Nursing home residents at risk as staff vaccines lag | #healthcare | #elderly | #seniors
Vaccination rates for COVID-19 among the staff at New Jersey’s long-term care facilities vary widely, but are too low at many facilities to prevent future outbreaks of the disease that has claimed more than 8,020 staff and resident lives so far at such facilities — more than one-third of the state’s pandemic deaths.
The first data on vaccination rates at the state’s 586 nursing homes and assisted living facilities shows that, on average, 55.7% of staff is vaccinated, along with 84.6% of residents.
“It appears efforts to provide access and education to long-term care health care providers are falling short of what we had hoped,” said Melissa O’Connor, a professor at Villanova University’s nursing school, whose work focuses on geriatrics.
The snapshot of vaccination rates, from data reported by the nursing homes for April 21, underscores the challenges that remain — for both long-term care and the public at large — in overcoming vaccine hesitancy to reach a level of immunity that will slow and ultimately stop the pandemic’s spread.
At six of the facilities — including Millennium Memory Care at Matawan and Manahawkin Nursing and Rehabilitation Center in Stafford — none of the staff is fully vaccinated. At five others — including Inglemoor Center in Englewood and The Arbor at Laurel Circle in Bridgewater — all of the nurses, aides, dietary workers and housekeeping staff are.
In contrast to staff vaccination rates, many more facilities — 58 — report that 100% of their residents have received the full vaccine regimen. Among them: the Actors Fund Home in Englewood, the Jewish Home at River Vale, and Arden Courts of Wayne. Only one — The Country Home in Morris Plains, a memory care facility — achieved a perfect score, with all staff and residents vaccinated, according to the Health Department data.
Infections and deaths from COVID-19 in long-term care facilities have plunged from the pandemic’s peak, but 229 facilities still have active outbreaks that have infected more than 3,600 staff and 2,800 residents.
Unvaccinated staff members can introduce the virus that causes COVID-19 into a facility, causing potentially deadly infections in unvaccinated residents and illness in some who have been vaccinated. Older people and those with compromised immune systems may mount a weaker response to the vaccine, making them particularly vulnerable.
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Low vaccination rates at veterans homes
Even at the nursing homes that suffered some of the greatest loss of life during the pandemic, the vaccination rates among staff are low.
Most of the residents at the state-run veterans’ homes at Paramus and Menlo Park, where 192 died from COVID last year, have been vaccinated. But only about 58% of the homes’ 950 workers are fully vaccinated.
The veterans’ homes were among the first long-term care facilities to get the vaccine, in late December. While there have been some positive cases among staff and residents, no one has died from COVID at either facility in months.
Managers continually emphasize the importance of vaccinations to all staff, said Kryn Westhoven, a spokesman for the state Department of Military and Veterans Affairs, which runs the homes. “Vaccine hesitancy among staff remains a concern,” he said.
The low rates are concerning to some families whose loved ones survived the height of outbreak, including a woman whose uncle lives at the Paramus facility.
“I want everyone in there to be vaccinated,” said the woman, who requested anonymity for fear of retribution against her uncle. “We haven’t been able to have an indoor visit with him because COVID is still a problem. It’s kind of insulting that they’re refusing this when so many died.”
A month ago, when Health Commissioner Judith Persichilli reported that half of the state’s nursing home staff members were vaccinated, Gov. Phil Murphy called it “unacceptable.”
“That number has got to change,” he said. Since then, ongoing efforts by long-term care administrators, unions representing their workers, and state and local health officials have seen modest success, as some staff overcame their initial hesitancy.
Nursing home and hospital workers were the top priority when the first doses of vaccine were distributed in late December and January. Through a federal partnership program, CVS and Walgreens sent vaccinators and vaccines to long-term care facilities three times to provide the shots on site.
Subsequently, the facilities have relied upon their usual group purchasing organizations for access to vaccines for newer staff and residents, as well as those who previously declined. Some staff with a “wait and see” attitude now are ready.
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By providing many opportunities for the staff to “ask questions until they are comfortable, and with constant encouragement … many have changed their minds,” one nursing home administrator said.
“We were the first group to get it, and we didn’t have much feedback from others — that was the biggest concern,” said Natasha Islam, administrator of the Phoenix Center for Rehabilitation and Pediatrics in Wanaque.
At an on-site vaccination day earlier this month, weeks after the initial three vaccine clinics by CVS were completed, 20 to 25 staff members received a shot at the Wanaque center, Islam said. Currently 65% of her staff are fully vaccinated.
