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This is why it is so alarming that only about a quarter of residents in nursing homes have received the updated coronavirus shot, according to the Centers for Disease Control and Prevention. The average age of people entering these facilities is 84. Nearly half have a severe disability, and most have several underlying medical conditions.
Two states, however, have managed to achieve surprisingly high vaccination rates: In North Dakota, 55 percent of nursing home residents have received the latest coronavirus vaccine. In South Dakota, almost 57 percent have. Their experiences can help inform other parts of the country on how to protect the most vulnerable among us, even in areas facing political opposition to the shots.
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To understand why these two deep-red states are such outliers in nursing home vaccination, I spoke with Jeremy Cauwels, the chief physician of Sanford Health, which is not only the largest rural health system in the United States but also the largest provider of long-term care in North and South Dakota. He told me that most of his system’s nursing homes, which operate under the name Good Samaritan Society, had at least a 50 percent uptake of the updated coronavirus shot. In some facilities, more than 90 percent of residents received it.
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Cauwels attributed much of this remarkable progress to a robust partnership with pharmacies. When vaccines first became available in the winter of 2020, vaccinators all over the country went directly to nursing homes to give shots to residents. While most such programs have ended, South Dakota-based pharmacy chain Lewis Drug continued to bring vaccines directly to many residents. Having these immunization clinics in nursing homes helped achieve a “tremendous amount of uptake by vaccinating people where they live,” he said.
It also helps that many nursing home residents have physicians who are part of the same health-care system. “We know who’s been vaccinated and who hasn’t,” Cauwels said. That allows conversations during medical visits to continue encouraging vaccination.
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Jennifer Galbraith, manager of adult immunization in North Dakota’s Health Department, also emphasized the importance of bringing vaccines directly to residents. Early in the pandemic, her team earned praise for proactively matching nursing homes with pharmacies. She and her staff called every long-term-care facility in the state and “connected each with a primary vaccinator and backup vaccinator.”
She and her team have maintained these relationships and still call all of these facilities regularly. Some nursing homes were so busy that they didn’t even know that the CDC had recommended a new round of coronavirus shots. “We’re providing that education to them over the phone,” she said.
These conversations also helped Galbraith understand the challenges nursing homes are facing. For instance, the end of the federal public health emergency for the pandemic added new administrative burdens. Vaccines were no longer provided free of charge, so facilities had to buy them and then seek reimbursement, adding to up-front costs. And because many nursing homes are short-staffed, many need assistance from pharmacies or health systems to administer the shots.
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Galbraith has been speaking to facilities about these challenges since early summer. “It’s kind of exposure therapy, getting them to know what’s coming and to at least start the preplanning process,” she said. She explained North Dakota’s success this way: “Quite frankly, it’s being annoying and keep on calling them and connecting them” with needed resources.
There is much to learn from the Dakotas’ hands-on approach. One crucial takeaway is that it’s possible to achieve high vaccination rates for vulnerable people even in areas hardly known for their embrace of vaccines. Indeed, legislators in both states are trying to pass bills that end childhood immunization requirements; some North Dakota lawmakers have even tried to ban the coronavirus vaccine.
“There are people that still believe that [vaccines] are a political issue,” Cauwels said. “But I would tell you that for us, this is an issue of making sure that we keep our elderly as safe as we possibly can.” He believes most nursing home residents and their families will choose to receive the vaccine. “It boils down to access and availability more than it does anything else."
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Low-uptake states, such as Arizona (where 12.5 percent of nursing home residents are vaccinated), Arkansas (12.2 percent) and California (22.1 percent) should take heed. With hospitalizations for covid on the rise yet again, now is the time to double down on efforts to protect those most vulnerable.
I plan to write more on lagging nursing home vaccination rates and would love to hear from you. Do you work in a long-term-care facility and want to share challenges — and successes — of getting residents vaccinated? Are you a resident or a family member and want to share your vaccination story? Please send me your thoughts.
