COVID-19 and the State of Nursing Homes

Bob Edwards:

According to the latest data from AARP’s Nursing Home COVID-19 Dashboard, cases of the virus are rising again among nursing home residents and staff.

To prevent further harm to this vulnerable population, federal and local governments have set forth new policies with the expectation that more people will be vaccinated.

Today, we discuss the state of the nursing home with AARP leaders from Florida, Arkansas and Utah. And later, we hear about the national trends from AARP Senior Vice President of Public Policy Susan Reinhard

Susan Reinhard:

The nursing home industry standard is that we should have at least 75% of workers vaccinated, to get a level that is closer to stopping the spread so quickly. But only one in four nursing homes in the country have reached that level.

Bob Edwards:

That’s coming up next.

Hi, I’m Bob Edwards, with An AARP Take on Today.

This week, President Biden announced his administration will require all employees in nursing homes to get vaccinated for COVID-19.

President Biden:

Today, I’m announcing a new step. If you work in a nursing home and serve people on Medicare or Medicaid, you will also be required to get vaccinated.

Bob Edwards:

The President is directing the Department of Health and Human Services to draw up new regulations making employee vaccination a condition for nursing homes to participate in Medicare and Medicaid.

Jeff Johnson:

We absolutely think that's the right move.

Bob Edwards:

That’s Jeff Johnson, AARP Florida State Director. He and other AARP leaders agree that the efforts to increase vaccination rates in nursing homes will bring necessary protections to residents. In Florida, just 45% of nursing home staff has been vaccinated so far, compared to about 60% nationally.

Jeff Johnson:

Throughout this, we have been pushing the facilities to try to figure out how to get more of their staff vaccinated. And some, by the way, have done an excellent job. But others have struggled significantly.

Bob Edwards:

Some Midwestern states are also struggling to reach national benchmarks. Ness Nehus, AARP Associate State Director of Arkansas, says Arkansan nursing home residents are mostly vaccinated – latest figures over 83% of residents are. But just 58% of nursing home staff are fully vaccinated.

Ness Nehus:

We have been a vaccine reluctant is how I would put it with only 38.8% of Arkansans fully vaccinated.

Right now in the communities in Arkansas, we have the fourth highest rate of new cases per capita and the second highest rate of deaths per capita, COVID related deaths. And so, because we have this surge and it's new, we've had a 300% increase in COVID cases in nursing homes in the last month.

Bob Edwards:

People in Utah are experiencing this uptick as well. This is Alan Ormsby, AARP Utah State Director.

Alan Ormsby:

For those people 65 and older, 304,000 are fully vaccinated and that's 83.3% of our population. So our older adults are really leading the way. But in nursing homes, just 67.6% of staff are fully vaccinated. That’s’ better than the national average, but still not enough. Our residents are doing well, though. They're 84.2% fully vaccinated. That's two and a half percent more than the national average.

Bob Edwards:

Vaccination rates aren’t the only concern in nursing homes. Some states are experiencing shortages in personal protective equipment, also known as PPE, and some are understaffed.

Jeff Johnson:

So, it's about 20% of facilities in Florida that say that they are short-staffed. And the reality is when you talk to people who operate long-term care facilities in Florida, they would tell you before the pandemic, that staffing was their biggest concern. Part of that is because the bulk of the folks who run a long-term care facility are not making a living wage or making close to what they would make if they were in say the fast food sector.

Unfortunately, the state's response has not been to ensure that the facilities have the means and the incentive to raise the wages of staff to make it a more attractive job. Instead, they've lowered the staffing requirements. So, in Florida, facilities can hire somebody in a role called a personal care assistant, who has no clinical training. They have two days of classroom training, and they're on the floor along with the certified nursing assistants. And we think that's a recipe for disaster

Bob Edwards:

Happily, not all areas are experiencing shortages on that scale.

Ness Nehus:

I think that we have done pretty well with providing nursing homes the PPE that they need to do their work. There's been a close collaboration between the Governor's office and the health care association, and they have had access to resources as needed. I will say that they also recently received approval for $116,412,000 of American Rescue Plan Act funding for specifically for nursing home related needs.

Alan Ormsby:

In June, about 12% of nursing home residents had an urgent need for personal protective equipment. That number went down to zero at the end of July, which is great. But there is still concerned because shortages can feed a vicious cycle that raises risks for residents and staff. And that’s a problem because as people get concerned about their own protection, they tend to not want to work in those places and we’re already struggling with very severe workforce shortages.

I think it's just important that people understand that the vaccination process is safe and effective. We have seen that a lot of folks are kind of holding off and waiting to see. I talk with people all the time who are trying to figure out if it's right for them to get vaccinated or not. And I would just say for those folks go and talk to your doctor. It's really important that you go and talk to your doctor or a medical professional about the vaccinations, get educated and then get out there and get the vaccine.

Bob Edwards:

If you want to keep up to date with the situation, you can find the Nursing Home Dashboard at AARP dot org slash nursing home dashboard. It provides a detailed snapshot of the virus’s impact on long-term care facilities across the country.

As we mentioned at the top of the episode, the most recent release shows the cases of COVID-19 rising again among nursing home residents and staff and national vaccination rates, while improving, remain lower than expected.

Here to discuss these trends and more is Susan Reinhard. She's AARP's Senior Vice President of Public Policy. Welcome Susan.

Susan Reinhard:

Hi, nice to talk to you Bob.

