January 24, 2021, Alex Spanko, Skilled Nursing News - After the physical health and safety of residents and workers, the prospect of normal visitation looms as the top promise of a smooth rollout of COVID-19 vaccines to the nation’s nursing homes. But operators will likely not make any moves until they’re given the all-clear by state and federal regulators, with a significant percentage planning to require vaccinations for all visitors before reopening their doors to family and friends.
Just about half of respondents to a recent online Skilled Nursing News poll said they would mandate proof of vaccination for potential visitors, while a nearly equal number said they would not.
The pulse around a formal reopening plan, however, was far more unified: The vast majority of respondents indicated that their organizations were unable to immediately reopen their doors due to state and local regulations.
Just 14% answered that restrictions would be lifted after the completion of the two-stage vaccination clinic process with an unequivocal “yes.”
Multiple news outlets and advocates have criticized the slow speed of the vaccine process thus far, though pharmacy giants CVS and Walgreens — which the federal government has placed in charge of distributing and administering shots at the vast majority of facilities across the country — have emphasized that the process remains on schedule; both companies tabbed January 25 as the deadline for completing the first of two required on-site vaccination clinics.
SNN conducted this non-scientific online survey to provide a fast snapshot of nursing home provider attitudes around the increasingly controversial vaccine rollout. While it may not necessarily consist of a representative cross-section of facilities and operators around the country, the poll does offer candid insights into the attitudes of leaders and workers at the nation’s long-term care facilities.
In all, 148 people answered at least one question in the online survey, which was sent to SNN readers several times in our daily and weekly e-mail newsletters between January 12 and January 21. Of those, 123 self-identified as employees of post-acute and long-term care facilities; these respondents were allowed to continue through to the actual questions.
The answers around visitation track with more in-depth interviews conducted by SNN over the course of the vaccine administration process. While operators have expressed optimism about the potential for a return to normalcy for nursing home residents and their families, they have also asserted that they must wait for formal approval from the appropriate authorities.
“In terms of visitation, the Department of Health in New York State determines visitation,” Gurwin Jewish Health and Rehabilitation CEO Stuart Almer told SNN earlier this month. “The way in which the formula exists now — and has been for many months — as long as we have just one case, whether it be staff or resident, just one, the clock gets reset in terms of visitation. For a large facility like Gurwin, it’s mathematically very, very challenging to ever get to the goal that we can have someone visit.”
David Mills, CEO of the Midwest-based nursing home and assisted living chain North Shore Healthcare, agreed with the need to take cues from the authorities.
“The most important thing is we’re going to follow the guidance of local and state public health [officials], and they will decide — with our feedback, of course — what and when that’s going to occur,” Mills said, adding that he expected the second quarter of 2021 to bring the end of lockdowns.
The breakdown of workforce-versus-resident willingness to take the vaccine also tracked with anecdotal reports from conversations that SNN has had with operators over the past month: Residents are far more excited to roll up their sleeves than staff.
Nearly 80% reported majority compliance, with 18% seeing universal uptake of the vaccine — and just 2% saw only a minority of residents take the shots.
For workers, the numbers were starkly worse. Only about 54% of operators reported that a majority of staff had opted into the program, with 43% logging less than half and only 3% indicating universal vaccination.
The relative lack of enthusiasm among frontline caregivers to receive the vaccine has been the primary story of the mass inoculation effort so far. Even before the Food and Drug Administration (FDA) granted emergency authorization to the Pfizer and Moderna shots in December, leaders sounded the alarm about the deep skepticism they were hearing among rank-and-file nursing home employees.
Lori Porter, CEO and co-founder of the National Association of Health Care Assistants (NAHCA), framed it as a matter of trust in a December interview with SNN: After having watched their residents and coworkers die over the past year, while also struggling with shortages of personal protective equipment (PPE) and constant worries about their own physical and mental health, many nursing home workers have lost faith in the institutions now telling them that the vaccines are safe and necessary.
“My concern is not necessarily the vaccine, if it’s proven safe,” Porter told SNN. “My fear is that if we don’t educate them, if we allow the facilities to provide the education on the vaccine, there is a trust issue. CNAs do not trust their leaders.”
To that end, operators have embarked on a full-court press to combat misinformation and highlight the benefits of the vaccine for employees, including their own health and the safety of their communities. Providers have also brought in experts to tackle common concerns, such as worries about the vaccines’ impact on fertility, though a truly comprehensive program may require one-on-one interventions with each hesitant employee.
Chirumbolo reported that vaccine uptake at his company’s facilities did increase among staff during the second visit, indicating that many staffers may just be uneasy about being the first person they know to receive a new treatment.
“Independently, we’ve got to educate, [by] I think arming people with the facts but then sitting down with them one-on-one,” Carespring Health Care Management CEO Chris Chirumbolo told SNN earlier this month. “It is extremely time-consuming, but it’s very much worth it. I think going forward, we’re going to find more nursing homes’ acceptance rates will continue to go up for future clinics, for future people, because they’re going to see more people in the community getting it. It will become the new norm.”
But residents, locked away from family for nearly a year now, have been far more excited about taking the shots — a trend that Chirumbolo also attributed to generational differences in attitudes about vaccination as a concept.
“I think what’s really being forgotten is that in the American public, people 65 and older, I imagine — as residents, 90% or more are receiving the vaccine — you’ve got a generation or a couple generations of people that have seen polio, who’ve seen really big things from their loved ones years ago, and they’re used to understanding what life is like when vaccines aren’t there,” he said.
Still, very few operators are requiring vaccines for workers: Just 2% of respondents indicated a mandatory program, with 87% saying they were encouraging employees or providing incentives. About 11% said there was no policy either way, with individuals left to make the decision on their own.
When asked for their overall perception of the rollout so far, a majority reported being either extremely satisfied or satisfied, with a total of about 23% indicating some level of dissatisfaction; around 23% had a neutral view of the process.