It seems no one is taking covid-19 seriously anymore, said Mollee Loveland, a nursing home aide who lives outside Pittsburgh.<\/p>\n
Loveland has seen patients and coworkers at the nursing home where she works die from the viral disease.<\/p>\n
Now she has a new worry: bringing home the coronavirus and unwittingly infecting her infant daughter, Maya, born in May.<\/p>\n
Loveland\u2019s maternity leave ended in late June, when Maya wasn\u2019t yet 2 months old. Infants cannot be vaccinated against covid until they are 6 months old<\/a>. Children younger than that suffer the highest rates<\/a> of hospitalization of any age group except people 75 or older.<\/p>\n Between her patients\u2019 complex medical needs and their close proximity to one another, covid continues to pose a grave threat to Loveland\u2019s nursing home \u2014 and to the 15,000 other certified nursing homes<\/a> in the U.S. where some 1.2 million people live.<\/p>\n Despite this risk, a CDC report<\/a> published in April found that just 4 in 10 nursing home residents in the U.S. received an updated covid vaccine in the winter of 2023-24. The analysis drew on data from Oct. 16, 2023, through Feb. 11, 2024, and was conducted by the Centers for Disease Control and Prevention.<\/p>\n The CDC report also revealed that during January\u2019s covid peak, the rate of hospitalizations among nursing home residents was more than eight times that of all U.S. adults, age 70 and older.<\/p>\n Billing Complexities and Patient Skepticism<\/strong><\/p>\n Last winter\u2019s low vaccination rate was partly driven by the end of the federal government\u2019s paying for administering the shots, said Rajeev Kumar<\/a>, a Chicago-based geriatrician.<\/p>\n While the vaccines remain free to patients, clinicians must now bill each person\u2019s insurer separately. That makes vaccinating an entire nursing home more logistically complicated, Kumar said.<\/p>\n Kumar is president of the Post-Acute and Long-Term Care Medical Association<\/a>, which represents clinicians who work in nursing homes and similar settings, such as post-acute care, assisted living, and hospice facilities.<\/p>\n \u201cThe challenges of navigating through that process and arranging vaccinations, making sure that somebody gets to bill for services and collect money, that\u2019s what has become a little bit more tedious,\u201d he said.<\/p>\n In April, after the study was released, the CDC recommended<\/a> that adults 65 and older get an additional dose of an updated vaccine if it\u2019s been more than four months since their last dose. That means most nursing home patients who have had only one shot in fall or winter are not considered up to date on the covid vaccines.<\/p>\n Kumar and his colleagues are encountering more skepticism of the covid vaccines, compared with their rollout.<\/p>\n \u201cThe long-term care population is a microcosm of what\u2019s happening across the country and, unfortunately, covid vaccine reluctance remains persistent throughout the general public. It\u2019s our most significant challenge,\u201d according to an emailed statement from David Gifford, chief medical officer at AHCA\/NCAL<\/a>, which represents both for-profit and nonprofit nursing homes.<\/p>\n Nursing aide Loveland also has observed doubts and misinformation cropping up among patients at her job: \u201cIt\u2019s the Facebook rabbit hole.\u201d<\/p>\n But there are ways to push back against bad information, and states show wide variation in the proportion of nursing home residents who got vaccinated last winter.<\/p>\n For example, in both North and South Dakota, more than 55% of residents<\/a> at nursing homes that reported data have gotten an updated covid vaccine this fall. Nationally, that share is 32%.<\/p>\n Building Trust Through Relationships<\/strong><\/p>\n One major medical system operating in the Dakotas, Sanford Health<\/a>, has managed more than two dozen nursing homes since a 2019 merger<\/a> with the long-term care chain Good Samaritan Society<\/a>.<\/p>\n In some of these nursing homes more than 70% of residents were vaccinated last fall and winter \u2014 at one Sanford facility in Canton, South Dakota, the rate exceeded 90%.<\/p>\n Sanford achieved this by leveraging the size of the health system to make delivering vaccines more efficient, said Jeremy Cauwels<\/a>, Sanford\u2019s chief medical officer. He also credited a close working relationship with a South Dakota-based pharmacy chain, Lewis Drug<\/a>.<\/p>\n But the most crucial factor was that many of Sanford\u2019s nursing home patients are cared for by doctors who are also employed by the health system. At most Sanford\u2019s North and South Dakota nursing homes, these clinicians provide on-site primary care, meaning patients don\u2019t have to leave the facilities to see doctors.<\/p>\n These employed doctors have been critical in persuading patients to stay up to date on their covid shots, Cauwels said. For example, a medical director who worked at the Good Samaritan nursing home in Canton was a long-serving physician with close ties to that community.<\/p>\n \u201cAn appropriate one-on-one conversation with someone who cares about you and has a history of doing so in the past, for us, has resulted in much better numbers than other places have been able to get to nationally,\u201d said Cauwels, who added that Sanford still needs to work on reaching more patients.<\/p>\n Sanford\u2019s success shows the onus of getting patients vaccinated extends beyond nursing homes, said Jodi Eyigor<\/a>, director of nursing home quality and public policy for LeadingAge<\/a>, which represents nonprofit nursing homes. She said primary care providers, hospitalists, pharmacists, and other health care stakeholders need to step up.<\/p>\n \u201cWhat conversations have occurred before they walked into a nursing home\u2019s doors, between them and their doctors? Because they\u2019re probably seeing their doctors quite frequently before they come into the nursing home,\u201d said Eyigor, who noted these other clinicians are also regulated by Medicare, the federal health insurance program for adults 65 and older.<\/p>\n Critics: Shot Uptake Linked to Residents\u2019 Dissatisfaction<\/strong><\/p>\n Nursing homes are required to educate<\/a> patients \u2014 as well as staff \u2014 about the importance of the covid vaccines. Industry critics contend that one-on-one conversations, based on trusted relationships with clinicians, are the least that nursing homes should do.<\/p>\n But many facilities don\u2019t seem to be doing even that, according to Richard Mollot<\/a>, executive director of the Long Term Care Community Coalition<\/a>, a watchdog group that monitors nursing homes. A 40% recent vaccination rate is inexcusable, he said, given the danger the virus poses to people who live in nursing homes.<\/p>\n A study from the Journal of Health Economics<\/a> estimates that from the start of the pandemic through Aug. 15, 2021, 21% of covid deaths in the U.S. were among people living in nursing homes.<\/p>\n Mollot said that the alarmingly low covid vaccination rate is a symptom of larger issues throughout the industry. He hears from patients\u2019 families about poor food quality and a general apathy that some nursing homes have toward residents\u2019 concerns. He also cites high rates of staff turnover<\/a> and substandard, even dangerous<\/a>, care.<\/p>\n These problems intensified in the years since the start of the covid pandemic, Mollot said, causing extensive stress throughout the industry.<\/p>\n \u201cThat has resulted in much lower care, much more disrespectful interactions between residents and staff, and there\u2019s just that lack of trust,\u201d he added.<\/p>\n Loveland, the nursing aide outside Pittsburgh, also thinks the industry has fundamental problems when it comes to daily interactions between workers and residents. She said the managers at her job often ignore patients\u2019 concerns.<\/p>\n \u201cI feel like if the facilities did more with the patients, they would get more respect from the patients,\u201d she said.<\/p>\n That means that when administrators announced it was time for residents to get one of the newest covid vaccines this year, Loveland said, residents often simply ignored the message, even if it meant putting their own health at risk.<\/p>\n This article is from a partnership that includes <\/em>NPR<\/em><\/a> and <\/em>KFF Health News<\/em><\/a>.<\/em><\/p>\n\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n