Aides at U.S. Nursing Homes Least Likely to Be Vaccinated, Study Shows

The study highlights the effects that a new federal mandate for all health care workers to be inoculated against Covid may have on vulnerable populations like the elderly in nursing homes, experts say.,


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Aides at U.S. nursing homes were least likely to be vaccinated, a study shows.

Erika Shaver-Nelson, left, the activities director at Chaparral House, a nursing home in Berkeley, Calif., speaking with a resident in March.Credit…Jeff Chiu/Associated Press

Sept. 16, 2021Updated 12:55 p.m. ET

Nursing home aides — the staff members who provide the most direct care to residents — were the least likely to be fully vaccinated against the coronavirus by mid-July, according to a new analysis of U.S. facilities.

The study underscores the influence that President Biden’s new federal mandate for all health care workers may have on populations like the elderly in nursing homes who are vulnerable to coronavirus infections, experts say.

The findings are “alarming and reason for pause,” said Brian McGarry, a health researcher at the University of Rochester and one of the authors of the analysis, which appeared in a research letter in JAMA Internal Medicine on Thursday.

Low vaccination rates among nursing home workers in some areas have fueled concern about fresh outbreaks among staff and residents in these facilities, even with high numbers of vaccinated residents. Covid deaths among nursing home staff and residents accounted for nearly one third of the nation’s pandemic fatalities as of June 1, and vaccination rates among staff average around 63 percent, according to the latest federal data.

But slightly under half of the certified nursing assistants were fully vaccinated, according to the analysis, which looked at federal vaccination data through July 18. That was before many nursing homes, states and cities began imposing mandates.

According to the study, in nursing homes overall, 61 percent of nurses, both registered nurses and licensed practical nurses, were vaccinated, compared with 71 percent of therapists and 77 percent of doctors and independent practitioners like physician assistants or nurse practitioners.

Some large nursing homes were starting to mandate vaccinations as the Delta variant began tearing through their communities and coming into nursing homes. Genesis HealthCare, one of the nation’s largest nursing-home operators, required vaccinations in August and said it had “met our deadline of 100 percent vaccinated staff, as promised — excluding the small number of individuals who received medical or religious exemptions.”

Nationally, about two-thirds of adults are now fully vaccinated, according to federal data.

David Grabowski, a professor of health care policy at Harvard Medical School and one of the study’s authors, said few nursing homes have mandates in place so far. While homes’ vaccination rates have ticked up slightly, the overall rate for nursing homes has hovered at just a little above 60 percent in the last couple of months even as the Delta variant took hold and drove up new cases among staff and residents.

The nursing home industry, which had been opposed to a mandate aimed specifically at its workers, favors the broader U.S. mandate. “We applaud President Biden for expanding Covid-19 vaccination requirements to all Medicare and Medicaid-certified health care settings as well as larger businesses,” said Mark Parkinson, the chief executive of the American Health Care Association, a major nursing home trade group, in a statement at the time.

“Despite rampant misinformation spreading online, the industry has made significant progress toward increasing the number of nursing home staff who are vaccinated since the beginning of the year,” the group said.

Understand Vaccine and Mask Mandates in the U.S.

Vaccine rules. On Aug. 23, the Food and Drug Administration granted full approval to Pfizer-BioNTech’s coronavirus vaccine for people 16 and up, paving the way for an increase in mandates in both the public and private sectors. Private companies have been increasingly mandating vaccines for employees. Such mandates are legally allowed and have been upheld in court challenges.Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.Schools. Both California and New York City have introduced vaccine mandates for education staff. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots. Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.New York City. Proof of vaccination is required of workers and customers for indoor dining, gyms, performances and other indoor situations, although enforcement does not begin until Sept. 13. Teachers and other education workers in the city’s vast school system will need to have at least one vaccine dose by Sept. 27, without the option of weekly testing. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.

The researchers also looked at characteristics of the nation’s 15,000 nursing homes to determine which facilities had the most success in vaccinating their workers. While the vaccination rates of the county where they were located played a significant role, the researchers also found that traits like higher quality ratings from the Medicare program, the nonprofit status of the facility and a long-tenured staff also seemed to lead to higher rates.

“That gives us some suggestion that facility culture and leadership may play a role,” Dr. McGarry said, and management at these nursing homes may be better able to work with their staff to increase vaccine acceptance.

But none of those factors alone appeared to be critical in a nursing home’s success. “A lot of things seemed to matter a little bit,” he said.

Most influential may be the president’s decision earlier this month to impose a new federal mandate requiring all health care workers to be vaccinated. Nursing home workers may no longer be able to “job shop” as easily to find employment where vaccines are not mandated.

“The mandate takes all those things off the board and says everyone has to do it,” he said.

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