“We are beginning to see rates of hesitancy decline as time passes, but the vaccination rates among long-term care staff remain far too low, and this will inevitably put residents at risk,” said Alison Kris, a Fairfield University professor whose research focuses on nursing home care.
Kentucky outbreak shows risk
A recent COVID outbreak at a nursing home in Kentucky underscores the serious risk when too few staff are fully vaccinated.
The federal Centers for Disease Control and Prevention last week reported on the outbreak, caused by one unvaccinated staff member with symptoms of COVID-19. It led to 46 infections, four hospitalizations and three deaths. All had been offered the Pfizer vaccine at three on-site visits in January and February, and 90.4% of residents and 52.6% of staff were fully vaccinated.
During the outbreak, 26 residents, including 18 who were fully vaccinated, became infected, along with 20 staff, including four who were fully vaccinated. Two unvaccinated residents and one who was vaccinated died.
“To protect skilled-nursing facility residents, it is imperative that health care providers, as well as [facility] residents, be vaccinated,” the CDC authors concluded.
Of particular concern, experts say, are long-term care facilities where both the residents and the staff have low rates of vaccination — a combination that could easily lead to an outbreak. Some of these may be rehabilitation facilities where the majority of patients are admitted directly from hospitals for short stays, such as after a joint replacement, and may not have previously been vaccinated.
But even residents who were vaccinated in the large-scale rollout that began in late December can be susceptible, as the Kentucky example showed. The elderly and those with compromised immune systems may generate a lower immune response to the vaccine, or the vaccine may be less protective against new variants of the virus that are circulating.
“Scientists are not certain how long protection from the vaccine will last,” said O’Connor, the Villanova professor. “The vaccine is preventing deaths, but not from getting COVID. Being exposed to the virus could still make older adults sick.”
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Efforts to overcome vaccine hesitancy
The reasons for low vaccination rates among staff vary, but a nursing home leader said access was not a problem.
“Supply of the vaccine is not a barrier,” said Andrew P. Aronson, president and CEO of the Health Care Association of New Jersey, which represents the long-term care industry. “It’s just a constant educational campaign, a constant encouragement campaign to let them know the vaccines are safe and effective.”
Aronson noted that the report on vaccination rates was new, and some of the data — showing vaccination rates of more than 1,000%, for example — was incorrect. It also fails to capture the nuances of eligibility. The Phoenix Center, for example, has many pediatric residents who are too young to be eligible for the shots, and that lowers the rate shown for residents’ vaccinations.
Women make up more than 90% of the direct-care workforce in the state’s nursing homes, and “many young women seem to be hesitant to take the vaccine because of concerns about fertility,” Aronson said. The Pfizer and Moderna vaccines use messenger RNA, an incomplete portion of the virus’s genetic material, to provoke the body to produce antibodies against the coronavirus. The mRNA does not enter the nucleus of human cells, and it degrades rapidly after injection.
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People of color also account for more than four out of five direct-care workers. The history of medical mistreatment and experimentation in such communities has naturally created skepticism, said Bryn Lloyd-Bollard, vice president of 1199SEIU, which represents some 8,000 nursing home workers in New Jersey.
The union sends out a weekly newsletter about vaccine safety, highlighting the experiences and insights of experts and union members and answering common questions. It has also canvassed its members to identify those who need transportation to a vaccine location or help to make an appointment, if they don’t have access to vaccines at their workplace.
“We’d like to see additional on-site [vaccination] visits by pharmacies,” Lloyd-Bollard said. More educational material in the primary languages of some of the immigrant workforce, such as Haitian Creole, would be helpful, he said.
Along with reinforcing how safe the vaccines have been for tens of millions of Americans, nursing homes have to do a better job of allowing paid sick time for staff to recover from minor vaccine side effects and ensure that night shift staff have easy access to shots, said Kris, the Fairfield professor.
At Hackensack Meridian Health, mobile units operated by its EMS teams have taken vaccines to its 12 nursing home and three assisted living facilities since March. The vaccination rates among staff at the facilities range from 29.1% in West Caldwell to 68.3% at the Regent Care Center in Hackensack.
The program has relied on the Johnson & Johnson vaccine, a spokesman said. Although the program was paused last week, it will resume this week with either the Johnson & Johnson or Moderna shots.
“We are committed to educating our residents and staff about the lifesaving benefits of safe, effective COVID vaccines, and ensuring they have convenient access now and in the future,” said Benjamin Goldstein, a Hackensack Meridian spokesman.
Lindy Washburn is a senior health care reporter for NorthJersey.com. To keep up-to-date about how changes in the medical world affect the health of you and your family, please subscribe or activate your digital account today.