February 14, 2024
By Michael Wasserman and Leslie Eber
McKnight's Long-Term Care News
On February 29, 2020, the first Coronavirus nursing home outbreak was reported by the media.
Experts in geriatric and long-term care medicine immediately understood the dangers to nursing home residents. Eleven days later, in McKnight’s, part of this writing team wrote, “My clinical instincts were telling me that COVID-19 was a nursing home resident killer.”
As the pandemic progressed, we lost many residents in our communities. It became eminently clear that one of the most important tools we could acquire was an effective vaccine. It also became apparent that the collaboration between the nursing home community, staff and providers would be the only way we could address this healthcare emergency.
It’s 2024, and we have effective vaccines, but both our residents and staff are vaccine-weary. According to the CDC, less than 40% of nursing home residents and only 7% of nursing home staff have achieved “up to date” status with their COVID-19 vaccination.
What are the barriers to COVID-19 vaccination this season, and how do we effectively address them?
Addressing vaccination barriers
Implementable and sustainable solutions exist, thanks to a CDC grant to AMDA — The Society for Post Acute and Long Term Care Medicine, that funds the Moving Needles Project. Moving Needles has demonstrated that prioritizing vaccination with the support of the director of nursing, medical director and leadership, coupled with hands-on partnerships with staff and lay leaders, can change our success rate.
Before addressing the major lessons and best practices from Moving Needles, we must discuss the issue of reimbursement. Until recently, the COVID-19 vaccine was free. While that never assured 100% vaccination rates among staff, in combination with vaccine mandates (which are effective but have drawbacks), it helped attain significantly higher rates than what we’re seeing now. If the cost of the vaccine for staff isn’t addressed, we must all be concerned about the ability to increase staff vaccination rates, regardless of best practices.
Resident vaccinations are covered by Medicare Part B and C. Facility responsibility for Part A costs has contributed to some facilities being asked to pay their long-term care pharmacy in advance for the vaccines. Reimbursement barriers must be addressed to make it easier to provide the care our residents need. There cannot be real or perceived impediments to vaccinating nursing home residents!
There is an abundance of evidence supporting the effectiveness and safety of the COVID-19 vaccine. The severity of illness with the most recent variants has fortunately not been as great as the original strain and earlier variants. However, we must remain vigilant to being just a mutation away from an increase in disease severity.
We should also recognize that even today, many vulnerable older adults are still dying from COVID-19. This year, we also have the opportunity to impact influenza and RSV infections through vaccination. How we communicate this medical information will directly affect vaccine uptake.
Communicating the benefits
Through current research, we know that fear-based communication is not effective. People want to feel empowered and know they are acting with purpose to provide benefit and make an impact. Our communication should be relatable, clear and accessible. We also want to be transparent about what we know, what questions are still unanswered and how the scientific community is working on finding those answers. Addressing knowledge gaps can help inform our community and make them less vulnerable to misinformation.
Moving Needles has identified several best practices to inform facility-specific recommendations. Addressing the vaccine concerns of staff, residents and families should always come first. This is a step that should never be cut short or missed.
Our partnership with staff should be built on a foundation of trust. Honoring, respecting and valuing the people who provide care on the frontlines should be the cornerstone of our communication. Telling the staff that the vaccine is “good for them” is not an effective method. We want to talk with staff, not at them.
A Moving Needles survey of frontline staff demonstrated that concerns over side effects compound the perception of disease prevention ineffectiveness. Engaged medical directors who hear and respond to staff concerns can have a significant impact on these types of perceptions. Moving Needles has also shown that making vaccines easily accessible at work (particularly for the night shift) is a foundational strategy that is necessary to increase staff vaccination rates.
Ensuring support and time off, if needed, for any vaccine side effects can also promote trust and increase vaccine confidence. A consistent process and checklist for assessing new residents and using renewable or evergreen consent documents have also been shown to be helpful.
Profoundly low COVID-19 vaccine rates in our communities will require a collaborative approach. Providing authentic information, accessible vaccination, and clear communication are three strategies that can make the 2024 respiratory season safer and healthier for our vulnerable and vaccine-weary communities.
It is another way we can honor our residents and the communities we serve. The clinical expertise of our providers, medical directors, DONs, nurses, and CNAs is a powerful tool that can “Move the Needle.”
Michael Wasserman, MD, CMD, is a geriatrician and certified medical director.
Leslie Eber, MD, CMD, is a certified medical director, works with multiple facilities as a part of Rocky Mountain Senior Care and is Chief Faculty for Abode Care Partners.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
