COVID killed thousands in KY nursing homes. Why aren’t employees taking the vaccine?

·9 min read

COVID-19 vaccination is rarer among Kentucky nursing home employees than in the state’s overall adult population, even though the nursing homes — with 2,320 reported novel coronavirus deaths — were ground zero for infectious outbreaks during the pandemic.

As of June 10, Kentucky nursing homes reported a 44 percent vaccination rate for employees in a weekly survey taken by the U.S. Centers for Medicare and Medicaid Services. That’s one of the 10 lowest rates in the country for such facilities, and it’s significantly less than the 58 percent vaccination rate for Kentucky adults.

In some Kentucky nursing homes, barely one in every five caregivers has gotten the shot.

Advocates say this is a worrisome trend.

“My concern is that having staff who are not vaccinated coming into these places every day and working in close proximity with residents could increase the incidence of COVID once again,” said Sherry Culp, Kentucky’s state long-term care ombudsman.

Sherry Culp, state long-term care ombudsman
Sherry Culp, state long-term care ombudsman

Seventy-eight percent of the residents of Kentucky nursing homes are vaccinated, Culp noted. Virus deaths in the facilities have slowed to just a half-dozen in recent weeks, with 13 active resident infections reported statewide on Wednesday.

But the state already saw one tragedy this year, in a Rowan County nursing home, when an unvaccinated worker brought in the virus and infected 46 people. Three people died, including a vaccinated resident.

In Florida, which has a slightly worse vaccination rate for its nursing home workers, at 42 percent, resident infections are climbing again, the Tampa Bay Times reported this week.

Culp said vaccinated residents are much less likely to get infected. But there still can be “breakthroughs,” when the vaccine’s protection is not always enough to shield people who are directly exposed to the virus , she said.

“The residents, most of them are taking the necessary precautions and getting vaccinated. They’re doing what they can to protect themselves,” Culp said. “So this is really coming down to the employees now.”

Reasons for skipping the shot

Among the vaccination obstacles cited by the industry are:

rapid turnover among staff, especially nurse aides, who make an average hourly wage of $13.12 in Kentucky;

skepticism about the safety and effectiveness of the vaccine, particularly for women of child-bearing age, and;

high rates of infection among employees over the last 15 months, which led some to assume they cannot be reinfected — an assumption that is not always accurate. Reinfection is rare but it happens, evidently with a higher likelihood for Black and Hispanic people and for people with asthma or a nicotine dependence.

Industry leaders say they’re trying to walk employees through an educational process.

“In Kentucky, we are finding that long-term care staff hesitancy for the COVID-19 vaccine mirrors the general public’s reaction,” said Betsy Johnson, president of the Kentucky Association of Health Care Facilities and the Kentucky Center for Assisted Living.

Betsy Johnson, president, Kentucky Association of Health Care Facilities
Betsy Johnson, president, Kentucky Association of Health Care Facilities

“The most successful strategies that we have seen are personal discussions with mentors, colleagues and experts to dispel fears and mistruths,” Johnson said. “Businesses are choosing to use approaches that are friendly and less forceful to manage those who are reluctant of the government. We continue to push vaccine efforts and are hopeful to see an increase among our front-line workers.”

Some nursing homes are having more difficulty than others. Cumberland Valley Manor in Burkesville on Wednesday reported three active COVID-19 infections among its 107 employees. It reported an employee vaccination rate of just 22.8 percent.

“I don’t know that there’s any one reason that they’re giving us for not taking it,” said Cumberland Valley Manor administrator Mary Beth Shelton. “I guess the one you hear the most is that it’s new on the market and it’s not FDA approved yet, so they have doubts about it.”

(The FDA gave emergency use authorization to the coronavirus vaccines being administered around the country, but it has not yet granted them full approval — a step that roughly one-third of vaccine hold-outs say could change their minds, according to one poll.)

“We’re educating people about it,” Shelton said. “We’re giving them the facts, we’re giving them the statistics. I’ve personally had the vaccine and I’ve had no side effects, and I talk about that.”

Get vaccinated or get out?

Making COVID-19 vaccination mandatory as a condition of employment is being hotly debated in the health care field. A federal judge ruled this month against Texas hospital employees who challenged a vaccination requirement from their employer. They were suspended from their jobs for refusing to comply.

“Every employment includes limits on the worker’s behavior in exchange for remuneration. That is all part of the bargain,” U.S. District Judge Lynn Hughes of Houston wrote in her decision.

Several Republican state senators filed a bill during last winter’s Kentucky General Assembly that would have prohibited employers in this state from requiring vaccination on the job. But the measure never left committee.

