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With COVID Cases in Nursing Homes Rising, AARP Calls for Mandatory Vaccinations

As cases in facilities double, as much as 40 percent of the workforce is not fully vaccinated

COVID-19 cases in U.S. nursing homes, where more than 133,000 residents have died during the pandemic, have started increasing again, according to a new AARP analysis of government data. The uptick prompted AARP on Thursday to call for mandatory COVID-19 vaccinations for nursing home residents and workers. Just 60 percent of nursing home workers are fully vaccinated nationally; in eight Southern states, fewer than 50 percent are.

"As the new variants are emerging, facilities cannot let preventable problems be repeated,” said Nancy LeaMond, AARP executive vice president and chief advocacy and engagement officer. “AARP is calling on nursing homes to require vaccinations for staff and residents. The low levels of staff vaccinations in particular creates an unacceptable level of risk, since the disease spreads so easily in these environments. And facilities must ensure all residents are vaccinated, including providing vaccines to newly admitted residents.

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“The key is to increase vaccinations, and do it now.”

The recent uptick in nursing home cases follows dramatic drops in infections since the beginning of 2021. In the four weeks from June 21 to July 18, about 2,000 new COVID-19 resident cases and 3,600 worker cases were reported by nursing homes to the federal government, according to the analysis. The figures represent only a slight increase from the previous four-week period, from May 24 through June 20.

But the week-to-week figures show an alarming trend. More than double as many resident and staff cases were detected in the week ending July 18 — more than 2,000 new infections between staff and residents combined — compared with the week ending June 27, when there were about 900.

More than 186,000 residents and staff of nursing homes and other long-term care facilities have died from COVID-19, accounting for 30 percent of America's coronavirus fatalities, even though less than 1 percent of the population lives in these facilities. These rates are “a national disgrace,” LeaMond said.

In some states, the jumps have been even more pronounced. While the national resident and staff infection rates increased only slightly between the May-June reporting period and the new June-July period, in Arkansas, Florida, Missouri and Nevada, both the resident and staff infection rates have more than doubled.

In Florida, home to more than 700 nursing homes, week-to-week data shows that cases increased almost fourfold — from 120 to 478 cases — between the week ending June 27 and the week ending July 18. By July 18, 40 percent of homes in the state had reported at least one staff infection during the four-week reporting period, almost tripling the national average.

While the most recent case counts are low when compared with the COVID-19 winter surge in nursing homes, the number of cases has topped 200,000 nationally over the past four weeks and “the trajectories are concerning, especially given the significant rise in cases we've seen recently in the wider community,” said AARP's Ari Houser, a senior methods adviser and coauthor of the analysis.

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"I think we're heading in the wrong direction,” he said.

Daily COVID-19 caseloads in the U.S. have increased tenfold since late June, thanks in large part to the rapid spread of the highly contagious delta variant. Death reports, which can lag well behind case data, have doubled and more coronavirus patients are hospitalized now than at any point since February. Throughout the pandemic, experts have warned that COVID-19 patterns in nursing homes tend to follow what's occurring in the wider population.

"If the virus is transmitting more efficiently in the community, no matter what measures we take to protect these facilities, the chance of the virus getting in is going to increase because the people who work there and visitors — they're all more likely to become infected,” said Justin Lessler, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

Check the vaccination rates of your loved one's nursing home

• To see the percentage of fully vaccinated residents or staff in a specific federally certified nursing home, visit the Centers for Medicare & Medicaid Services’ COVID-19 Nursing Home Data page .

• Click the "Visualize Data" button at the top of the page or the “Visualization” link on the left to search for your nursing home.

• Click your nursing home’s location dot and a box will appear with the resident and staff vaccination rates listed at the bottom.

• Alternatively, you can download an Excel spreadsheet listing the resident and staff vaccination rates of each individual nursing home. There’s also a separate tab in the spreadsheet for nursing homes with a staff vaccination rate of 75 percent or more. 

• New data is released weekly on Thursdays.

Vaccine mandates gain momentum

As the delta variant spread accelerates and as vaccination rates among nursing home workers continue to lag, more states and long-term care providers are mandating that nursing home workers be inoculated against COVID-19 as a condition of employment.

Nationally, only 60 percent of nursing home workers were fully vaccinated against COVID-19 as of July 18, while 82 percent of residents were, according to AARP's analysis. Only a quarter of all homes had achieved an industry goal of vaccinating at least 75 percent of their workers. In Louisiana, Florida, Missouri, Mississippi, Oklahoma, Georgia, Kentucky and Tennessee, less than 50 percent of workers are fully vaccinated.

Some long-term care facilities began mandating vaccines for workers as early as December 2020, when the first vaccines were first given emergency use authorization. But the majority of nursing homes did not, citing widespread vaccine hesitancyexisting staffing shortages and potential lawsuits as major concerns. The long-term care workforce commonly experiences low pay and scant benefits, has been disproportionately affected by COVID-19 and disproportionately comprises Black workers, who are more vaccine-wary than other Americans.

But some states, including California, Massachusetts, Connecticut and Washington, have recently introduced mandates for nursing home staff, with many requiring workers to be fully vaccinated by the end of October or earlier. Some of the nation's largest long-term care chains, including Genesis HealthCare, Brookdale Senior Living and Good Samaritan, are doing the same.

"Now that vaccines are widely available and scientifically proven to be safe and the most effective method for preventing hospitalization and death, it would be absolutely irresponsible for anyone working in long-term care facilities to not receive this protection that could prevent widespread infection among those most vulnerable from dying from this communicable disease,” Connecticut Gov. Ned Lamont said in a statement.

"While we would have greatly preferred a strictly voluntary process, our commitment to health and safety outweighs concerns about imposing a requirement,” Genesis CEO Harry Wilson said in a statement. “Universal COVID-19 vaccination provides the safest and most effective course of action to ensure the health and welfare of our patients, residents and staff."

AARP's analysis, conducted by the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio, draws primarily on data acquired from the Nursing Home COVID-19 Public File by the Centers for Medicare & Medicaid Services. Most nursing homes are federally certified and are required to submit data to the government each week.

The ongoing analysis captures data only from federally certified nursing homes, not from all long-term facilities (such as assisted living, independent living, memory care and others), as some other tallies do. An updated analysis will be released next month as new federal data becomes available. Read more about the analysis.

Emily Paulin is a contributing writer who covers nursing homes, health care, and federal and state policy. Her work has also appeared in Broadsheet, an Australian lifestyle publication.

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