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

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.

"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.

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 hesitancy, existing 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.