Covid-19 booster rates in nursing homes lag, especially among staff, and especially in Ky., where rate is among nation's lowest

National Council on Aging photo

By Melissa Patrick
Kentucky Health News

Covid-19 booster rates lag in both nursing-home residents and staff, but especially among the staff.

A Kaiser Family Foundation analysis found that while over 85% of nursing home residents and staff were "fully vaccinated" last month, only 74% of residents and 51% of staff had received booster shots that protect against current subvariants of the Omicron variant of the coronavirus.

Kentucky's numbers were similar, except that staff booster rates were much lower than the national rate. 

Using Centers for Medicare & Medicaid Services Covid-19 Nursing Home Data from August 2021 to Sept. 18, Kaiser found that only 37% of Kentucky nursing-home staff had received at least one booster shot or an additional dose, placing Kentucky among the 10 worst states for staff boosters.

The analysis showed Kentucky's nursing-home residents were much more protected, with 74% of them having received at least one booster or an additional dose. 

Asked what Kentucky is doing to improve these numbers, Susan Dunlap, spokesperson for the Cabinet for Health and Family Services, first noted in an email that more recent data show that 43% of nursing-home staff in the state have been boosted.

Dunlap cautioned that punitive measures to increase Covid-19 vaccination and booster rates among staff could hurt the facilities: "Imposing fines or other responses for the flattened compliance rates for [vaccinations] doesn’t seem productive, given staffing challenges that facilities are grappling with."

The nursing-home lobby, the Kentucky Association of Health Care Facilities, agreed with the cabinet. KAHCF said its members have been working to improve booster rates by providing frequent clinics in their facilities and regularly communicating with their staff about the need to maintain safety for themselves, their co-workers and the residents for whom they they care. 

"Historically, we have seen our long-term care vaccination rates mirror the community rates," Emily Weber, director of communications, marketing and public affairs for the association, said in an e-mail. 

Karen Venis, CEO of Sayre Christian Village in Lexington, which offers a range of housing and care options for seniors, said her facilities continue to stress the importance of Covid-19 vaccines and boosters as a way to protect this most vulnerable population from a virus that is a great health and safety risk to them.

"We continue to provide ongoing education to our staff and residents and do everything we can to encourage them to get the vaccine and/or the booster, including going the extra step of hosting on-site vaccine clinics on a regular basis so that we meet people where they are and make it more convenient for them," Venis said. 

At The Jordan Center in Louisa, vaccination rates were high early on. In an interview, owner David McKenzie said several strategies that contributed to that: establishing a culture of trust to thwart misinformation, allowing time for private discussions to assess concerns, working with community partners such as health departments, and identifying "unofficial influencers" inside the facility. 

On its website, this nursing home thanked its staff for getting vaccinated.

"I just think it takes good old-fashioned one-on-one communication, just sitting down with people," McKenzie said. "That's what it really really takes. . . . If they're fearful, then what are they afraid of?" 

He added that people can't be forced to take the vaccines and are more likely to listen to someone they know and trust than the government or a corporation. (Most Kentucky nursing homes are owned by non-family corporations.)

McKenzie said 93% of his residents are "up to date" with their Covid-19 vaccinations, meaning they have received a booster, and that 94% have received their primary series. He said 95% of staff had received their primary series and 40% were up to date with boosters. 

"I have to admit that it's getting harder and harder to get people to take the boosters," he said. 

McKenzie offered several theories for this. He said some staff had already gotten a booster and been infected with the virus, which makes them think they are immune and don't need it, which may not be the case.

Others, he said, have told him that it could be a branding issue – that staff would respond better to the booster if it were called an annual vaccine.  

McKenzie added that it has also been a challenge to address the misinformation on social media and elsewhere on the internet about the vaccines, and that his center has worked from the very beginning of the pandemic to establish itself as a reliable source of information for its residents and their families. 

"We wanted them to trust us as a resource for information," he said. "We constantly kept them updated. We constantly tried to find the very best sources for information and then disseminate that. . . . It didn't necessarily happen overnight, but over time I think we built a lot of trust."

McKenzie concluded the interview with a story of vaccine success, noting that his facility recently had its worst Covid-19 outbreak since vaccinations became available – but not one of his residents had died from it and most of those who were infected had mild or symptoms or nor at all. "It was miraculous," he said. 

The Kaiser foundation stressed the importance of making sure seniors are vaccinated and boosted, pointing to a recent report from the Centers for Disease Control and Prevention that found a second Covid-19 booster dose was 90% effective against death and 74% effective against severe Covid-19 related outcomes for nursing home residents. 

More than one-fifth of all U.S. Covid-19 deaths occurred in long-term care facilities and that death rates from the virus are rising for people ages 65 and older, a recent analysis by the foundation found.

"The number of Covid-19 deaths per month among people 65 and over doubled between April 2022 and July 2022, exceeding 11,000 for the months of July and August," Priya Chidambaram and Alice Burns report for Kaiser. 

The foundation calls for creating new opportunities for on-site vaccinations and updating the federal health-care-worker vaccination mandate to reflect current CDC guidance, saying those steps could increase the number of nursing facility residents and staff who are up to date with their Covid-19 vaccinations.

The CDC’s new definition of “up-to-date” is having received a bivalent booster or having received a final shot of the original vaccines less than 2 months ago. Nursing homes started using this new definition in their reporting on Sept. 26, according to the foundation.