Nursing homes have discussed whether to make COVID-19 vaccination mandatory for caregivers in order to protect the residents.
Nursing homes have discussed whether to make COVID-19 vaccination mandatory for caregivers in order to protect the residents.

Culp says she has spoken to Kentucky nursing home administrators who are privately advising their facilities’ corporate owners to consider making vaccination mandatory for employees.

“I think they’re of the mindset that ‘We’ve been here on the front lines, seeing this terrible virus, and I don’t know what’s wrong with them, why they don’t want to get it,’” Culp said. “These are people who are frustrated, who told me they thought it should be mandatory.”

However, other administrators say they already struggle to fill caregiver shifts at their facilities, so threatening to fire half or more of their workers is simply not practical.

“I would hate to lose anybody because of that,” Shelton said. “The reality of the situation is that it’s just not doable in our setting, especially in rural areas where we fight for staff. It’s just not possible for us.”

Making vaccination numbers public

CMS, the federal health agency that regulates nursing homes, last month began requiring them to report the vaccination rates for residents and staff. The information is posted in a public database to promote transparency, allowing Americans to compare the facilities, CMS said in its explanation in the Federal Register.

“COVID-19 vaccines are a crucial tool for slowing the spread of disease and death among both residents, staff and the general public,” the agency wrote. “However, participation in these efforts is not universal, and we are concerned that many individuals are not receiving these important preventive care services.”

For the first week of data, posted on June 10, only 90 of Kentucky’s roughly 280 nursing homes submitted their required vaccination numbers. Such omissions were common across the industry nationally, CMS told the Herald-Leader in a statement.

CMS will allow a brief grace period before it starts penalizing nursing homes that refuse to comply with the new transparency rule, the agency said.

“Beginning on June 20, 2021, failure to meet these new reporting requirements will result in a (penalty) starting at $1,000 for facilities with no previous occurrences of noncompliance,” the agency said.

Keep asking, and listen patiently

The Jordan Center, a Louisa nursing home, reported an employee vaccination rate of 81.7 percent in the June 10 data, which put it at the top of the list in Kentucky.

The owner/operator, David McKenzie, said his facility promoted the vaccine even before the shots were made available seven months ago. (In his comments on Thursday, McKenzie said the facility’s staff vaccination rate now stands at 88 percent.)

“Our facility was proactive in starting one-on-one conversations early in fall 2020 to address hesitancy and misinformation,” McKenzie said.

“We took each person’s fears in consideration to counter their specific issues,” he said. “Our staff is like a family that has each other’s backs. We want to do what’s right to protect each other and our loved ones.”

In a guide for nursing homes addressing vaccine hesitancy among nurse aides, the U.S. Department for Health and Human Services tells administrators to listen patiently to the reasons their employees give. As a group, nurse aides are experienced health care workers who witnessed the horrors of the COVID-19 pandemic as graphically as anyone, the guide says, so don’t write them off as callous or oblivious.

“You might assume that CNAs didn’t get vaccinated because they made a deliberate choice not to, when in reality, they were busy caring for residents when vaccines were offered on site or they haven’t had time to book an appointment since the nursing homes stopped offering them,” the guide says.

“It’s important to remember that some CNAs have not gotten vaccinated because of logistical challenges, not because they don’t want to,” the guide says.

In a survey of 233 nurse aides that is included in the guide, the most popular incentives to encourage vaccination included paid time off for the appointment and afterward, in case of ill effects; small monetary payments; more information about vaccine safety and possible side effects; and free transportation to a vaccination site.

Shelton, the administrator of Cumberland Valley Manor in Burkesville, said she continues to encourage her staff to take the shot.

“We go back at least once a week and bring it back up to everybody,” Shelton said. “There are blast emails and texts we send out to our staff. Every now and then, we get one, someone comes forward.”

“Minds will change once it’s been around for a while,” she said. “Because our employees care about our residents, and eventually, I think they’ll see the benefits of it and come around to it.”

Highest rates of staff vaccination

The Jordan Center, Louisa ... 81.7 percent

The Willows at Harrodsburg, Harrodsburg ... 78.6 percent

Laurel Heights, London ... 76.7 percent

Sayre Christian Village, Lexington ... 76.2 percent

Grand Haven Nursing Home, Cynthiana ... 73 percent

Lowest rates of staff vaccination

Stanford Care and Rehabilitation, Stanford ... 22.8 percent

Hillcrest Health and Rehabilitation Center, Corbin ... 21 percent

Christian Heights Nursing and Rehabilitation, Pembroke ... 20.9 percent

Salem Springlake Health & Rehabiliation, Salem ... 15.8 percent

Twin Rivers Nursing and Rehabilitation, Owensboro ... 15.1 percent

Source: U.S. Centers for Medicare and Medicaid Services

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