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“I am so grateful that she was able to get that vaccine,” Diane wrote. “Without it, I’m not convinced that she would still be with us.”
Melinda from Arizona and Dan from New York also had to push for their spouses to get the vaccine. Both partners are in nursing homes because of Alzheimer’s disease, and the families had to ask the facilities multiple times to protect their loved ones.
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As Helen from Connecticut describes, those who are in facilities for dementia, such as her parents, are especially vulnerable. “Alongside their physiological vulnerability, their cognitive abilities make managing a covid outbreak extremely challenging,” she wrote. “They eat in a cafeteria and cannot remember to mask.”
The facility where Helen’s parents are living was unable to schedule shots before an outbreak hit the memory-care unit. Half the residents got the virus, Helen said, and her mother needed to be hospitalized for it.
These stories are consistent with my reporting that the low vaccine uptake in nursing homes is more the result of logistical barriers than vaccine hesitancy. While the latter plays a part, trusted providers can often overcome it with thoughtful engagement and ongoing conversations.
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Susan Reinhard, director of the public policy institute at AARP, gave me another important data point to support this hypothesis. Her organization conducted a series of focus groups with nurses who work in long-term-care facilities across the country. What they found, Reinhard said, was an “absolutely enormous variation” across nursing homes in the same area. Whereas one facility would have vaccinated nearly all of its residents, others nearby would have very low rates.
This ran counter to the narrative she often heard, which was that vaccine misinformation can be so pervasive in a community that the nursing homes simply cannot solve it. But if hesitancy were solely to blame for poor vaccination rates, why would there be dramatic differences in uptake between two neighboring nursing homes?
Reinhard looked into this further. She spoke with a nurse practitioner who worked in two nursing homes that were located just five miles apart in rural Tennessee. Both were even owned by the same corporation. But one had about double the vaccine uptake of the other.
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Part of the reason is that the nursing home with the higher rate had a system that automatically indicated whether a resident had been vaccinated; the other one didn’t. That means, in the former facility, clinicians didn’t have to dig for vaccine records and could immediately flag which residents they needed to speak with about the shot.
This nurse practitioner also shared that it often takes several conversations to explain the necessity of the vaccines and answer questions about each resident’s circumstances. For example, some wanted to know whether to wait until after having surgery. Others wanted to know whether it was okay to get the shot while using medications such as prednisone. The nursing home that had higher uptake made clinicians available to talk directly to residents and their families. In the other, Reinhard said, “education and consistent communication weren’t occurring.”
Reinhard also pointed to other administrative barriers, including problems with payments and reimbursements now that the vaccines are no longer provided free of charge to nursing homes. Beyond that, she said, “there is the question of how important this is to the leadership.” She believes nursing home officials must ask themselves: “Are we really going to make this a priority? And if so, how are we going to do it?”
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That has been my biggest takeaway from expert interviews and reader comments. Of course, nursing homes face major logistical barriers for this round of vaccines that did not exist in previous ones. Vaccine misinformation is also a big problem; systemic policy reforms and consistent public messaging can help.
Boosting nursing home vaccine rates, however, is ultimately up to facilities. Those with higher rates have processes in place to bring vaccines to residents, to track who has not yet received them and to ensure ongoing clinician dialogue with residents and families. In other words, success requires leadership that fosters a culture of active engagement around public health.
Thank you for all your reader submissions about nursing home vaccinations. Next week, I plan to write about the top 10 health policy issues for 2024. What makes the list for you? Please let me know, and in the meantime, happy new year!
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In recent weeks, I have written a lot about low coronavirus vaccination rates in long-term care facilities. While some have speculated that this is because residents are hesitant to receive the shot, many readers have shared experiences reinforcing a different reason: Accessing vaccines in nursing homes is often far too difficult.
Christina from Pennsylvania wrote that when her uncle asked for the coronavirus vaccine, staff members at his facility told him they did not have it. “I was shocked. No one told his family, and he ended up contracting covid a week ago.” Her mother, too, was told that her facility didn’t have it, so they took her to a pharmacy themselves.
