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Nursing homes struggle to reduce a serious COVID risk: many employees resist vaccination

Administrators have courted holdouts with raffles, gift cards, and cash, but more than 40 percent nationwide are still unvaccinated.

CNA Uvalyn Davis served lunch to resident Jane Mellis, 94 at the Leavitt Family Jewish Home in Longmeadow. “I almost died, but I wanted to come back.” Davis said about her coming down with COVID-19 in March of 2020. She has been at the facility for 24 years and is an ambassador trying to get unvaccinated staff to get their shots.
CNA Uvalyn Davis served lunch to resident Jane Mellis, 94 at the Leavitt Family Jewish Home in Longmeadow. “I almost died, but I wanted to come back.” Davis said about her coming down with COVID-19 in March of 2020. She has been at the facility for 24 years and is an ambassador trying to get unvaccinated staff to get their shots.John Tlumacki

If any nursing home had a reason to ensure everyone was fully vaccinated against COVID-19, it would be the Leavitt Family Jewish Home in Longmeadow. Sixty-three residents died last year from the disease.

Yet, six months after staffers there became eligible for shots, more than 30 percent have yet to be fully vaccinated.

Now, the Leavitt is pairing up with behavioral psychologists from the University of California, Berkeley to test the effectiveness of making the shots super convenient by reserving one for each unvaccinated employee and then asking them to either get their jab in the home during one of their shifts or decline the shot specifically reserved for them.

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The failure of many nursing home staff members to get vaccinated has emerged as one of the most serious gaps in the United States’ defenses against COVID. Fully one-quarter of the nation’s pandemic deaths have occurred in nursing homes; yet, nationwide, more than 40 percent of staff members are still unvaccinated, leaving the homes’ frail, elderly residents vulnerable.

Nursing home administrators across the country have dangled gift cards, cash, T-shirts, and more, but such incentives have largely failed at convincing holdouts. Instead, administrators are finding slow but steady success with intimate, albeit time-consuming, one-on-one sessions, pairing the hesitant with colleagues, medical directors, or other trusted sources who listen to workers and talk them through their fears.

“You need to sit across from them, and ask how their kids are,” said Barry Berman, chief executive of JGS Lifecare, which includes the Leavitt nursing home. “It’s those personal connections that sometimes makes the difference.”

Berman has taken to sharing pictures of his five grandchildren on his iPad and telling staff that his fervent prayer is that the youngsters, 8 years old and younger, may soon be eligible for a shot and gain protection, too.

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Some nursing homes have considered requiring employees to get a COVID vaccine, but many operators fear a mandate would simply worsen an already serious worker shortage in nursing homes. So persuasion remains the name of the game.

But it’s been an uphill challenge as many nursing home workers are immigrants or from communities of color where mistrust of the government and medicine can run deep. In addition, some harbor fears about vaccine side effects, often fed by social media.

As a result, the industry’s goal of getting 75 percent of the nation’s approximately 1.5 million nursing home staff vaccinated by June 30 may be a tall order. Only about 57 percent of nursing home employees nationwide are fully vaccinated, federal data show, though Massachusetts is doing better than many states, with roughly 70 percent vaccinated.

The COVID risk to nursing home residents remains significant despite the overall declining numbers. The number of new and ongoing clusters in Massachusetts nursing homes is second only to those in child care settings, state data show.

A deadly cluster in a Kentucky nursing home in April serves as a grim reminder of the urgency. An unvaccinated employee ignited a COVID-19 outbreak at a nursing home where most residents — but only about half the staff — had been vaccinated. In all, 26 residents were infected, including 18 who had been vaccinated, according to a review by the Centers for Disease Control and Prevention. Three residents died, including two who were unvaccinated.

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Nursing home residents are at special risk even after vaccination, due both to their close quarters and largely indoor life as well as their often weakened immune systems. But in general, serious illness or death is very rare in those who are vaccinated.

Dr. Asif Merchant, a medical director at four nursing homes in the Metro West area where staff vaccination rates range from around 60 percent to 85 percent, said he walks from floor to floor during his regular rounds and casually asks workers whether they’ve been vaccinated. Last week, one worker confessed she hadn’t gotten a shot because she is afraid of needles.

“I told her, ‘It’s like a mosquito bite. If you are scared, I will come and personally give you the shot.’ And she immediately agreed,” Merchant said. “I told her a lot of people are afraid of needles” and get the shot.

Merchant has also found that offering cash incentives to staff can sometimes backfire.

“Sometimes, that may make them suspicious,” he said. “They think, ‘Why are they asking me to take that [shot] for a $20 gift card.’”

A state health department spokeswoman said nursing home staff vaccination rates have improved by 4 percent statewide over the past month, and the department is helping facilities boost rates with mobile clinics and sending teams to help administer shots.

The American Health Care Association, the national trade association for nursing homes, on Tuesday held an online session for workers across the country to ask medical experts questions about the vaccines. It was clear from many of the queries that employees have been riveted by false rumors swirling around social media, claiming bizarre and scary side effects from the shots, such as infertility or that the vaccines make recipients magnetic.

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One expert, Dr. Sarah Berry, a geriatrician at Hebrew Rehabilitation Center in Boston, nodded knowingly, saying she had gotten similar questions from her 12- and 15-year old children who recently received a Pfizer vaccine.

“The 15-year-old is like, ‘Is this vaccine still going to be in me when I get old and is it going to cause side effects down the road?’” she said. Berry explained that researchers have not seen long-term effects in the people who enrolled in the first vaccine trials and have been followed for more than a year. She assured viewers that vaccines “very seldom cause side effects beyond the first couple of months, and that was sort of reassuring to my son.”

Federal regulators, hoping to increase rates of nursing home staff vaccinations and better understand outbreaks, recently required the facilities to start reporting their progress weekly, and began posting the data. But the information is hard to find on the Centers for Medicare & Medicaid Services Nursing Home Data website.

“It’s definitely not consumer friendly,” said Toby Edelman, a senior policy attorney with the Center for Medicare Advocacy. “And knowing whether staff and residents are vaccinated would be important for families.”

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At Sherrill House in Boston, vaccination rates are at 84 percent, but chief executive Patrick Stapleton is aiming still higher. One factor working in their favor, he said, is many longtime, older employees who are more open to getting vaccinated. While Stapleton offered $50 gift cards early on in their vaccine campaign, he found personal conversations seemed more productive in convincing later holdouts.

Now, he is considering mandating shots for new employees. Given the severe labor shortage in the industry, it’s a dicey proposition, he concedes.

“It’s not something we take lightly, but it’s something we are talking about,” he said. “There is a lot of employer peril here, but it’s a balance against what is safe for our residents.”


Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar.