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4 in 5 U.S. Nursing Homes Behind on Staff Vaccination Goal, Analysis Finds

Some states have especially low vaccination rates for residents and staff

En español | COVID-19 vaccination rates among U.S. nursing home workers continue to lag nationwide, with only 1 in 5 facilities hitting an industry target of getting 75 percent of their health care staff fully vaccinated, a new AARP analysis of government data shows. A handful of states have especially low vaccination rates among both staff and residents.

Nationally, 56.7 percent of nursing home workers are fully vaccinated. But in Louisiana, just 41 percent of workers are, representing the lowest staff vaccination rate of any state or territory, the analysis finds. In Florida, home to over 700 nursing homes, only 42 percent of workers are fully vaccinated.

Although a much higher share of nursing home residents are fully vaccinated nationwide — 78 percent — some states are reporting much lower rates. In Arizona, just 63 percent of residents — fewer than 2 in 3 — are fully vaccinated, the lowest of any state. In Florida, only 68 percent of residents are.

Low vaccine uptake among both staff and residents in nursing homes leaves residents highly vulnerable to a resurgence of the virus, experts say.

More than 650,000 nursing home residents have been infected with COVID-19 during the pandemic, and more than 130,000 have died from the virus. Nearly a third of the more than 600,000 U.S. COVID-19 deaths have been in nursing homes, assisted living facilities and other long-term care settings. The virus has disproportionately killed older Americans; more than 80 percent of victims have been 65 or older.

AARP's analysis, released Thursday, also shows that COVID-19 cases and deaths in nursing homes are continuing to decline to all-time lows. Yet the newly released vaccination rates — which the federal government only required nursing homes to publicly report starting in June — are a new cause for alarm, says AARP's Susan Reinhard, senior vice president and director of the AARP Public Policy Institute.

"They show we've not passed the threat of COVID to nursing home residents,” she says. “In some states, the situation is really, really serious — there are just not enough people vaccinated, particularly as this delta variant takes off.”

Missing the target

Two of the country's largest nursing home trade groups, the American Health Care Association (AHCA) and LeadingAge, had set a target to vaccinate 75 percent of nursing home workers in every facility nationwide by the end of June. At the time, it was estimated that this rate among staff would provide facilities with a high degree of herd immunity.

Only 20 percent, or 1 in 5, of the nation's 15,000-plus nursing homes achieved the target as of June 20, according to AARP's analysis. Hawaii, which has hit the 75 percent staff vaccination goal in 86 percent of its facilities, reports the highest rate. California follows, with 66 percent of facilities hitting the target, then comes Vermont with 55 percent.

But in 46 states, less than half of nursing homes have reached the 75 percent staff vaccination threshold. In Kentucky, with the lowest count, only three percent of facilities have vaccinated 75 percent of staff. In Georgia, only 4 percent of facilities have hit the target, while only 5 percent did in Alabama, Florida and Idaho.

David Gifford, chief medical officer of the AHCA, which represents more than 14,000 nursing homes and other long-term care facilities across the country, has said the rates show “more work needs to be done.”

"Vaccination rates among long-term care staff continue to mirror other health care settings and general population rates, especially in certain parts of the country, because there continues to be a large amount of misinformation circulating around these safe and effective vaccines,” Gifford said in a statement last month.


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A Southern slump

Staff vaccination rates are especially low in some Southern states. Alongside Florida and Louisiana, Georgia, Mississippi and Oklahoma also reported staff vaccination rates lower than 45 percent. Missouri was the only other state to report a staff vaccination rate lower than 45 percent.

Resident vaccination rates are also lower than the national average in those states, with only 68, 70 and 74 percent of nursing home residents fully vaccinated in Florida, Georgia and Oklahoma, respectively. In Tennessee, 47 percent of workers and 74 percent of residents are fully vaccinated. In South Carolina, 49 percent of workers and 74 percent of residents are fully vaccinated.

This low vaccine uptake across the board leaves nursing home residents highly vulnerable to a resurgence of the virus, experts warn.

"Staff that aren't vaccinated and protected, they remain a very direct route by which the virus can enter the building,” says Justin Lessler, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The more unvaccinated workers there are, the higher the chances are of that occurring. And the more unprotected residents there are, the higher the chances are of infection and death. That's particularly true as the spread of the new delta variant, which is more contagious and harmful than America's dominant alpha variant, increases.

"There are going to be pockets of infection,” says Jennifer Schrack, also an associate professor in epidemiology at the Johns Hopkins Bloomberg School of Public Health. “And in the South, where vaccinations are lagging, it seems like it's going to be more of a problem than in other areas.”

Cases and deaths keep falling

After several months of stagnation, the rates of new COVID-19 cases and deaths in nursing homes have begun to fall again, AARP's analysis shows. The rate of new resident infections in the four weeks ending June 20, was about 1 out of every 600 residents, representing a decline of about half from the four-week period ending May 16. The rate of new staff cases also declined between these two periods, dropping by two-thirds to about 1 staff infection for every 400 residents.

COVID-19 deaths among residents also declined, to around 600 over the four weeks, or less than 1 out of every 1,500 residents. It represents a dramatic decline from COVID-19's winter peaks in nursing homes, where about 20,000 residents died from the virus over the four weeks from mid-December to mid-January.

A recent AARP letter to the agency commended the federal Centers for Medicare & Medicaid Services’ (CMS) new vaccine education and vaccination reporting requirements for long-term care facilities but presses for more action. That includes making the new vaccination data more consumer-friendly and sustaining rigorous COVID-19 testing.

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 CMS. 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.

Editors note: This story, published July 15, was updated on July 19 to correct errors in CMS data for three nursing homes in Connecticut, New Jersey and Texas related to the number of staff or residents that were able to be vaccinated.

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