Forty percent of U.S. nursing home residents and more than 70 percent of nursing home workers had not received a COVID-19 booster as of late January, a new AARP analysis of government data shows. The analysis covered a recent four-week period during the omicron variant’s surge and found that infections among nursing home residents and workers, who account for roughly a fifth of the Americans who’ve died from COVID-19, hit their highest levels of the pandemic during those weeks.
In some states, the booster numbers were much lower. In Arizona and Nevada, less than 40 percent of nursing home residents had received a booster. In eight states, fewer than 20 percent of nursing home workers had received one.
“It’s very concerning,” says Susan Reinhard, AARP senior vice president and director of the AARP Public Policy Institute. “Those booster rates are just way too low for such a vulnerable population, who really need this extra protection.”
During the same time period, nursing homes nationwide reported their largest shortage of workers since they started reporting such data to the federal government in 2020. Almost 40 percent of facilities reported a shortage of direct care workers, a 25 percent increase from previous highs.
The new AARP analysis, which captures COVID-19 data in nursing homes between Dec. 27, 2021, and Jan. 23 of this year, shows that the period was one of the most devastating of the past year for care facilities. While the monthly death rate for residents was lower than in 2020, before vaccines were available, more than 3,600 nursing home residents died in these four weeks — more than double the number of deaths reported during the previous month. The recent death toll is about 10 times as high as it was during a four-week period at the beginning of last summer, right before the delta variant began circulating the U.S.
New nursing home data from the Centers for Disease Control and Prevention (CDC) captures three weeks of more recent data than AARP’s analysis, showing that both staff and resident infections in nursing homes started to decline dramatically in late January and early February. New weekly staff cases dropped from almost 67,000 for the week ending Jan. 16 to roughly 13,000 for the week ending Feb. 13, while new weekly resident cases dropped from more than 49,000 for the week ending Jan. 23 to roughly 14,000 for the week ending Feb.13. The most recent figures are likely undercounts, with some facilities not yet submitting their data. And while cases have declined, they’re still significantly higher than those recorded pre-omicron.
Some 200,000 of the nation’s COVID-19 deaths have been residents or staff in nursing homes, assisted living facilities and other senior care facilities.
Booster rates much lower in some states
The CDC began recommending boosters for nursing home residents last September, after studies showed that vaccination becomes less effective over time, especially in people 65 and older. When the highly contagious omicron variant emerged, CDC data showed that the rate of new COVID-19 infections in nursing home residents who got a booster was more than 90 percent lower than the rate among residents who were not fully vaccinated or who had only received their primary series of shots.
AARP called on nursing homes to require COVID-19 booster shots for their residents and staff in January.
But as omicron surged, only 60 percent of all U.S. nursing home residents were boosted as of Jan. 23, according to AARP’s analysis. The CDC’s more recent national data says that 69 percent of fully vaccinated residents had received a booster shot as of Feb. 6. But that count excludes the roughly 13 percent of unvaccinated or only partially vaccinated residents.
Among nursing home workers, who the CDC officially recommended get boosted starting last November, booster uptake is much lower. Only 28 percent of all workers nationwide had received the extra shot as of Jan. 23, according to AARP’s analysis. In Arizona, Florida, Georgia, Indiana, Louisiana, Missouri, Mississippi and Tennessee, fewer than 20 percent of workers have had one.
CDC data says that 35 percent of fully vaccinated workers had received a booster shot as of Feb. 6. But again, that count excludes the roughly 15 percent of unvaccinated or only partially vaccinated workers. This booster rate for nursing home workers trailed that of the general U.S. population, which hit 42 percent on Feb. 7.
Check the vaccination rates of your nursing home
You can now find vaccination and booster rates of both residents and staff at any Medicare-certified nursing home and compare it with state and national averages on Medicare.gov’s Care Compare website.
- Find a nursing home’s profile via the home page’s search function
- Visit the “Details” section of its profile
- Click the “View COVID-19 Vaccination Rates” button
Reasons for lagging booster rates
Some nursing home operators say that the lag in staff uptake is due to many workers being ineligible for the extra shots; either they’re not five months past their initial series of vaccination yet, or they currently have or recently had COVID-19 and have been recommended to wait. Roughly 1 in 8 nursing home workers nationwide became newly infected with COVID-19 between Dec. 27 and Jan. 23, according to AARP’s analysis.
But given that roughly 60 percent of nursing home workers were fully vaccinated as of mid-July, and therefore probably eligible for a booster in mid-December, it’s likely that workers are forgoing the booster shots for other reasons, experts say.
Many staff members are unsure of the official guidance for boosters or fatigued by continually changing guidance, says Glen Lewis, executive director of the Edgewater senior living community in West Des Moines, Iowa. “That’s causing some to delay or just give up trying to keep up.”
Other operators are attributing the lags to ongoing vaccine hesitancy. “So much misinformation about [vaccines and boosters] continues to run rampant in our society, still, after two years of this public health emergency,” wrote a LeadingAge spokesperson in an email to AARP. The organization represents more than 5,000 non-profit aging services providers.
Delays in receiving consent from resident representatives, long waits for pharmacy partners to provide on-site vaccinations and widespread staffing shortages in the health care industry are also reasons for lags, according to operators.
The lack of a cohesive federal campaign to bring boosters to the nursing home population may also be having some effect, says Jennifer Kates, senior vice president and director of global health and HIV policy at the Henry J. Kaiser Family Foundation.
“In the beginning of the U.S. vaccine rollout, there was a lot of focus and effort to reach those in nursing homes,” says Kates, highlighting the federal campaign that sent teams from CVS, Walgreens and other drugstores into long-term care facilities with COVID-19 vaccines, from December 2020 to March 2021.
“I think all of that attention and concern resulted in uptake in those populations, but we haven't seen that same push on the booster side.”
Staffing shortages hit pandemic high
Since last fall, around 30 percent of nursing homes nationwide have consistently been reporting a shortage of nurses or aides each month, according to AARP’s analysis. That figure jumped to almost 40 percent in the recent four-week period analyzed by AARP, representing the worst shortages reported throughout the pandemic.
In some states, include Alaska, Kansas, Maine, Minnesota, Oregon, Washington, Wisconsin and Wyoming, the shortages are particularly bad, with more than 60 percent of facilities statewide reporting a lack of staff.
Low staffing levels in nursing homes, particularly among registered nurses, are associated with worse outcomes for residents, including more COVID-19 cases, deaths and a higher likelihood of an outbreak.
The record-breaking COVID-19 infection rates among workers during the omicron surge are largely to blame for the hikes in shortages, experts say. But other factors, including high levels of worker burnout and the federal vaccination mandate for workers in health care facilities that participate in Medicare and Medicaid, could be having some effect.
There are reports of nursing home employees — who held one of the deadliest jobs of 2020 — leaving the field for other positions with better pay, benefits and working conditions. Most certified nursing assistants (CNAs), who make up the largest group of employees in long-term care facilities and provide more than 90 percent of the direct resident care, make less than $15 per hour. Many don’t qualify for paid sick leave or benefits. The vast majority are women, including many people of color and immigrants.
After facing months of legal challenges, the Biden administration’s COVID-19 vaccine requirement for staff of Medicare- and Medicaid-certified health care facilities — which include most nursing homes — is also now enforceable in all states after a recent Supreme Court decision overruled state challenges. Around half of all states have until have until March 28 to fully vaccinate their staff before penalties are issued, while the other half of states have until April 14.
The requirement, which AARP “strongly supports,” covers only the initial series of vaccinations, not boosters.
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.