Vigilance, persistent and empathetic communication, and collaboration are key to keeping nursing home residents up-to-date on COVID-19 vaccinations.
Midway through the respiratory disease season, “people are burned out on COVID-19—all Americans, I would say, even those who work in public health,” says John Donovan, health communication, education, and partnerships specialist for the Centers for Disease Control and Prevention (CDC). Donovan was a guest on the January 22, 2024 LeadingAge Member Update Call, where he noted a “sizable gap” between flu vaccination and COVID-19 vaccination rates, “not just in long-term care facilities, but [more broadly] in the country.”
Unfazed by those challenges, LeadingAge and members across the country are persevering with efforts to promote COVID vaccine education and encourage nursing home residents to get the most recent dose. And, as demonstrated by the most recent data on COVID vaccine rates, at 51%, LeadingAge member nursing homes are far outpacing all other providers (37%) and older adults over age 60 in the general population (38%) in uptake of the most recent vaccine, available in fall of 2023.
Still, the push to raise those numbers continues. Donovan recommended building trust, cultural sensitivity, and making one-on-one connections for shots to minimize the impact of COVID-19 or other respiratory illnesses. Staff at LeadingAge member organizations concur, and bring other insights into what works.
Read on for more about effective member vaccination programs and strategies.
Vigilance, Collaboration, and Constant Information Sharing
All 82 residents and 102 staff members are fully vaccinated and up to date for COVID-19 at St. Joseph’s Home in Ogdensburg, NY. Many of the residents were ready and willing to get every new dose, says CEO and Administrator Colleen Steele: “They said, ‘Our whole lives, we have had to do things we necessarily didn’t want to do. But, it’s not always about me, it’s about the people I live with. I want to keep my family safe.’ They were the first ones in line.”
St. Joseph’s home has had zero loss of life and zero hospitalizations since early 2020 with only one outbreak. Steele, a self-described “early advocate” for getting the first round of vaccines to residents and her staff, has maintained that approach ever since: “As soon as we know [a vaccine is] available, we’re working with community partners and getting clinics set up for the people we serve and the community around us.”
To address the concerns of those who are hesitant or have questions, Steele relies on strong collaboration between herself, the director of nursing, and the infection control specialist, and encourages conversations around the science and research of the vaccine to succeed.
Over the years, “we met with [residents] personally, myself and the director, in a small group. We asked them, “Why are you afraid? What’s your concern?” Sometimes, it is misinformation. But for the most part, every resident knows me and knows I care for them on a personal level. They trusted me.”
Her advice to other members: Give residents all of the information, not only the benefits of the vaccine, but the long-lasting effects if they contract COVID: “We tell them stories of people who had COVID. We say, ‘Do you understand people who get COVID can have long lasting effects?’ These are 95- and 98-year-olds getting their vaccines. After a certain number, the hope is maybe we don’t need this vaccine forever, but for now, we’re staying on top of it.”
Data Dashboards and ‘Vaccine Champions’
Hali Reiter, R.N., is lead infection preventionist for the post-acute service lines of Sanford Health and the Good Samaritan Society, Sioux Falls, SD. The affiliated organizations operate more than 300 sites: 168 assisted and independent living communities, 132 skilled nursing communities, and 50 home-based services agencies.
Using dashboards created by Sanford Health, Reiter tracks data on vaccine rates at all sites, and targets her efforts on those communities that have lower rates. She is known as a “positive annoyer,” following up regularly with post-acute care communities, most of which are located in rural locations, to ensure that vaccines are administered and to help work through any problems.
“Our most successful centers have that stable person, whether it’s the infection preventionist, director of nursing, or another leader, that really takes ownership of the process, and feels it’s their personal responsibility to make sure every resident and their family is educated. If I can help them by monitoring and overseeing this and giving them reminders, I’m more than happy to be that person,” she says. Reiter also makes available vaccine information packets including consent forms, billing information, and other resources to help community staff maintain their programs.
When COVID-19 vaccines first came out, Reiter says the organization’s resident vaccination rates approached 90%, and today’s rate for residents with updated vaccines—defined as the fall 2023 vaccine—is above 50%. Flu vaccination rates are currently above 80%.
“There’s a little vaccine fatigue,” Reiter observes, echoing the CDC’s Donovan. “Some residents that are not now considered up-to-date may have had four other COVID vaccines and they’re just tired of it; that’s probably the number one reason. Another is probably just the atmosphere of the community in general. Vaccines are talked about differently across the country. Our main goal is to make sure that every resident has been offered the opportunity to receive the vaccine.”
The most common reason for an individual community falling behind in its vaccinations, Reiter says, is the departure of its program leader. So when a vacancy arises, she prioritizes helping to identify a new person to oversee the program. Access to vaccines is occasionally an issue, for instance in a rural community where a retail drug store must service the whole community and the nursing home, perhaps needing only a few doses, might not be the priority. She says Sanford Health’s pharmacy staff can help solve such issues.
Embrace Resident Enthusiasm
For each round of vaccine or booster administration, Connie Yuen, executive director of St. Paul’s Towers, a Front Porch life plan community in Oakland, CA, says only a few residents need assistance with paperwork, but the majority of people are on board right away, leading to the organization’s current 100% vaccination rate. This past fall, she says, “Residents were asking when they could get the vaccine, and even tried to get other people in their lives vaccines, like family caregivers.”
Caring for older adults who are former medical professionals, advocates, and technology experts—St. Paul’s Towers’ resident demographic—makes vaccinating them “the easiest process ever,” according to Yuen.
“A lot of our residents want to do good for the greater population,” says Yuen. “They (understand) that this could save a life. It impacts staff; in order for us to come back to ‘normal’ we had to get vaccinated. They stay on top of their reading, their own research.”
Though resident education is rarely a concern, getting vaccines in arms can present an organizational challenge. Recalling the “beautiful chaos.” of 2020, when she collaborated with the community’s local pharmacy to do on-site clinics for all 200 residents, Yuen says “it was all hands on deck. … a beautiful thing to see” – a process that is repeated each time a new vaccine comes out.
Now, Yuen recommends providers focus on ensuring residents’ access to the vaccine. If residents cannot go out and get it themselves, providers should bring it to them and make it as easy as possible on both the resident and the vaccine administrator. She points to their first vaccine clinic in 2020 as an example of going an extra step to ensure bed-bound residents could receive their vaccines.
“We spent the last 45 minutes of the (primary vaccine) clinic going to residents’ rooms. The night before the vaccine clinic, we made personal protective equipment (PPE) kits for each room the nurse or pharmacist was going into to make the process as efficient as possible,” Yuen says. “We knew the best way to handle vaccinating was bringing it internally.”
Tips for Success
These members summarize the key elements of their successful vaccination efforts:
St. Joseph’s Home:
Stay informed on the availability of each new round of vaccines.
Collaborate with community partners to host on-site clinics.
Share accurate, up-to-date information with residents on the vaccine’s purpose—and the potential impact of not getting it.
Sanford Health/Good Samaritan Society:
Have and support a “vaccine champion” that talks to every resident and family about the benefits of vaccination.
Have a process in place for managing new residents and finding out their vaccination status, ideally before they arrive. Admissions staff can be very helpful in this.
Form partnerships: “Long-term care facilities, especially those that are standalone, should try to form a strong partnership with a health system, a pharmacy, or both,” says Hali Reiter.
St. Paul’s Towers:
Be ready to facilitate vaccination for whoever needs it, when they need it.
Encourage residents to talk with each other about new and relevant COVID information to create a space for engagement and learning.