FORT WORTH, Texas — When Alice Hakata first heard her colleagues at the Midlothian Healthcare Center debating whether they were going to take a COVID-19 vaccine, she remembers joking with them, “Well, that just makes the line in front of me shorter.”
The 59-year-old physical therapist got her first shot in late January at a mass vaccination site in Fort Worth. As she waited for her second dose, she continued hearing staff members at the skilled nursing facility, located 25 miles south of Dallas, sharing their fears about the vaccines.
“My co-worker who is African American was like, ‘They’ve killed us, they’ve abused us for these things, so how do I know it’s safe?’ So, I explained to her what I knew, and she was like, ‘Oh, OK.’”
Hakata, an immigrant from Zimbabwe, said she learned about the vaccines by listening to NPR and consulting a friend who specializes in medical technology. So far, she’s helped persuade at least two of her co-workers to take the vaccines.
Union leaders, facility owners and staff members who led by example, such as Hakata, have been working to curb vaccine hesitancy of long-term caretakers nationwide, but only about half those workers have been vaccinated so far, according to Ruth Link-Gelles, an epidemiologist and member of the Centers for Disease Control and Prevention’s Vaccine Task Force. Vaccinating the remaining half of these frontline workers may fall only on states and the facilities themselves when a federal program to inoculate caretakers ends in the next few weeks.
As of March 18, 1.86 million staff members at long-term care facilities nationwide had received at least one dose of a COVID-19 vaccine, according to CDC data, shared with Stateline. The numbers were reported by pharmacies that partnered with the agency to administer vaccines through the national Pharmacy Partnership for Long-Term Care Program.
Residents and staff at nursing homes, assisted living centers and skilled nursing facilities received their first immunizations through the pharmacy program Dec. 18. The public-private partnership, which includes the CDC, CVS Pharmacy, Managed Health Care Associates, Inc., and Walgreens, was launched to provide on-site COVID-19 vaccination to residents and staff members at more than 63,000 enrolled long-term care facilities in 49 states.
A February CDC report estimated that 37.5% of staff members nationwide received at least one dose of a COVID-19 vaccine through the program between Dec. 18 and Jan. 17.
“We’re well over 80% coverage amongst residents at this point, but obviously there is still some work to be done on staff,” Link-Gelles, who led the CDC data initiative, said in an interview. “But I think in the end it may depend on the specific facility or the state to find what the best strategy is.”
Link-Gelles said it is difficult to estimate a total rate because the data only captures those vaccinated through the long-term care partnership. She also said facilities participating in the program varied by state.
“What is considered a residential care facility in one state might be called adult foster care in one state and be called assisted living in a third state so it's really, really tricky to get an accurate numerator and denominator that aligns, especially nationally,” Link-Gelles said.
The CDC is working on a follow-up to its February report, she said, but it could take months for officials to figure out the data. The CDC has partnered with the American Health Association to study why staff at some facilities were not inclined to get vaccinated, Link-Gelles said.
In South Dakota there are about 10,000 employees working at nursing homes, assisted living centers and skilled nursing facilities, according to the latest U.S. Bureau of Labor Statistics data from September 2020. CDC data shows 1,510 staff members, or about 15%, were vaccinated through the long-term care program.
Daniel Bucheli, communications director for the state’s health department, said many long-term care workers receive immunizations through other routes.
“We have been able to identify [long-term care] staff coverage at 55% or greater in South Dakota,” Bucheli said in an email.
Two states, Massachusetts and New Hampshire, had more staff members vaccinated through the program than any other states, but that might be because some facilities were counting non-staff members.
John Moore, CEO of Atria Senior Living, a long-term care company with 200 communities in Massachusetts, Texas and 26 other states, said their vaccination numbers include home health aides, contractors and third-party employees vaccinated at their facilities and counted as staff through the long-term care partnership.
Employment data from the U.S. Bureau of Labor Statistics analyzed by Stateline does not include contractors, third-party employees or home health aides, because not all facilities included these employees in the program.
“We’re trying to vaccinate everybody that has access to our buildings and anyone that would come in contact with our residents,” Moore said.
“If we're going to have a business that's trying to improve the lives of frail seniors, then they deserve to live in a COVID-vaccinated environment and our staff deserves to work in a COVID-vaccinated environment,” he added.
More than 174,000 residents and staff have died of COVID-19 at long-term care facilities since the start of the pandemic, according to the COVID Tracking Project, a volunteer organization launched by The Atlantic that collected and published COVID-19 data through early March.
Less than 1% of America’s population lives in these facilities, but as of March 4, this fraction of the country accounted for more than a third of U.S. COVID-19 deaths, according to the project’s website.
