
Mary Ann Herbst, a patient at the Good Samaritan Society nursing home in Le Mars, Iowa, gets her first COVID-19 vaccine shot on Dec. 29, 2020. A recent study found only 4 in 10 nursing home residents in the U.S. have received at least one dose of the most recent COVID vaccine, which was released last year.
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Molly Loveland, a nursing home assistant who lives outside Pittsburgh, said it seems like no one is taking COVID-19 seriously anymore.
Loveland has seen patients and co-workers in nursing homes die from the virus.
Now she has a new worry: bringing Covid home and unknowingly infecting her newborn daughter, Maya, who was born in May.
“She’s still so young,” said Loveland, whose maternity leave ended at the end of June. Infants can be vaccinated for COVID at six months old.
Loveland is also concerned about the possibility that nursing homes could see a COVID outbreak this summer, just like last year.
“This problem is further aggravated by breathing problems because it is very humid, very hot and very humid here,” he said.
Because of her patients’ complex medical needs and their proximity to one another, COVID remains a serious threat to Loveland’s nursing home — and to the 15,000 other certified nursing homes in the U.S., home to about 1.2 million people.
Despite this risk, an April report found that only four in 10 nursing home residents in the U.S. had received the most recent COVID vaccine, which was released last year. The analysis is based on data from October 16, 2023, to February 11, 2024, and was conducted by the Centers for Disease Control and Prevention
The C.D.C. report also showed that during the peak of COVID in January, the hospitalization rate for nursing home residents was eight times higher than for all U.S. adults age 70 and older.
Billing complications and patient doubts
Dr. Rajeev Kumar, a Chicago-based geriatrician, said one reason for the low vaccination rate is that the federal government is no longer paying for vaccines.
Though the vaccine is free for patients, physicians now must bill each person's insurance company separately. That makes vaccinating an entire nursing home more complicated, Kumar said.
Molly Loveland and her daughter, Maya, at a park in Washington, Pennsylvania. Loveland works at a nearby nursing home. Loveland worries about getting COVID and taking her child home after returning to work. Federal data shows that only about 4 in 10 nursing home residents in the U.S. have received at least one dose of the most recent COVID vaccine, released last fall.
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Kumar is president of The Society for Post-Acute and Long-Term Care Medicine, which represents physicians working in nursing homes and other similar settings, such as post-acute care, assisted living and hospice facilities.
“Going through that process and arranging vaccinations, making sure that somebody can bill for the services and collect the money, all of those challenges have become a little more painful,” he said.
(In April, after the study was released, the CDC recommended that adults 65 and older should get an additional dose of the updated vaccine if it has been more than four months since their last vaccination. This means that going forward, most nursing home patients who only got one shot in the fall or winter are not considered up to date for the COVID vaccine.)
Another issue is that Kumar and his colleagues are facing more skepticism toward the COVID vaccine than when it was first introduced.

“The long-term care population is a microcosm of what's happening across the country, and unfortunately, reluctance to get the COVID vaccine continues to be persistent in the general public. This is our biggest challenge,” according to an emailed statement from Dr. David Gifford, chief medical officer for AHCA/NCAL, which represents both for-profit and nonprofit nursing homes.
Nursing assistant Molly Loveland has also seen suspicion and misinformation thrive among patients at her workplace: “It’s the Facebook trap.”
But there are ways to prevent misinformation, and states show wide variation in the proportion of nursing home residents recently vaccinated.
For example, in both North and South Dakota, more than 60% of nursing home residents have received at least one COVID shot since the beginning of October.
building trust through relationships
Sanford Health, a major medical system operating in the Dakotas, has managed more than two dozen nursing homes since merging in 2019 with long-term care chain Good Samaritan Society.
Some of these nursing homes have vaccinated more than 70% of residents since early October — at one Sanford facility in Canton, South Dakota, the rate is over 90%.
Sanford Chief Medical Officer Dr. Jeremy Cowles said Sanford achieved the feat by leveraging the health system's size to make vaccine rollout more efficient. He also credited a close working relationship with South Dakota-based pharmacy chain Lewis Drug.

But most importantly, many of Sanford’s nursing home patients are cared for by doctors who work within the health system.
At most of Sanford’s nursing homes in North and South Dakota, these physicians provide primary care on-site, meaning patients don’t need to leave the hospital to see their doctors.
Another benefit of this integration is that both Sanford physicians and nursing home staff have access to the same patient’s medical records, allowing them to keep track of which patients have been vaccinated and which have not.
Cowles said these employed doctors have played a key role in motivating patients to get their COVID vaccines. For example, a medical director who worked at the Good Samaritan Nursing Home in Canton was a long-serving physician with close ties to that community.
“A proper face-to-face interaction with somebody who cares about you and has a history of doing this in the past, for us, has gotten far better results than what we’re getting nationally compared to other places,” said Cowles, who added that Sanford still needs to work to reach the remaining patients who haven’t recently gotten a COVID shot.
Sanford's success shows that the responsibility to get patients vaccinated extends beyond nursing homes, said Jodi Igor, director of Nursing Home Quality and Policy, a nonprofit that represents nursing homes. Primary care providers, hospital doctors, pharmacists and other health care stakeholders need to step up, she said.
“What conversations have they had between them and their doctors before they walk in the door of the nursing home? Because they probably see their doctors leave their jobs often before they come to the nursing home,” said Igor, who points out that these other physicians are also regulated by Medicare, the federal health insurance program for adults 65 and older.
Critics: Rising demand is causing residents' discontent
Still, nursing homes need to educate patients as well as staff about the importance of the COVID vaccine. Industry critics argue that face-to-face interactions, based on trusted relationships with physicians, are something nursing homes should minimize.
But many facilities don't even do that, according to Richard Mollot, executive director of the Long Term Care Community Coalition, a watchdog group that tracks nursing homes. He said the recent 40% vaccination rate is inexcusable, given the threat the virus poses to nursing home residents.
A study in the Journal of Health Economics estimates that 21% of COVID-related deaths in the US from the start of the pandemic to August 15, 2021, occurred among nursing home residents.
According to Molotch, the abysmal rate of COVID vaccinations is actually a symptom of larger problems across the industry. He hears from patients' families about poor food quality and a general indifference to residents' concerns at some nursing homes. He also cites high rates of staff turnover and substandard, and even dangerous, care.
Mollot said these problems became even more acute in the years following the start of the COVID pandemic, causing widespread stress across the industry.

“This has resulted in diminished care, increased disrespect between residents and staff, and a lack of trust,” he said.
Nursing assistant Molly Loveland also believes there are fundamental problems in the industry when it comes to the daily interactions between staff and residents. She said managers at her work often ignore patients' concerns.
“I think if hospitals treated patients more kindly, they would get more respect from patients,” he said.
Loveland said when administrators announce it’s time for residents to get the latest COVID vaccine, they’re often ignored, even if it puts their own health at risk.
This story is from NPR's health reporting partnership KFF Health News,