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Quality in Nursing Center Care

A blog for and about The Joint Commission’s Nursing Care Center Accreditation Program.

Vaccine Hesitation Among Senior Living and Home Care Workers

04/09/2021

By Gina Zimmermann, Executive Director, Business Development, Nursing Care Center Services

COVID-19 vaccination rates for workers in nursing homes lags behind that of health care workers in general.

In most areas of the country, long-term care workers were a priority group to receive COVID-19 vaccinations in early 2021. However, that opportunity has not necessarily translated into more inoculations, although trends are improving. According to a March 23 article in Skilled Nursing News, 62% of post-acute and senior living workers reported being willing to take the vaccine. 

Record numbers of nursing home residents have been vaccinated but it is still noted that 39% of workers surveyed do not plan to take the shot. While the rate of refusal decreases with every survey, every denied vaccination opportunity represents an increased risk to the fragile population in senior living and home care settings.

Declining Case Rates in Nursing Homes
It’s been gratifying to see COVID-19 case rates drop in nursing homes – up to 80% in some areas – since the vaccine became available. According to data from the Centers for Disease Control and Prevention (CDC), the rate of resident COVID-19 cases in nursing homes was 0.84 per 1,000 residents for the week ending March 21. This is down from 30.98 per 1,000 residents during the Dec. 20 peak last year.

By the same token, nursing home staff infections have fallen by 83%, according to an article by Kaiser Health Network. Overall, it’s great news for an industry disproportionately affected by COVID-19. Over the course of the pandemic, data from the Centers for Medicare and Medicaid Services (CMS) shows that 550,000 nursing home staff members have been infected with the virus, and therefore, many workers in nursing homes may mistakenly believe they are still protected by antibodies. 

The CDC recommends that people still get the vaccine even if they had COVID-19, as long there was no treatment with convalescent plasma or monoclonal antibodies. It’s still unknown how long people who have already been infected with COVID-19 are protected with antibodies so vaccination is recommend.

Impact of High Turnover
While race and education levels may play a role, part of the reason vaccinations may be lagging among senior living and home care staff may have to do with the nature of the job itself.

Staff turnover is much higher in these settings than in acute care. In fact, according to research by OnShift, employee turnover rates in senior care range from 40-75%. With that rate of near constant change, it can be a real logistical challenge to constantly get new employees hired and oriented – let alone vaccinated.

Trust Issues
Some nursing home workers during the pandemic may harbor feelings of resentment for how hard their industry was hit during the pandemic.

In our own research study, home care workers responded that personal protective equipment (PPE) issues lingered much longer for their specialty because hospitals were prioritized. Staff who felt victimized by working in unknown conditions during the pandemic may be less eager to trust leaders who are now pushing them to get vaccinated.

Mandating Vaccines
There is some discussion in the industry about mandating vaccines for health care workers, including those in senior living and home care settings, and some organizations have stated their intent to make COVID-19 vaccines a condition for employment. Many organizations already do this for flu shots.

Given that the vaccines are being distributed under emergency use approval – not full Food and Drug Administration (FDA) approval – employers mandating vaccination may be in a legal grey area. 

For the record, The Joint Commission does not have an accreditation standard for organizations to require employee vaccination. Ideally, we’d like to see the vaccine go in as many arms as possible without making it a requirement. We take our role as an educator of accredited organizations very seriously and invite you to share our COVID-19 resources with your colleagues and patients. 

Gina Zimmermann is the executive director for business development for Nursing Care Center Services. In this role, she oversees the strategic direction and performance of the Nursing Care Center Accreditation Program.