Bob Edwards:

Tell me about the key findings from the dashboard.

Susan Reinhard:

So, as you just said, cases are going up. We had expected to see cases going down from the winter when we had the last surge. But with the Delta virus, and I know people are seeing this in the news, with that virus we are seeing surges in nursing homes. Not to the level we saw in January, for example, but starting to concern us that we're going in the wrong direction. So, in the last week of July, thereabouts, cases about doubled. And more than that, we're worried that only about 60%, so 40% of the workers do not have vaccine, they haven't been fully vaccinated. And that's a real concern given this Delta virus and the spread of it in the communities around the nursing homes.

Bob Edwards:

Yeah. Why are we continuing to see staff and residents catch the virus? If so, many are vaccinated?

Susan Reinhard:

Well, the problem is they aren't. So, the industry standard, the nursing home industry standard is that we should have at least 75% of workers vaccinated, to get a level that is closer to stopping the spread so quickly. But only one in four nursing homes in the country have reached that level. So, there's several states, particularly in the south that are below 50% of staff being vaccinated. And the average is 60%. Of course, that varies. Hawaii is 87%. They're just doing fantastic. But if you live in Louisiana, the average is only 44% of staff workers in nursing homes being vaccinated. So, there's a lot of variance.

Bob Edwards:

Now, wait a minute, from the get-go, we were told that older people are more vulnerable so, shouldn't we have started there with vaccinations?

Susan Reinhard:

We did. It was in December almost a year ago, right? In December that the vaccines were approved. And in December, January, February, March, et cetera, they were put at the top of the list, along with healthcare workers, that they would be the first to get the vaccine. And we were doing pretty well. The majority, over 80% of nursing home residents are vaccinated. But we think that all of them should be, of course. And I think later today, or sometime this week, we're going to hear that there's going to be a need for booster shots. And that'll start with probably the same group, healthcare workers and nursing home residents, because they are so vulnerable. Living together in one place in a nursing home, many of them have shared rooms. So, you're in close contact. And again, having staff coming in from the community without being fully vaccinated is a real recipe for a problem

Bob Edwards:

How is AARP speaking up for nursing home residents?

Susan Reinhard:

Well for one thing, we have been calling now for nursing homes to mandate, to require that all staff and residents, that frankly anyone who's in a nursing home should be vaccinated. Because this is preventable. It's really outrageous that we're seeing any of these increases in cases and deaths, because it is preventable with these vaccines, largely preventable. So, we continue to advocate for that. That was a big step that we took, just about a week ago. And we are going to monitor that. State by state, our state offices are quite active in trying to show this data, talk about the evidence, the science, and really implore nursing homes to require this. And many of them are, many of the nursing home chains and independent nursing homes are beginning to require their workers, some states are requiring it as well. So, we are very much doing that. But we also want to help residents, people just consumers know how they can find out what's going on in the nursing home that interests them. That's a big step so that what's going on. It's one thing to know what's going on in the country. It's another thing to know what's going on in the nursing home where you have a loved one.

Bob Edwards:

Well, it should be a specialist, right? I mean, some homes have an infection control nurse. It would be nice if they all did it.

Susan Reinhard:

That's right. And we are calling for that because we definitely should have that. The evidence, the research is quite clear about this. If you have someone who's a specialist that is making sure everybody knows how to put their masks on, right and wash their hands and use the protective equipment appropriately, get the tests going when needed. All of that makes a difference. So, we do think that's really, really important.

Bob Edwards:

So, there are lots of questions for us to ask of that infection control nurse or whoever is in charge of the nursing home.

Susan Reinhard:

Yes. Yeah, definitely. For one thing, it is a call to the nursing home to say, what is the status of vaccinations there? Just call them. We are urging what we call transparency, fancy word for saying, what are the facts? We need to know what's going on there. And so, what proportion of your residents are fully vaccinated? Your staff are fully vaccinated? What are you doing to educate and encourage people to do this? And are they readily available? Typically, this, the nursing home may not have the vaccines right there in the nursing home, but they have a relationship or a contract with a pharmacy or some other group. It's usually a local pharmacy that will come in and do the vaccinations because new people are admitted every day to nursing homes. So, they have to have that chance to get the vaccine if they haven't been able to get it before.

Bob Edwards:

Anything else you'd like to add?

Susan Reinhard:

Just in general, making sure that we are advocating that people get the, nursing homes, get the protective equipment that they need. And beyond that, what are nursing homes doing to make sure that they're able to communicate? That people in the nursing home are able to talk to their family members and friends. We worry about visitation as rates go up. We don't want to see that happen again, where families couldn't even visit people. So, we're really keeping an eye on that and making sure that there are ways to how people communicate no matter what the situation is.

Bob Edwards:

Well, Susan, thank you very much.

Susan Reinhard:

You're welcome. Nice to talk to you Bob.

Bob Edwards:

Susan Reinhard is AARP's Senior Vice President of Public Policy. You can find the most recent nursing home figures at aarp.org/nursinghomedashboard.

That’s it for today’s show.

Thanks to our news team.

Producers, Colby Nelson, and Danny Alarcon.

Production Assistant Fernando Snellings.

Engineer, Julio Gonzalez.

Executive producer, Jason Young.

And of course, my co-hosts, Wilma Consul and Mike Ellison.

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For An AARP Take on Today, I’m Bob Edwards.