Diane from California also took matters into her own hands when she was told that her 89-year-old mother, who was admitted to a nursing home following a hip fracture, could not get the vaccine in the facility. Diane ended up calling the county health department and arranging for someone to administer the shot. Just three weeks later, there was an outbreak at the nursing home. Her mother still contracted the virus, but the vaccine might have saved her life.
“I am so grateful that she was able to get that vaccine,” Diane wrote. “Without it, I’m not convinced that she would still be with us.”
Melinda from Arizona and Dan from New York also had to push for their spouses to get the vaccine. Both partners are in nursing homes because of Alzheimer’s disease, and the families had to ask the facilities multiple times to protect their loved ones.
As Helen from Connecticut describes, those who are in facilities for dementia, such as her parents, are especially vulnerable. “Alongside their physiological vulnerability, their cognitive abilities make managing a covid outbreak extremely challenging,” she wrote. “They eat in a cafeteria and cannot remember to mask.”
The facility where Helen’s parents are living was unable to schedule shots before an outbreak hit the memory-care unit. Half the residents got the virus, Helen said, and her mother needed to be hospitalized for it.
These stories are consistent with my reporting that the low vaccine uptake in nursing homes is more the result of logistical barriers than vaccine hesitancy. While the latter plays a part, trusted providers can often overcome it with thoughtful engagement and ongoing conversations.
Susan Reinhard, director of the public policy institute at AARP, gave me another important data point to support this hypothesis. Her organization conducted a series of focus groups with nurses who work in long-term-care facilities across the country. What they found, Reinhard said, was an “absolutely enormous variation” across nursing homes in the same area. Whereas one facility would have vaccinated nearly all of its residents, others nearby would have very low rates.
This ran counter to the narrative she often heard, which was that vaccine misinformation can be so pervasive in a community that the nursing homes simply cannot solve it. But if hesitancy were solely to blame for poor vaccination rates, why would there be dramatic differences in uptake between two neighboring nursing homes?
Reinhard looked into this further. She spoke with a nurse practitioner who worked in two nursing homes that were located just five miles apart in rural Tennessee. Both were even owned by the same corporation. But one had about double the vaccine uptake of the other.
Part of the reason is that the nursing home with the higher rate had a system that automatically indicated whether a resident had been vaccinated; the other one didn’t. That means, in the former facility, clinicians didn’t have to dig for vaccine records and could immediately flag which residents they needed to speak with about the shot.
This nurse practitioner also shared that it often takes several conversations to explain the necessity of the vaccines and answer questions about each resident’s circumstances. For example, some wanted to know whether to wait until after having surgery. Others wanted to know whether it was okay to get the shot while using medications such as prednisone. The nursing home that had higher uptake made clinicians available to talk directly to residents and their families. In the other, Reinhard said, “education and consistent communication weren’t occurring.”
Reinhard also pointed to other administrative barriers, including problems with payments and reimbursements now that the vaccines are no longer provided free of charge to nursing homes. Beyond that, she said, “there is the question of how important this is to the leadership.” She believes nursing home officials must ask themselves: “Are we really going to make this a priority? And if so, how are we going to do it?”
That has been my biggest takeaway from expert interviews and reader comments. Of course, nursing homes face major logistical barriers for this round of vaccines that did not exist in previous ones. Vaccine misinformation is also a big problem; systemic policy reforms and consistent public messaging can help.
Boosting nursing home vaccine rates, however, is ultimately up to facilities. Those with higher rates have processes in place to bring vaccines to residents, to track who has not yet received them and to ensure ongoing clinician dialogue with residents and families. In other words, success requires leadership that fosters a culture of active engagement around public health.
Thank you for all your reader submissions about nursing home vaccinations. Next week, I plan to write about the top 10 health policy issues for 2024. What makes the list for you? Please let me know, and in the meantime, happy new year!
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