In long-term care settings, reliable statistics on staff vaccinations elusive

A woman is helped out of a car and into a wheelchair
Many agencies stopped counting vaccinations in long-term care settings in March. (Getty Images)

Statistics make plain why vaccinating long-term care health workers is critical. Residents in these places account for 65 percent of the state’s coronavirus deaths, a tally so high New Hampshire led the nation at one point. 

The statistics, however, do a poor job tracking the vaccination rate among those health care workers even though evidence has shown that an increase in vaccination rate triggers a decrease in COVID-19 cases and deaths.

The state Department of Health and Human Services puts the staff vaccination rate at 68 percent. A report published in March said it was 81 percent, higher than any other state. The CDC, which worked with CVS and Walgreens to provide vaccinations in the state’s long-term care facilities, reports 19,456 people in those sites are fully vaccinated. But it doesn’t differentiate between residents and workers or calculate the total as a percentage of all workers. A spokeswoman for the agency said nationally less than 40 percent of long-term care workers are fully vaccinated.

And while the federal Centers for Medicaid and Medicare Services has long tracked at least 120 coronavirus-related metrics at nursing homes, it only recently announced that it will require those facilities to report vaccination rates for staff and residents. The reports are expected to be available on its website beginning this month. 

The counts are further suspect because each source includes a disclaimer about its data’s shortcomings, something that has made counting all vaccinations uncertain

For example, many agencies stopped counting vaccinations in long-term care settings in March, when the CDC’s partnership with CVS and Walgreens ended. And agencies identify long-term care facilities differently, with some excluding assisted-living facilities or places serving people with developmental disabilities. 

This mishmash of data led The Atlantic’s Covid Tracking Project in March to call on states and the federal government to create a consistent and comprehensive reporting system for all long-term care facilities and to make it easily accessible by the public in a single place. 

Without such a change, it will be impossible to track the true effects of COVID-19 – and future pandemics – on this highly vulnerable population,” it said. “Even if this data is imperfect, detailed information about the vaccination rollout in (long-term care) facilities is too important to remain secret.”

DHHS spokesman Jake Leon said the state saw very quickly the benefits of increasing vaccination rates among long-term care residents and staff, who were among the first people eligible for vaccines in the state. In the four months prior to the CVS and Walgreens vaccination program, the state saw 3,333 coronavirus cases and 429 deaths associated with long-term care settings. Since that program ended in March, there have been 429 cases and 20 deaths associated with those facilities, he said. 

The vaccination effort has also decreased the number of outbreaks in long-term care settings, Leon said. Of the 102 outbreaks associated with them, there have been only seven since the federal vaccination effort ended. 

Lawmakers, like their counterparts in many other states, have debated legislation this session prohibiting employers from requiring vaccines but exempted health care facilities. Still, few if any are mandating COVID-19 vaccinations. 

If we mandated them, we would lose good people, and we already have a workforce shortage,” said Brendan Williams, president and CEO of the New Hampshire Health Care Association. Facility administrators are instead hoping educating staff about the value of vaccines and talking through their concerns will persuade more to be vaccinated. He said the DHHS staff provided association members vaccine messaging talking points. “We hope if people don’t believe us, staff will find the facts on their own.”

Dr. Richard Feifer, chief medical officer of Genesis HealthCare, saw the impact of high vaccination rates at Genesis’s sites, which includes Bedford Hills Center, where there were 170 cases and 25 deaths among residents and staff. Feifer said the company’s COVID-19 cases across multiple states dropped 99 percent since the CDC long-term care facility vaccination program ended. Without a vaccination mandate, the company has had 70 percent or more of its staff get fully vaccinated, it said.

“Vaccination is the critical third leg of the stool, along with personal protective equipment and testing, in stemming COVID-19 spread in nursing homes and protecting residents and health care workers,” he said. “This is unquestionably the biggest vaccination effort ever undertaken and will help protect this vulnerable population.”

Matt Lagos, administrator at the Merrimack County Nursing Home in Boscawen, said 97 percent of their residents and about 60 percent of staff are fully vaccinated. Like Genesis HealthCare, the nursing home does not mandate staff be vaccinated. “It’s an individual choice, and we would hope everyone would make a wise and sound decision,” he said. “We hope people would realize where they work and make the right decision.”

Lagos said the CDC’s partnership with CVS and Walgreens made all the difference in getting staff, as well as residents, vaccinated. “It was one of the best days of being an administrator that I can remember,” he said. “To get that sense of normalcy and that sense of protection . . . it made my day.” 

After the CDC announced nursing homes would have to report vaccination rates weekly and show its efforts to educate staff and residents about the value of vaccines, Lagos distributed nearly 400 vaccine information pamphlets at a testing clinic. Ten people signed up to be vaccinated, he said. “The likelihood of getting to 100 percent will probably never happen,” he said. “We just keep messaging that it’s the right thing to do.”