Every long-term care resident deserves to enjoy these festivities to the fullest without the risk of acquiring a respiratory virus that may land them in the hospital, or worse. As highlighted during the pandemic, what happens in the outer community is the major driver of viral spread into long-term care centers. So, it is incumbent upon all of us to ensure that our population is equipped to fight off common respiratory viruses, such as influenza, RSV and COVID-19; however, the challenge lies in convincing our nation’s seniors, healthcare workers, and the general public to roll up their sleeves and get vaccinated. 

As a geriatrician and current chief medical officer at the nation’s largest organization representing long-term and post-acute care centers, I have witnessed both the devastating impact these viruses can have and the incredible strides the global medical community has made in developing effective vaccines. We know that these vaccines may not necessarily prevent infection, but they do reduce the risk of severe illness and a potential trip to the hospital or worse — death. 

A need to double-down

Despite these major advancements and historic milestones, we are seeing a decline in the number of individuals willing to receive these vaccines. “Vaccine fatigue” and hesitancy are rampant throughout our society but especially when it comes to the COVID-19 and RSV vaccines. 

A recent KFF survey found that more than half (51%) of all adults say they “definitely” or “probably” will not get the latest COVID-19 shot and two-thirds of the general public are not worried about getting the virus. Meanwhile, only 16% of adults 60 years and older report having received the RSV vaccine. These surveys are consistent with what we’re seeing unfold. 

Recent data from the CDC shows low vaccination rates in the community. While we are seeing the same trends in long-term care settings, it is encouraging that our uptake is higher than in the community. Nonetheless, we need to double-down on our efforts to increase those numbers. 

Much has been written about challenges with vaccine availability or why we should hold more clinics to vaccinate our residents. These are not the reasons we’re seeing slow uptake. While initially the new COVID-19 vaccine was hard to access because it was first sent to commercial pharmacies serving the general public, the vaccine is now more widely available through the pharmacies serving nursing homes. National regulations require nursing homes to educate and offer every resident and staff member the COVID-19 vaccine. 

Harmful ripple effects

The primary issue is that the majority of residents or their family members who are making decisions for them either no longer believe the COVID vaccines are necessary or express fear and skepticism about getting the new shots. We are hearing similar concerns related to the RSV vaccine, despite evidence that it is most effective among the elderly, individuals with chronic diseases, and those who live in a long-term care setting. 

I’m also concerned that this vaccine fatigue and hesitancy is impacting interest in the influenza vaccine, which is lower this year than in pre-pandemic years. 

In addition, there are administrative and insurance reimbursement challenges that need to be addressed. In long-term care, we need vaccines to be readily available to order when a current resident or new admission wants the vaccine. Additionally, those orders need to come with a guarantee that we, as providers, or the pharmacy receives reimbursement from all insurance providers — not just Medicare. Cutting the red tape around reimbursement can help ensure that long-term care providers have access to the vaccine and remain focused on encouraging uptake. One way federal policymakers could take this a step further would be to offer a pool of free vaccines available to long-term care providers. This would eliminate the administrative burden and streamline access to vaccines for residents and staff. 

While free vaccines would be ideal, most importantly we need effective and consistent public health messaging, which is the major driver of the current vaccination rates. We need every provider in every healthcare setting — from the physician’s office, commercial pharmacy, adult day care, hospital and beyond — to discuss the importance of the vaccines with the elderly and their family and address each person’s concerns. 

We’ve come a long way, but … 

Unfortunately, many new admissions arrive to a nursing home or assisted living community without having been offered or received the vaccine during their encounters with clinicians in other healthcare settings. 

Using nursing homes as a stopgap to vaccinate all individuals is ineffective and insufficient. Seniors and families need to be offered the vaccine before they’re admitted to a long-term care facility — and at every subsequent interaction, especially since primary healthcare providers are seen as trusted advisors. Long-term care staff can then help pick up those missed or continue to work to convince hesitant or skeptical residents to get vaccinated. By increasing our education efforts throughout the healthcare community, we can work together to encourage more individuals — residents and staff alike — to get vaccinated.

