Nursing Homes Share Best Practices, Challenges In Vaccinating Staff
Nursing homes in Connecticut are racing to vaccinate all of their workers against coronavirus before the state-imposed deadline in September, but some face a greater challenge than others: Half of the 204 Connecticut nursing homes that are reporting data have staff immunization rates below 75%, and a handful are under 50%.
Gov. Ned Lamont’s administration has mandated that nursing home workers receive at least one dose of the coronavirus vaccine – and be scheduled for a second – by Sept. 7, or their facilities could face fines of $20,000 per day.
Over the last nine months, in an attempt to stave off another devastating COVID-19 surge, several nursing home leaders have taken it upon themselves to implement their own vaccination requirements for staff. Dozens of others had called on the state to adopt an industry-wide edict, fearing staff shortages or worrying that employees would depart for jobs at other facilities.
Some tried to incentivize workers with prizes or cash bonuses. Others held staff conversations about the vaccine, with medical experts on hand to answer questions.
The efforts were met with mixed success. Although the statewide average for nursing home staff vaccinations is 74%, some facilities have achieved much higher participation among workers, and others are much lower.
As of last week, federal data show that the range of staff vaccination rates among individual nursing homes varies widely, from 37% to 100%.
The push to boost immunizations comes at a critical time. Nursing home staff and residents have seen cases rise steeply over the past few weeks. The state reported 118 resident cases and 97 staff cases between Aug. 4 and Aug. 17. Last month, Connecticut recorded just six resident cases and 19 staff cases between July 7 and July 20.
Here’s a look at the highest and lowest vaccination rates among health care staff at nursing homes and what strategies administrators say have encouraged the highest participation.
Chestelm Health & Rehabilitation Center in Moodus is ranked No. 1 among Connecticut facilities, with 100% of workers fully vaccinated, according to data from CMS from Aug. 8.
Autumn Lake Healthcare at Bucks Hill in Waterbury was No. 2, with 99.3% of employees vaccinated.
Manchester Manor in its namesake town is No. 3, with a 98.5% participation rate.
Jewish Senior Services in Bridgeport is No. 4, with 97.4% of the staff participating.
Newtown Rehabilitation & Health Care Center is No. 5, with 97.1% of workers vaccinated.
And The Suffield House is ranked No. 6, with a 96.4% participation rate among staff.
At least three of the six nursing homes with the highest vaccination rates recorded among staff had already imposed COVID-19 immunization mandates.
But even among those that had, administrators say they worked extensively with employees to understand concerns and break down myths about the vaccine.
Jason Yarbrough, an infection prevention nurse at Chestelm, a family-owned facility, said staff members encouraged one another to get the shot.
“When they announced the vaccines, I went around and talked to everyone to get their thoughts. We were at about 45% [of staff] who were going to get it,” he said. “And then we did a lot of education. We had a whiteboard, we had posters, we made a brochure going over what the vaccines are, how they work, what an mRNA vaccine is. We put it out there in plain and simple terms and really spent a lot of time educating, doing one-on-ones.”
By the time the first clinic was held, 83% of staff decided to get a shot. By the second clinic, 93% were participating, Yarbrough said. The nursing home also held a raffle and offered other incentives.
Chestelm eventually imposed a vaccine mandate, but the majority of staff had already been inoculated. Yarbrough estimated that the facility lost “a handful of people” who refused to get the shot.
Manchester Manor doesn’t have a vaccine mandate, but owner Paul Liistro also credited education for driving up immunization rates among staff.
“Whenever we hear an objection, we go research it,” he said. One of the most common concerns raised was about fertility. Liistro said administrators would do research and share information from the Centers for Disease Control and Prevention and other health agencies dispelling misconceptions.
Management also tried handing out cash incentives of $150 per person to get vaccinated, but only two workers took them up on the offer.
“We thought that people would respond immediately, and they didn’t,” he said. “Education is really what the secret has been.”
Although he hasn’t imposed a mandate for current staff, Liistro is requiring any new workers hired to be immunized.
At Suffield House, administrators made the vaccine a condition of employment in February. But they also pointed to education and emotional support as key factors in their high participation rate.
“We did a lot of education. We answered questions and gave the staff plenty of information about it. That was the biggie,” said owner Carrie Riccio. “They just needed a lot of support emotionally and educationally.”
Autumn Lake Healthcare at Bucks Hill catapulted from the second-lowest vaccinated nursing home just two weeks ago – with 36.2% of staff inoculated – to the second highest. Administrators did not return calls seeking comment about the shift.
