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Nursing Aides With Direct Resident Contact Least Likely to Be Vaccinated

Study suggests unvaccinated staff can spark outbreaks, even if residents have shots

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Nursing aides most likely to interact with long-term care residents are the industry's least likely workers to be vaccinated against COVID-19, according to a new study from the Centers for Disease Control and Prevention (CDC) that suggests low staff vaccination rates could lead to outbreaks, even in facilities where most residents have been inoculated.

CDC researchers looked at data from 300 U.S. facilities and found that just 45.6 percent of long-term care nursing aides were vaccinated against COVID-19 — compared with 56.7 percent of nurses, 75.1 percent of physicians and advanced practice providers, and 56.8 percent of all staff. The data are from March and early April, but a more recent AARP analysis of vaccination rates submitted to the Centers for Medicare & Medicaid Services (CMS) shows a similar trend. Just 45 percent of aides, assistants and technicians were vaccinated by the week ending July 4, compared with 54 percent of all health care workers in facilities that reported vaccination rates by staff job type.

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Experts have expressed alarm that staff vaccination rates are so low, especially among a group of workers who regularly interact with residents.

"I am very concerned about the low staff vaccination rates and believe they are associated with the recent [nursing home] outbreaks we are seeing across the country,” says Charlene Harrington, a nursing home researcher at the University of California, San Francisco. “You would hope for rates of 80 to 90 percent for staff and residents.”

The CDC report notes several demographic trends, with vaccination rates lower at facilities in areas with lower median income, higher poverty and larger concentrations of racial and ethnic minorities. It also points out that nursing aides are “disproportionately women and members of racial and ethnic minority groups, with median hourly wages of $13 to $15 per hour.” Separate research suggests that vaccine acceptance varies along demographic lines, with vaccination rates lower among lower-income adults and racial and ethnic minorities.

The report goes on to suggest that low staff vaccination rates are potentially dangerous even in facilities where most residents have been vaccinated. Vaccines are not foolproof shields against COVID-19, particularly for older adults. People 65 and older have accounted for nearly 3 in 4 breakthrough infections documented by the CDC that were fatal or required hospitalization.

In March an unvaccinated health care worker at a Kentucky nursing home sparked an outbreak that resulted in nearly 50 infections and three resident deaths. More than 90 percent of the facility's residents, but less than 53 percent of its staff, had been vaccinated at the time of the outbreak. Of the affected residents who were fully vaccinated, 18 were infected and one died.

"The vaccinated residents appear, unsurprisingly, to have a lower mortality than if they were unvaccinated. But there nevertheless is going to be some mortality and morbidity associated with outbreaks, even among vaccinated residents,” says Michael Wasserman, a geriatrician and past president of the California Association of Long Term Care Medicine.

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The nursing home industry has for months grappled with staff vaccine hesitancy, despite relatively high buy-in from residents. A recent AARP analysis of CMS data found that roughly 78 percent of residents but less than 57 percent of workers were fully vaccinated against COVID-19 in the four weeks ending June 20. Only about 1 in 5 facilities have reached an industry goal of fully vaccinating at least 75 percent of their staff.

"I don't think it's surprising to find out we're continuing to have outbreaks in facilities where the staff hasn't been vaccinated,” Wasserman says. “Unvaccinated staff are the ones who are going to put residents at the greatest risk."

Nursing homes and other long-term care facilities have accounted for nearly a third of America's more than 600,000 COVID-19 deaths. AARP has for months called for greater transparency around facility outbreaks and vaccination status, praising new long-term care vaccine education and reporting requirements in a recent letter to CMS Administrator Chiquita Brooks-LaSure. In the letter, AARP urges the CMS “to ensure that those facilities can access and administer vaccines on a continuing basis for the foreseeable future."

Andrew Soergel covers nursing homes and federal and state policy for AARP. He was previously a senior economics writer at U.S. News & World Report and was awarded an Economics of Aging and Work fellowship through the Associated Press-NORC Center for Public Affairs Research at the University of Chicago. 

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