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: Nursing-home residents and staff are not up to date on COVID-19 vaccines


Moving into the holiday season — and the so-called “tripledemic” of COVID-19/flu/RSV — less than half of nursing home residents and less than a quarter of staff were up to date with COVID-19 vaccines, a new study found.

KFF found that only 45% of nursing home residents and 22% of staff were up to date with their COVID-19 vaccines as of Nov. 20, the Sunday before Thanksgiving. Vaccination rates among residents ranged from a low of 24% in Arizona to a high of 73% in South Dakota. For staff, Alabama scored the lowest at 10%, while California came in the highest at 48%.

“We expected to see some drop in vaccination rates, but rates this low were surprising,” said Priya Chidambaram, KFF’s senior policy analyst with the program on Medicaid and the uninsured. 

This is concerning because people in nursing facilities are at higher risk of having worse outcomes if infected with COVID-19 and one-fifth of all U.S. COVID-19 deaths occurred among residents and staff in long-term-care facilities, KFF said. 

“The implications are increased mortality and more severe infections that could lead to long COVID among nursing facility residents. Death and severe sickness at a time when hospital capacity is just not there. For the staff, the repercussions are potentially infecting residents or getting sick and creating staffing shortages,” Chidambaram said. 

Read: ‘This isn’t just gonna go away’: Long COVID is crashing the retirement hopes of many Americans

Keeping nursing facility residents and staff current on vaccines is an important tool for reducing deaths from COVID-19 and especially important this holiday season when risks may be compounded by high rates of other respiratory viruses, KFF said. 

Public health experts have said that the U.S. will see higher than normal cases of flu, RSV, and COVID-19 and hospital capacity may be reduced. 

Preliminary data support these predictions, showing that flu hospitalizations have hit their highest levels for this time of year in a decade. Similarly, COVID-19 hospitalizations increased by 17% in the week leading into Thanksgiving. 

The Biden administration has been encouraging Americans to get their COVID-19 boosters prior to the holiday season, but take-up of the booster has been lower compared with the primary vaccination series.

Long-term-care facilities now report the share of residents and staff that are up-to-date with their COVID-19 vaccinations using the CDC’s definition of up-to-date: “having received a bivalent booster or having received a final shot of the original vaccines less than 2 months ago.”

Federal vaccine clinics and healthcare worker vaccine mandates contributed to high initial vaccination rates among nursing facility residents and staff, but without ongoing federal initiatives, fewer people may stay up-to-date with their vaccines, KFF said.

Nearly 87% of nursing facility residents and staff completed their primary vaccination series, but those rates fell sharply when it came to keeping up with their vaccines. The high take-up rate of the primary vaccine series reflects several factors, including the high death rates among nursing facility residents and the focus on nursing facility residents during the initial vaccine roll-out.  

Quicker initial take-up of vaccines and boosters in 2021 is also attributable to the three on-site vaccination clinics held at all long-term-care facilities participating in the Federal Pharmacy Partnership for Long-Term Care Program. Facilities are still able to request additional clinics, but it’s unclear how many facilities are doing so or how many pharmacy partners continue to participate. 

“There’s no longer standardization. The policies and practices are happening at the will of the individual facilities. It’s very different from facility to facility,” Chidambaram said. 

Among nursing facility staff, initial adoption of COVID-19 vaccines was low until the healthcare worker vaccination mandate required providers that participate in Medicare and/or Medicaid to be vaccinated. The vaccine mandate does not require boosters, so booster rates among staff may remain low, KFF said.

“Generally, the culture about COVID has changed in the past year or so. I’d be surprised if the mandate changed to require boosters,” Chidambaram said. 

Looking ahead, current rates of COVID-19 deaths among nursing facility residents and staff remain relatively low, but death rates spiked immediately following the 2021 holiday season. 

The death rate went from 35 deaths per 100,000 in mid-November 2021 to 131 deaths per 100,000 in mid-January 2022. This year, in the week ending Nov. 20, 2022, the death rate among nursing facility residents was at 19 deaths per 100,000.

Last year’s spike raises concerns about the potential for a similar increase in preventable deaths among nursing home residents in the upcoming postholiday season, KFF said.

Creating new opportunities for on-site vaccinations and updating the healthcare worker vaccination mandate to reflect current CDC guidance could increase the number of nursing facility residents and staff who are up-to-date with their COVID-19 vaccinations and decrease preventable deaths. KFF said. 

More generally, without continued communication and education, there may be more people who are vaccinated and boosted but not up-to-date as vaccination immunity wanes.

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