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Since the start of the pandemic, it has been obvious that nursing home residents are especially vulnerable to covid-19. Though less than 1 percent of Americans live in long-term-care facilities, more than 1 in 5 deaths from covid have happened in that setting.
This is why it is so alarming that only about a quarter of residents in nursing homes have received the updated coronavirus shot, according to the Centers for Disease Control and Prevention. The average age of people entering these facilities is 84. Nearly half have a severe disability, and most have several underlying medical conditions.
Two states, however, have managed to achieve surprisingly high vaccination rates: In North Dakota, 55 percent of nursing home residents have received the latest coronavirus vaccine. In South Dakota, almost 57 percent have. Their experiences can help inform other parts of the country on how to protect the most vulnerable among us, even in areas facing political opposition to the shots.
To understand why these two deep-red states are such outliers in nursing home vaccination, I spoke with Jeremy Cauwels, the chief physician of Sanford Health, which is not only the largest rural health system in the United States but also the largest provider of long-term care in North and South Dakota. He told me that most of his system’s nursing homes, which operate under the name Good Samaritan Society, had at least a 50 percent uptake of the updated coronavirus shot. In some facilities, more than 90 percent of residents received it.
Cauwels attributed much of this remarkable progress to a robust partnership with pharmacies. When vaccines first became available in the winter of 2020, vaccinators all over the country went directly to nursing homes to give shots to residents. While most such programs have ended, South Dakota-based pharmacy chain Lewis Drug continued to bring vaccines directly to many residents. Having these immunization clinics in nursing homes helped achieve a “tremendous amount of uptake by vaccinating people where they live,” he said.
It also helps that many nursing home residents have physicians who are part of the same health-care system. “We know who’s been vaccinated and who hasn’t,” Cauwels said. That allows conversations during medical visits to continue encouraging vaccination.
Jennifer Galbraith, manager of adult immunization in North Dakota’s Health Department, also emphasized the importance of bringing vaccines directly to residents. Early in the pandemic, her team earned praise for proactively matching nursing homes with pharmacies. She and her staff called every long-term-care facility in the state and “connected each with a primary vaccinator and backup vaccinator.”
She and her team have maintained these relationships and still call all of these facilities regularly. Some nursing homes were so busy that they didn’t even know that the CDC had recommended a new round of coronavirus shots. “We’re providing that education to them over the phone,” she said.
These conversations also helped Galbraith understand the challenges nursing homes are facing. For instance, the end of the federal public health emergency for the pandemic added new administrative burdens. Vaccines were no longer provided free of charge, so facilities had to buy them and then seek reimbursement, adding to up-front costs. And because many nursing homes are short-staffed, many need assistance from pharmacies or health systems to administer the shots.
Galbraith has been speaking to facilities about these challenges since early summer. “It’s kind of exposure therapy, getting them to know what’s coming and to at least start the preplanning process,” she said. She explained North Dakota’s success this way: “Quite frankly, it’s being annoying and keep on calling them and connecting them” with needed resources.
There is much to learn from the Dakotas’ hands-on approach. One crucial takeaway is that it’s possible to achieve high vaccination rates for vulnerable people even in areas hardly known for their embrace of vaccines. Indeed, legislators in both states are trying to pass bills that end childhood immunization requirements; some North Dakota lawmakers have even tried to ban the coronavirus vaccine.
“There are people that still believe that [vaccines] are a political issue,” Cauwels said. “But I would tell you that for us, this is an issue of making sure that we keep our elderly as safe as we possibly can.” He believes most nursing home residents and their families will choose to receive the vaccine. “It boils down to access and availability more than it does anything else."
Low-uptake states, such as Arizona (where 12.5 percent of nursing home residents are vaccinated), Arkansas (12.2 percent) and California (22.1 percent) should take heed. With hospitalizations for covid on the rise yet again, now is the time to double down on efforts to protect those most vulnerable.
I plan to write more on lagging nursing home vaccination rates and would love to hear from you. Do you work in a long-term-care facility and want to share challenges — and successes — of getting residents vaccinated? Are you a resident or a family member and want to share your vaccination story? Please send me your thoughts.
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