COVID-19 Cases and Deaths Rise in Nursing Homes as Booster Uptake Halts

America’s long-term care facilities, including nursing homes, assisted living facilities and other senior care settings, have been disproportionately impacted by the pandemic, suffering more than 200,000 COVID-19 deaths among residents and staff. The facilities account for roughly a fifth of all U.S. COVID-19 fatalities, with more than 170,000 of those deaths attributed specifically to nursing homes

Shots stagnate

Vaccination rates in nursing homes have ground to a halt, the analysis shows. As of July 17, 88 percent of residents and 89 percent of nursing home staff nationwide were vaccinated with their first two shots, which represents no change from the previous three monthly reporting periods.

Booster rates have also stagnated, but at lower rates. As of mid-July, about 75 percent of residents nationwide had received at least one booster dose, the analysis found. This uptake rate is virtually unchanged from the previous monthly reporting period, up only a fraction of a percentage point.

It leaves some 300,000 residents without up-to-date vaccinations, even with most nursing home residents now recommended for another booster shot. In April, director of the Centers for Disease Control and Prevention (CDC) Rochelle Walensky, M.D., said second boosters are “especially important” for people over 65 and those over 50 with chronic health problems, both highly represented in the nursing home population.

Federal data on second booster shots in nursing homes is currently unavailable.

Among nursing home workers, just over half had received at least one booster dose as of mid-July, virtually unchanged from mid-June. That leaves roughly a million nursing home staff without a booster dose, even though most were recommended by the CDC for one in late 2021.

Booster rates vary widely among states, the analysis found. Resident booster rates ranged from less than 60 percent in Arizona and Florida to 92 percent in Vermont. Worker booster rates ranged from a low of 30 percent in Mississippi to a high of 96 percent in Massachusetts.

Massachusetts and other states with high booster rates among staff, including California and Connecticut, are requiring nursing home staff to get the additional shot. The federal government, meanwhile, is only requiring an initial series of COVID-19 vaccinations for all staff of Medicare- and Medicaid-funded health care facilities, which includes the vast majority of the country’s 15,000 nursing homes.

AARP called on nursing homes to require boosters among both residents and staff in January, saying boosters are “necessary to remain protected.” Critics of vaccine mandates said such requirements would lead to increased staffing shortages in nursing homes, forecasting that vaccine-hesitant nursing home workers would quit instead of getting the shots.

Staffing shortages are a longstanding problem in U.S. long-term care. More than a quarter of nursing homes nationwide reported a shortage of nurses or aides in the four weeks ending mid-July, the analysis found. In Minnesota, New Hampshire and Washington, more than 60 percent of facilities reported such shortages.

But a new study released last month on JAMA Health Forum, which studied nursing homes in 38 states, found that state-level vaccine mandates were associated with increased staff vaccination coverage without increases in reported staffing shortages.

“These findings support the use of state mandates for booster doses for nursing home employees because they may improve vaccine coverage, even in areas with greater vaccine hesitancy,” the authors wrote.

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 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 care 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.