As nursing homes prepare for a federal COVID-19 vaccine mandate for healthcare workers, researchers have identified what types of facilities have the highest hills to climb.
For-profit and chain nursing homes, sites with Medicare star ratings and facilities with shorter-tenured staff have the lowest vaccination rates among the 14,900 nursing homes that submitted vaccination data to the National Healthcare Safety Network, a new study shows. As of July 18, 60% of nursing home employees and 81% of residents were fully vaccinated.
Vaccination rates were 2.5 percentage points lower for workers and 3.5 percentage points lower for residents at for-profit nursing homes, according to the findings of a study published in JAMA Internal Medicine on Thursday. Each additional star in a nursing home's Medicare ratings is associated with 1.4 percentage points higher vaccination rate among employees and 1.2 percentage points higher among residents.
Facilities with greater populations of non-white staff and residents also had lower vaccination rates, as did sites where workers' average employment tenures were shorter than 33 weeks.
For every 10 percentage point increase in a county's adult vaccinate rate, a facility's vaccination rate rises 2.7 and 1.4 percentage points, respectively, for staff and residents, the study found. For every 10 percentage point increase in the local Republican vote margin during the 2020 presidential election, staff vaccination rates were 1.4 percentage points lower.
"We find that a lot of things matter a little bit or moderately. To me, that seems like something that's hard to address through targeted outreach campaigns," said Brian McGarry, assistant professor in the division of geriatrics and aging at the University of Rochester and one of the study authors.
The federal mandate will have have a big impact on staff vaccination rates. McGarry said. "The results do lend some credibility to these heavy-handed policy approaches like a mandate because it's not just one thing that needs to be addressed, it's a lot of things," McGarry said.
The federal government mandating the vaccine instead of individual employers could make conversations about vaccination easier between management and staff.
"There's a relief not to be the bad guy in this scenario, and a renewed focus on working with staff to help get them to yes," McGarry said. "In some ways, because the outcome is predetermined, it may sort of change their relationship and allow the nursing homes to have some of the outreach efforts make more of an impact."
While overall staff vaccination levels are low, they are even lower among certified nursing assistants, who have the most direct contact with patients. McGarry said. Greater levels of education are linked to a higher likelihood of getting vaccinated among healthcare personnel, as it is in the general population, the findings show. Just under half of certified nursing assistants were vaccinated at the time of the study compared to 61% of registered nurses and licensed practical nurses, 71% of therapists, and 77% of physicians, nurse practitioners and physician assistants.
The American Health Care Association and National Center for Assisted Living and other healthcare industry groups have supported vaccine mandates, as long as they apply to all healthcare workers to avoid putting more staffing pressure on nursing homes.
"We applaud President [Joe] Biden for expanding COVID-19 vaccination requirements to all Medicare and Medicaid-certified healthcare settings as well as larger businesses. This will help prevent unvaccinated nursing home staff from looking for new lines of work, alleviating some of the staffing challenges too many long-term care facilities are currently facing," AHCA/NCAL President and CEO Mark Parkinson said in a news release when Biden announced his broader vaccine mandate.