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Nearly Half of Nursing Home Residents Are Behind on COVID-19 Shots

More than half of nursing home staff are also behind, an AARP analysis finds

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Nearly half of all U.S. nursing home residents and more than half of staff are behind on their COVID-19 shots, a new AARP analysis of federal data shows, leaving roughly half a million residents and more than 1 million staff without crucial protection heading into the cold-weather season.

As of mid-September, only 55 percent of nursing home residents and 43 percent of staff were up to date on their vaccines, according to the analysis.

Uptake was even worse in certain states, like Arizona, where just 36 percent of nursing home residents were up to date on their shots, the lowest rate in the country. In Alabama, only 23 percent of nursing home workers were current, the analysis found.


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The news is slightly better when it comes to nursing home deaths and infections. Both rates declined in September after four straight months of increases, the data shows, but they’re still up significantly compared to the spring.

AARP is “very concerned” about the low vaccine uptake, especially as the winter months approach, said Susan Reinhard, vice president of AARP’s Public Policy Institute and a coauthor of the analysis.

Over the last two years, the worst COVID spikes have occurred during late fall and early winter, and public health experts are also bracing for a tough flu season, based on winter trends in the Southern Hemisphere.

“Things are looking a little better when it comes to infections, but we’re facing the fall and winter — and we have flu on top of it all,” Reinhard said. “We need concerted efforts to get residents and staff both their COVID boosters and their flu vaccine.”

In addition to vaccines, Paxlovid has been available to Americans since December. A study published in The New England Journal of Medicine in August found the drug reduced hospitalizations and deaths in patients 65 and older during the omicron surge in Israel earlier this year.

Check the vaccination rates of your nursing home

You can check the vaccination rates of residents and staff at any Medicare-certified nursing home, and compare them with state and national averages, on Medicare.gov’s Care Compare website.

1. Find a nursing home’s profile via the home page’s search function.​

2. Visit the Details tab on its profile.​

3. Click the View COVID-19 Vaccination Rates button.

America’s long-term care facilities, including nursing homes, assisted living facilities and other senior care settings, have been battered 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 175,000 of those deaths attributed specifically to nursing homes.

Older Adults Still Most Vulnerable

report released last week from the Kaiser Family Foundation showed the virus continues to take a major toll on older adults. It found that COVID-19 deaths among people 65 and over — the age of most nursing home residents — made up 88 percent of all COVID deaths in September, the highest share since the start of the pandemic.

While COVID deaths rose among people of all ages this summer, the report found they rose faster among those 65-plus, with deaths in that age group more than doubling between April and July. The foundation blamed the spike on the more easily transmitted omicron variant, combined with relatively low booster uptake and waning immunity.

AARP’s latest analysis found at least 900 nursing home residents died from COVID-19 in the four weeks ending Sept. 18. That’s down from more than 1,000 during the previous four-week period in mid-August, but still three times as high as it was in mid-April, before the latest surge, according to AARP’s Ari Houser, a senior methods adviser and coauthor of the report.

Roughly 37,000 residents, or 1 in 30, tested positive for COVID-19, according to the report, down from 1 in 22 in the previous four weeks. Still, that’s up significantly from April, when only 1 in 200 residents tested positive. About one worker for every 27 residents also tested positive, down slightly from mid-August, when there was one staff case for every 20 residents.

AARP has been tracking COVID-19 vaccination rates among nursing home residents and staff since June 2021, but this is the first time the analysis looked at the percentage of nursing home workers who are “up to date” on their shots. AARP began reporting on the percentage of nursing home residents who are “up to date” on vaccines last month.

Check the staffing rates of your nursing home

You can find staffing data — including staff turnover rates, average hours of care provided to residents by different types of nurses, and weekend staffing levels — for any Medicare-certified nursing home, and compare them with state and national averages, on Medicare.gov’s Care Compare website:

1. Find a nursing home’s profile via the home page’s search function​.

2. Visit the Ratings tab on its profile​.​

3. Under Staffing, click View Staffing Information.​

Residents and staff are considered “up to date” if they’re fully vaccinated and have gotten all boosters for which they are eligible. For most people 50-plus, that means getting their primary vaccination series plus two boosters, or their primary vaccination series or first booster within the last four months. 

Next month, the definition will change to include new omicron-specific bivalent boosters, which the Centers for Disease Control and Prevention recommended in early September for those who are at least two months past their last shot.

Booster Rates Lower in Some States

Like previous AARP analyses of federal nursing home data, the latest found wide disparities among the states when it came to vaccine uptake. Hawaii had the highest percentage of nursing home residents up to date on their shots, at 78 percent, compared to a low of just 36 percent in Arizona.

Washington, D.C., led the pack in staff vaccinations, with 78 percent of nursing home workers up to date, while Alabama came in last with a mere 23 percent of staff current on shots. 

Nationwide, only 16 percent of nursing homes had at least three-quarters of their health care staff up to date on vaccinations. In California, 70 percent of facilities had at least three-quarters of their workers current, the most in the nation, while 32 states had fewer than 10 percent of facilities reaching this threshold.

The report also found that nursing homes around the country continue to face a staffing crisis. A quarter of nursing homes nationwide reported a shortage of nurses or aides during the four weeks ending mid-September, roughly the same percentage as the previous four-week period ending Aug. 21. The percentage of facilities experiencing worker shortages has remained at that level or higher since the delta wave hit in the summer of 2021.

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.

Natalie Missakian is a contributing writer who focuses on state news. She is a former reporter for the New Haven Register and her freelance work has appeared in the Hartford Business Journal and CTNewsJunkie.com.