We’ve come a long way since 2020: COVID-19 is no longer a pandemic, and the mortality rate among nursing home residents remains at record lows. Vaccines are a major reason why, but after three years of battling this virus, Americans have a hard time acknowledging vaccines are still necessary. 

Nursing home providers cannot shoulder the responsibility of combating these deeply held beliefs all on their own. As a country, we need to focus on collectively increasing vaccination rates among the general population and avoid isolating or placing blame on specific communities or individuals. 

Long-term care providers should be applauded for achieving higher vaccination rates than in other settings, but we need a collective endeavor to take this further. 

By having the entire healthcare community and public health system collaborate, we can overcome vaccine skepticism and hesitancy and achieve even better vaccination rates among our residents. In turn, we can better protect our most vulnerable community members. 

David Gifford, MD, M.PH, is the chief medical officer of the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL). 

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.

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Across the country, case rates in the general population are rising again. At the same time, the financial survival of many nursing homes is on the line. Some federal provider relief payments will be tied to improved infection control through the end of the year.

As nursing homes work even harder to protect their residents and staff while grappling with the devastating impacts of isolation and loneliness, they are told to do more. 

But there is something nursing home leaders can do to lighten the load and even get ahead of the coronavirus crisis: Join the new National Nursing Home COVID-19 Action Network, which supports nursing homes around the country in their fight against COVID-19. 

This is a unique opportunity for access to up-to-the minute guidance and conversations on how to protect residents and staff from the virus. Staff of member nursing homes are part of a community of practice, where they can learn not only from experts but learn from and teach their peers.

Collaborating for quality, safety

The network is a partnership of the federal Agency for Healthcare Research and Quality, the Institute for Healthcare Improvement and Project ECHO. It pairs the lead federal research agency for improving health care quality and safety with the country’s foremost experts on quality improvement and a globally recognized model for scaling up health expertise quickly in communities.

 The priority deadline for registration for nursing homes is November 13.

It’s free, voluntary, collaborative and proactive – not punitive.  It’s something that many nursing homes have requested for years: comprehensive, timely technical assistance. 

You’re already getting numerous directives from states and federal agencies. This isn’t another one. In fact, we believe this will really help support your efforts to figure out how to meet and implement all the requirements already out there.

And if reporters, surveyors or potential residents ask what you’re doing to address the quality challenges of COVID and protect residents, participating in Project ECHO’s continuous improvement collaboratives demonstrates a proactive approach to staying on top of all the federal recommendations. 

Taking a proactive approach

Here’s how the network will operate: Training centers across the country (think academic medical centers or large health systems with access to geriatricians and infectious disease experts) will run 16-session, virtual communities of practice focused on preventing and reducing the spread of COVID-19 in nursing homes. Using Project ECHO’s “all teach, all learn” guided mentorship model, expert teams at each training center will share best practices and use case-based learning to support the on-the-ground efforts of staff from up to 35 nursing homes.

In this way, staff will learn from experts and from each other, and the expert team will gain valuable insights from the direct experience of community providers.

After all, you’re the experts too.  You’ve had to learn how to combat this virus on your own over the past months – and you have a lot to share. 

In this program, nursing home staff are not passive recipients of outside knowledge. They are equal participants in an effort to reduce the impact of COVID-19 in their facilities, and they bring with them their own frontline experience and wisdom.

In recognition, each nursing home that completes the 16-week training will receive $6,000 through the Provider Relief Fund. We think of this not as compensation for staff time, but more as an honorarium for the value that nursing home staff add to the program. Staff will also earn continuing education units for completing the training.

After months of struggling against the pandemic, we still face enormous challenges ahead. It is imperative that we do everything we can to equip staff with the knowledge and guidance they need to protect residents and themselves.

This is the collaboration you’ve been wanting. The network will help members navigate change and complexity, and it will bring support and empowerment to frontline staff who have been battered down for far too long.

You’re doing so much already. But we don’t want to get to the other side of this pandemic and regret not taking advantage of this opportunity to learn from your peers and experts.

Joining the National Nursing Home COVID-19 Action Network is a positive step that you can take, right now. We hope you will.

Ruth Katz is the senior vice president of Public Policy & Advocacy at LeadingAge. David Gifford, M.D., is the chief medical officer at the American Health Care Association and National Center for Assisted Living.