Despite the toll the virus had taken on community nurses, especially Black nurses, many originally had their doubts about the vaccines. A survey conducted in October by the American Nurses Foundation, an advocacy group, found 43% of nurses at long-term care facilities said they would not voluntarily take COVID-19 vaccines if their employer did not require it. That number was 73% for Black nurses.
In January, Moore issued a May 1 deadline for all Atria staff employees to get a COVID-19 vaccine. As of March 24, 87% of staff and 92% of residents at all Atria communities had received at least one dose of a COVID-19 vaccine, according to Moore.
Federal guidance issued in December allows employers to require that their workers get COVID-19 vaccines, although they must accommodate employees’ religious objections and also make sure vaccine requirements don’t discriminate against employees with disabilities. Lawmakers in at least 23 states have proposed banning employers from requiring workers get vaccinated against COVID-19 or other infectious diseases, but experts say the measures are unlikely to pass.
“We’ve lost a few employees, but they were also the people who had to be told the most to put on their mask,” Moore said about some employees who quit after the mandate announcement. “I’m confident we will get to 100% one way or another.”
Meghan Finegan, assistant director of communications for the health care arm of Service Employees International Union, which represents about 1 million health care workers, said mandating vaccines can cause more people to distrust them.
“They should be making information available, bringing in voices that workers can relate to and that they trust,” Finegan said. “Numbers show all of these things are working, so we need to continue doing this.”
Following the CDC’s February report and polls showing health care worker vaccine hesitancy, SEIU teamed up with the University of California, San Francisco to host a series of virtual town halls with Spanish-, Mandarin- and Vietnamese-speaking medical professionals. The events gave thousands of union members the chance to hear information about the vaccines in their first language and to ask questions.
Diana Martinez, president of the Texas Assisted Living Association, a lobbying and advocacy group, said in addition to educational campaigns, some facility owners are providing incentives such as gift cards or paid time off to get vaccinated.
Martinez said she thinks any staff member who is in direct contact with residents at long-term care facilities should get vaccinated but added that not all employers have the luxury of mandating it because of understaffing.
Authors of a study published in March in Health Affairs, a health policy journal, found nursing homes have an employee turnover rate that averages 128% annually. The driving force behind the high turnover: few benefits and low pay.
Amanda Fredriksen, associate state director of advocacy for the AARP in Texas, which advocates for older adults, said many people think nursing homes are almost like hospitals. But these facilities are only required to have one registered nurse eight hours a day, seven days a week, she said.
Typically, she said, most of the people providing direct care at nursing facilities are certified nurse aides who often get most of their training on the job and don’t have any specific medical experience. She said their average pay is around $11 an hour and they don’t always have benefits.
“I think in a perfect world, it would be great if residents and staff were all vaccinated, but we don't live in a perfect world. And people need to get the facts and they need to make up their own mind about it. And that's hard because they're caring for a really vulnerable population.”
Nearly 6 in 10 long-term care workers earned less than $30,000 in 2018, according to a study by the Kaiser Family Foundation, an advocacy group focused on national health issues. The vast majority, 82%, of long-term care workers were female and a disproportionate share, 1 in 4, were Black.
“I think if you talk to anyone about long-term issues at nursing homes it begins with this, there’s systemic racism and sexism that has created a structure where people do not need to be paid a living wage and are seen as disposable,” said SEIU’s Finegan.
“Because of the way it was rolled out, people felt it was a government-produced vaccine and many had concerns about how they had been treated or discriminated against within our health care system,” she added. “Others were just misinformed.”
Kelsey Lindsey, 33, works with Hakata at the skilled nursing facility in Midlothian. At first, she said, she hesitated to get a vaccine because it was developed so fast. She wondered whether it was just rushed through without proper testing.
“I heard random stories on social media of people developing Bell’s palsy,” Lindsey said. “At work we didn’t really have many conversations about it, so it wasn’t until friends and colleagues started getting the vaccine that I started to feel more confident.”
But before Lindsey could sign up for the vaccine, she contracted COVID-19 from her husband. After she recovered this past month, the pharmacist administering the vaccines at the facility suggested she wait 90 days before getting inoculated because some patients who recently had the virus were getting sick from the vaccine.
COVID-19 vaccines are safe even for patients who have been sick with COVID-19 in the past 90 days, according to the CDC. Patients can get vaccinated as soon as their isolation period is over and their symptoms are gone.
Lindsey said she’d still rather wait the 90 days and would ask her employer to help her schedule a vaccination. “I have every intention of getting the vaccine, but my doctor said the same thing, so I’d rather be safe than sorry,” she added.