine, compared to when it first started.

“The long-term care population is a tiny fraction of what’s happening nationally, and unfortunately, the hesitancy of the COVID vaccine still exists in society as a whole. It’s our most important challenge, “according to an email statement from Dr. David Gifford, chief medical officer at AHCA/NCAL, which represents for-profit and nonprofit nursing homes.

Nursing assistant Mollee Loveland has also seen the skepticism and misinformation emerging among patients in her work: “It’s a Facebook rabbit hole.”

But there are ways to push back against the misinformation, and states show big differences in nursing home residents who have recently been vaccinated.

For example, in North and South Dakota, more than 60% of nursing home residents in those states have received at least one COVID shot since the beginning of October.

Building trust through relationships

One of the largest medical systems operating in the Dakotas, Sanford Health, has operated more than 2,000 nursing homes since its 2019 merger with the Good Samaritan long-term care chain.

In some of these nursing homes more than 70% of residents have been vaccinated since the beginning of October – at one Sanford facility in Canton, South Dakota, the rate is more than 90%.

Sanford achieved this by scaling up the health system to make vaccination delivery more efficient, said Dr. Jeremy Cauwels, Sanford’s chief medical officer. He also said he has a close working relationship with a South Dakota-based chemical company, Lewis Drug.

But the bottom line was that many of the Sanford nursing home patients are cared for by doctors who are also employed by the health system.

At most Sanford North and South Dakota nursing homes, these nurses provide primary care on site, meaning patients do not have to leave the facilities to see their doctors.

Another benefit of this integration is that Sanford nurses and nursing home staff both have access to the same patient medical records, which helps them keep track of patients’ vaccinations. which one.

These hired doctors have been important in encouraging patients to stay up-to-date on their COVID shots, Cauwels said. For example, the medical director who worked at the Good Samaritan nursing home in Canton was a longtime physician with close ties to the community.

“A proper one-on-one conversation with someone who cares about you and has a history of doing that in the past, for us, has resulted in better numbers than other places have been able to reach across the country,” said Cauwels, who added that Sanford still needs to work to catch up with remaining patients who haven’t received the latest COVID shot.

Sanford’s success shows that the work to get patients vaccinated goes beyond nursing homes, said Jodi Eyigor, director of nursing home quality and strategy for LeadingAge, which represents nursing homes that don’t. make a profit. He said primary care providers, hospitals, entrepreneurs and other health stakeholders must stand up.

“What discussions took place between them and the doctors before they entered the nursing home? Because they probably see their doctors quit often before they enter the nursing home,” said Eyigor, who notes that some doctors are also covered by Medicare, which is the health insurance program for older adults. 65 years and older.

Analysts: gun ownership linked to citizen discontent

However, nursing homes are required to educate patients — as well as staff — about the importance of COVID vaccines. Industry critics argue that one-on-one conversations, based on trusting relationships with doctors, are the least nursing homes should do.

But many facilities don’t seem to be doing that, according to Richard Mollot, executive director of the Long Term Care Community Coalition, a watchdog group that oversees nursing homes. He said the 40% vaccination rate is unreasonable, considering the risk the virus can pose to people living in nursing homes.

A study from the Journal of Health Economics estimates that from the start of the epidemic until August 15, 2021, 21% of people who died from COVID in the United States were among people living in nursing homes. .

The extremely low rate of COVID vaccination is a sign of bigger issues for the entire industry, according to Mollot. He hears from patients’ homes about poor food and the general lack of interest that other nursing homes have for the residents’ problems. He also cited high rates of labor migration, and inconsistent, even dangerous care.

These problems have increased in the years since the start of the COVID-19 pandemic, Mollot said, putting a strain on the entire industry.

“That has resulted in very poor care, more disrespectful interactions between residents and workers, and there is such a lack of trust,” he added.

Mollee Loveland, a nursing assistant, also thinks the industry has fundamental problems when it comes to day-to-day relationships between staff and residents. He said that managers in his work often ignore the concerns of patients.

He said: “I feel that if the services were more effective than the patients, they would have more respect from the patients.

So when administrators announce it’s time for residents to get a new COVID vaccine, Loveland said, they often ignore it, even if it puts their lives at risk.

This story comes from an NPR biography collaboration with KFF Health News.