Staff vaccination coverage against COVID-19 in long-term care facilities dropped to six percent for the week ending Nov 8, down significantly from 51 percent in July 2022, according to data from the Centers for Disease Prevention and Control published by McKnight’s Long-Term Care News.
Facilities across seven nursing home chains generally failed to increase staff uptake within a one-year period despite a variety of efforts, a study in the Journal of the American Medical Directors Association found. Lead researcher Elizabeth Sobczyk and her team examined interventions at 15 skilled nursing facilities and six assisted living facilities across nine states.
Of the 21 facilities studied, only one showed improvement in staff COVID-19 vaccination rates, while seven improved or maintained influenza vaccination and four improved hepatitis B vaccination.
The percentage of vaccinated staff has fallen each year since the expiration of a federal mandate requiring all long-term care staff to receive the primary COVID-19 vaccine series and stay up-to-date on shots, dropping to seven percent in February before reaching six percent in November.
Mandates and free vaccinations drive immunization uptake
- Tracking barriers: Facilities struggled to collect immunization records due to manual processes and data gaps that hindered quality improvement evaluations.
- Access and cost: Offering free, on-site vaccinations increased uptake, but coverage dropped in most facilities after government purchases ended.
- Mandate impact: The study identified a required vaccination mandate as the most effective method for increasing staff immunization levels.
Operational hurdles block nursing home immunization tracking
Staff in the study found it difficult to collect vaccination data and reported that tracking required many manual processes and workarounds. Access to staff immunization records through databases helped but did not fully address the challenge, according to the research team. Because of these data gaps, facilities lacked complete vaccination records at certain points, creating a barrier for quality improvement teams trying to evaluate their progress.
Establishing data infrastructure to support ongoing tracking of employee vaccination “must be an important starting point for future PALTC staff vaccination efforts,” the authors wrote in the Journal of the American Medical Directors Association. Offering on-site vaccination options at no cost to staff was shown to increase uptake among long-term care employees, but after government purchases of COVID-19 vaccines ended, coverage dropped in all but three of the studied facilities.
Providing complimentary, location-based immunizations proved advantageous, yet this strategy independently fell short of reaching specified inoculation goals, the data indicates. Researchers determined that implementing a mandatory employee vaccination policy served as the most successful strategy for boosting immunization numbers.
| Vaccination Period / Metric | Reported Staff Coverage Rate | Primary Source |
|---|---|---|
| July 2022 Rate | 51% | Centers for Disease Prevention and Control |
| February Rate | 7% | Researchers |
| Week Ending Nov 8 Rate | 6% | Centers for Disease Prevention and Control |
CMS changes oversight as reporting requirements shift
The findings arrive as federal policies about tracking vaccination coverage in nursing home settings change. The Centers for Medicare & Medicaid Services finalized the removal of two COVID-19 vaccination measures from the Skilled Nursing Facility Quality Reporting Program this summer.
Starting in 2028, facilities will no longer need to submit 2026 staff COVID-19 vaccination data to meet compliance standards. Nursing homes also would be relieved of mandates to provide staff education regarding COVID-19 immunization, distribute the vaccine, or maintain records of these initiatives, based on modifications outlined by CMS in November within the proposed Cutting Administrative Requirements for Excellence in Patient Care regulation.
Recommendations for facility administrators
Despite the challenges, the study’s findings suggest that vaccination rates among long-term care staff require more than on-site vaccination availability, which remains difficult amid operational challenges and staffing shortages. Administrators can evaluate the success of vaccination initiatives with consistent monitoring, the authors said.
To overcome these hurdles, the authors suggest setting up dependable tracking mechanisms that utilize state immunization registries while reducing dependence on manual data entry. Furthermore, they said that facilities can successfully tackle obstacles through strong leadership involvement, partnerships with pharmacies, and the integration of immunizations into everyday employee health initiatives.
References
- Journal of the American Medical Directors Association — JAMDA
- Centers for Medicare & Medicaid Services — Skilled Nursing Facility Quality Reporting Program
- Centers for Medicare & Medicaid Services — Cutting Administrative Requirements for Excellence in Patient Care
