COVID-19 vaccines are administered during a pop-up clinic at the Broadmoor

COVID-19 vaccines are administered during a pop-up clinic at the Broadmoor World Arena in Colorado Springs on Saturday, Feb. 13. (Chancey Bush, The Gazette)

More than a third of employees at Colorado's long-term care facilities haven't been vaccinated, far fewer than the residents they care for and other targeted groups.

Just over 62% of staffers in nursing homes, assisted-living facilities and immediate care centers have been inoculated, according to data provided by the state Department of Public Health and Environment. While a nursing home official said the numbers are improving, it's a weaker showing than other populations for a group that was among the first eligible to receive doses in Colorado and nationwide. Facilities are turning to in-house education, and some are offering various incentives, to improve uptake.

The low uptake among these staffers stands in stark contrast to the eagerness of their residents. According to state data, 87% of long-term care residents have been inoculated. The impact of that can already be measured in fewer hospitalizations, cases and deaths among residents, who have long been particularly at risk from the disease.

It also differs significantly from the flu vaccine. According to federal data, more than three-quarters of long-term care staffers in Colorado received the flu vaccine in 2017, which was roughly in the middle of the pack nationwide. 

But the mass vaccination of residents doesn't mean the pandemic will no longer touch those facilities. The low vaccination rates for staff have led to outbreaks; NPR reported last week that an outbreak among staff forced a lockdown at an Arkansas facility and that several states vaccinated fewer than a third of their staffers. 

Gregory Gahm, the medical director of senior living company Vivage, said staffers believe what they read on social media or hear from prominent vaccine skeptics. He noted the millions of doses — more than 665 million, according to the New York Times — distributed worldwide and the dearth of serious complications associated with any of those doses.

"There have been 2.8 million deaths (from COVID) and another three million with long-term complications," he said. "And we still have people scared to get the vaccine." 

It's a particularly concerning number because vaccines were made readily available to staffers and residents alike beginning in January. Through a federally run program, CVS and Walgreens ran three clinics in each facility to give residents and staff multiple bites at the apple. Other targeted groups were more successful: The vast majority of health care workers received a vaccination, and uptake has steadily ticked upward for older residents, educators and others.  

Though facilities have thus far shied away from requiring vaccinations, they face the risk of stricter federal regulations in the future. The pandemic is still ongoing and many of the infection control measures that may be pushed upon low vaccine facilities in the future are required now. But the Centers for Medicare and Medicaid Services, which oversees nursing homes, may institute thresholds in the future that, if not met, may require facilities to institute stricter infection control measures, said Doug Farmer, the head of the Colorado Health Care Association. 

"There are indications that what CMS will do is that they’ll offer more flexibility, regulatory flexibility, related to infection control practices once we have higher levels of vaccination," he said. "They haven’t given us a number, haven’t said either way. But (it may be) to not have to go through federally required testing protocols and federally required use of face shield and masks and goggles. That’s going to be the next thing we see before we get to a point where they say, 'You must be this or you’re going to face some kind of consequence for this.'"

Long-term care officials are actively working to improve uptake, experts said. The American Health Care Association, which is a national nursing home group, has unveiled a messaging campaign, complete with media talking points, fact sheets dispelling vaccine myths and various frequently asked questions. 

The good news is that Colorado is doing better than most states when it comes to vaccinating long-term care employees. But the number is still below what would be needed, on a society scale, for herd immunity, and it's a potential warning for general population vaccination efforts: the influence of vaccine skeptical messaging on the public, even among those who appear highly incentivized to be vaccinated.

Gahm said he's traveled to do lectures and information sessions at every nursing home he's affiliated with, and he's "done a lot" via the American Health Care Association. 

Farmer said the numbers are improving, as some wait-and-see staffers watch vaccinations elsewhere and see their fears assuaged. He, too, said the political climate — vaccines became their own political touchstone — has affected uptake.

He said some facilities have turned to incentives. Some are offering gift certificates or an extra day off. They're focusing on education and one-on-one conversations as well.

Facilities have almost universally shied away from requiring inoculations, he said. A Washington Post poll found that roughly 40% of staffers nationally would not support their facilities' requiring vaccinations. Farmer said that high number puts facilities in a bind: They can require vaccines and risk losing staff, or they can leave it optional and risk staff outbreaks and infections.

"The workforce is such a challenging issue in long-term care," he said. "It's taking this step of, 'You either get vaccinated or leave,' and then they call your bluff and leave, and you're sitting on a bigger problem."

The target of the American Health Association is 75% of staffers vaccinated by the end of June, Farmer said. Colorado will have to climb 13 points in the next three months. 

Jessica Brailish, the director of communications for the state Department of Public Health and Environment, said in an email that the state's "residential care strike team" is working on improving uptake.

"Vaccine confidence outreach has been ongoing through all of our communications channels including facility portal messaging, resources/toolkits, webinars, and long term care facility focus work groups," she wrote.

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