DPH verifies outliers in the federally reported data on a biweekly basis and “facilities are contacted to inquire about the data and advise about error correction,” according to a statement provided by Chris Boyle, the Department of Public Health spokesperson.
Vaccination rates can fluctuate because some nursing homes may not be clear on what constitutes health care staff as the CMS definition, which includes “employees, contractors, or students/trainees and volunteers who are scheduled to work in the facility at least 1 day every week … regardless of clinical responsibility or patient contact.”
For the week of Aug. 8, DPH identified data errors among the lowest performing nursing homes: Ledgecrest Health Care Center, an Apple Rehab-owned facility in Kensington, had 18.5% of workers vaccinated according to CMS data, but DPH found that its rate was higher, currently at 83%.
Similarly, Bloomfield Health Care Center had 34.1% of workers vaccinated as per federal data, but DPH’s most recent figures put it at 50%.
The third lowest was Chesterfields Health Care Center in Chester, where the employee immunization rate was 36.9%.
Middlesex Health Care Center in Middletown was fourth, with 42.1% of workers inoculated.
Cheshire House in Waterbury was fifth, with 42.7% of staff vaccinated.
And the Advanced Center for Nursing & Rehabilitation in New Haven was the sixth lowest, with 43.5% of staff inoculated.
Administrators at several of the lowest-ranked nursing homes said they are working diligently to boost vaccination rates among staff.
But concerns about the vaccine, including possible side effects, political influence and a lack of information about the long-term effects, have created challenges at some buildings.
Christina Fleming, chief marketing officer for National Health Care Associates, of which the Bloomfield Health Care Center is an affiliate, said some employees across their facilities are hesitant because of fears about infertility, even though the claim has been widely debunked
“One of the biggest concerns we’re hearing is about pregnancy, fertility and lactation. That being a very big concern,” she said. “And then, of course, the [U.S. Food and Drug Administration] full approval, which we were able to share some updated fact sheets today, now that the Pfizer vaccine has been FDA approved.”
Fleming said nursing home managers are trying to put those fears to rest by conducting one-on-one conversations and educating staff.
“Where we’re seeing a big difference is in the hands-on, one-to-one discussions for questions and concerns,” she said. “That’s a positive thing that’s going to help us.”
Karen Donorfio, a spokeswoman for Apple Rehab, which owns Ledgecrest and Chesterfields, said the company has updated its reporting on vaccination rates and that the two facilities have recorded much higher rates recently. Two days before the state announced its immunization mandate for nursing home workers, Apple Rehab imposed one of its own for staff.
“Apple Health Care and its facilities are facing the same challenges on getting employees vaccinated as local communities throughout the country are having,” she said. “Employees are deciding not to get vaccinated due to medical exceptions, religious exceptions, non-FDA approval, fear of long-term effects, personal beliefs, political influence, etc.
“While we have experienced vaccine hesitancy, Apple Rehab has made great strides in staff education and incentives. … We are confident that our staff vaccination percentages will continue to increase.”
Timothy Brown, a spokesman for Athena Health Care Systems, which owns Middlesex Health Care Center, said managers are still trying to increase worker inoculation rates. He estimated that the vaccination rate there has risen since the last data report to about 60%.
“Our medical director, Dr. Jessie Cohen, has been made available to speak with our unvaccinated and provided education and feedback to our staff,” Brown said. “We are working with our staff daily to verify their vaccination status and continue our vaccine education. The governor’s mandate had a significant impact on the uptick in our numbers and those in other centers.”
“We’ve gone to great lengths to educate and advocate for employee vaccinations and also have offered cash incentives and other giveaways,” he added.
Broadly, nursing homes that have struggled with improving their vaccination rates cite misinformation as a reason why they are straggling, health officials said.
“We’ve seen the exact same disparities when it comes to flu vaccinations before COVID. I was someone who pushed very hard to get flu mandates implemented in nursing homes because I knew that there were a lot of outlier facilities that just didn’t have very good flu vaccine” coverage, said Arthur Caplan, professor of bioethics at New York University Langone Health. “We’re seeing a repeat of the same vaccine hesitancy or vaccine hostility, and I think [it’s] because some of the workforce has a lot of misinformation.”
Mandates are effective at increasing vaccination rates but are most successful when they are complemented by an education program, Caplan said, so “it’s not either-or.”
Health officials are also hopeful that the full FDA authorization granted to the Pfizer vaccine this week will convince people on the fence to get vaccinated.
“The licensing is a big step,” Caplan said.