A young caregiver conducts a quick health exam on her patient | Getty Images creative
COVID-19 infections and deaths are on the increase again in nursing homes nationally and in Wisconsin, while about one in three nursing home employees is still not fully vaccinated, according to federal data.
Nursing home operators say they’re trying to encourage all their employees to get vaccinated, but they are wary that a pending federal vaccine mandate could drive some health care workers away, exacerbating a labor shortage that was already made more difficult by the pandemic.
After several months of steady improvements in nursing home COVID cases, AARP reported Monday that its latest review of federal data showed things got worse in the four weeks ending Sept. 19, compared with the previous four-week period.
The trend threatens to repeat an increase in cases logged a year ago, AARP’s Wisconsin director, Sam Wilson, told the Wisconsin Examiner. “There’s an alarming similarity to the data we saw late last summer and early fall,” Wilson said. “COVID-19 hasn’t gone anywhere, and it’s particularly impactful on those most vulnerable in our communities, particularly in nursing homes.”
Since October 2020, AARP’s Public Policy Institute has been reporting data every four weeks from the federal agency that monitors nursing homes. The advocacy group posts the information on a dashboard created in collaboration with the Scripps Gerontology Center at Miami University in Ohio. The data collection started in June 2020.
In the four-week period ending Sept. 19, 20 Wisconsin nursing home residents died from COVID-19, AARP reported. That was a death rate of 0.11 per 100 residents, and was twice the death rate of 0.05 per 100 residents in the previous four weeks ending Aug. 22.
Infections tripled from 0.3 per 100 residents in the Aug. 22 period to 0.9 per 100 in the Sept. 19 period. The September rate is also higher than the equivalent four-week period a year ago ending Sept. 20, when there were 0.7 infections per 100 residents.
“We don’t want to see a repeat of what happened last year happen again in 2021,” said Wilson. A year ago, “the numbers looked relatively small, and we just saw the numbers pick up incredibly fast.”
Nursing home staff cases also increased. There were 1.5 staff cases of COVID-19 per 100 residents in August and 2.5 per 100 residents in September. (AARP’s methodology calls for counting staff cases per 100 nursing home residents, not employees, to provide a common scale for counting residents’ and employees’ infection rates. The architects of the dashboard also found that the total number of employees in a home isn’t consistently reported in the federal data and according to AARP.)
The rate of staff cases is also higher than for the equivalent period in 2020, when there were about 2 per 100 residents in September. “That’s incredibly concerning to us,” said Wilson. “The only way the virus gets into a nursing home is going to be through outside entrants into a facility.”
That makes the current staff vaccination rate worrisome as well, he said. “We’ve only got about 65% of staff in our nursing homes fully vaccinated.” The report also found that Wisconsin nursing homes with at least 75 percent of staff vaccinated as of Sept. 19 accounted for less than 28% of the facilities in the state.
While the federal government has announced vaccination mandates for all employers of 100 or more people and all health care providers that participate in the federal Medicare and Medicaid programs, those are still in development under the federal rulemaking process.
“We certainly believe that long-term care facilities should be prioritizing ensuring that their staff is fully vaccinated,” Wilson said.
Nursing home representatives said Monday that facility operators have been trying to increase vaccination rates. “The vaccine is the best way to protect people,” said John Sauer, executive director of Leading Age Wisconsin, a trade group for primarily nonprofit nursing homes.
He noted that the vaccination rate for nursing home employees exceeds that for the state as a whole. According to the state Department of Health Services (DHS) on Monday, 54.7% of Wisconsin residents are fully vaccinated.
Some of the homes Leading Age represents have instituted vaccine mandates for their employees, Sauer said. The same is true in for-profit homes represented by the Wisconsin Health Care Association (WHCA), said Rick Abrams, the association’s president.
While Sauer and Abrams said they supported the right of individual providers to require COVID-19 vaccines, both also said they worried that the pending national mandate might drive away some nursing home and health care employees, further exacerbating a shortage of workers that began well before the pandemic but has worsened in the last year and a half.
“We believe strongly that it should be a facility-specific decision,” Abrams said of a requirement. “Because of the labor crisis, I hope that once the [federal] mandate becomes effective that we will see a great increase in employees that get vaccinated,” he added. But among nursing home operators who have declined to institute a mandate, “they don’t want to take that chance.”
He implored lawmakers not to enact a ban on employer vaccine mandates. (Gov. Tony Evers has already vetoed one such attempt early in 2021; additional bills are pending that would ban vaccine requirements of various kinds, including by employers.)
“We need all of our public officials all of our policymakers to urge the public to be vaccinated,” Abrams said
Sauer said the increase in nursing home cases has several possible causes, although they remain the subject of speculation. They might be rising where the surrounding community has a relative low vaccination rate, or where community spread is higher, he suggested.
Leading Age has developed an education video for nursing home employees that includes medical experts from DHS who seek to dispel myths about the vaccine. Some employers have tried incentive programs, such as cash awards, Sauer said.
AARP also wants the Biden administration to produce guidance on safe staffing ratios in the face of staff shortages in nursing homes. “If the ratio of staff to residents is too large, then losing even one staff member can make for a very unsafe environment,” Wilson said.
Both Sauer and Abrams said nursing homes have already reduced some of their capacity in response to lower staffing. Abrams mentioned a home he had visited two weeks ago that is licensed for 90 residents, but is holding its occupancy at 60 because it lacks enough employees to safely cover more people.
In the meantime, nursing home operators are waiting for federal approval of a booster shot for the Moderna COVID-19 vaccine, the variety provided to nursing homes at the beginning of the vaccination program. When that goes forward, they expect the pharmacies with which they already contract for medication and other programs, such as the flu shot, to arrange booster visits, Sauer and Abrams said.
A DHS spokeswoman, Jennifer Miller, said Monday that “all skilled nursing facilities have been matched with a vaccinator and are prepared to offer booster doses when residents/clients are eligible.” The department is in contact with assisted living facilities to match them with vaccinators as well, she said.
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