Long-Term Care Facilities Fail To Meet COVID-19 Vaccination Target

Oregon long-term care residents had an 84% COVID-19 vaccination rate in May among facilities that reported data, according to an Oregon Health Authority report released Monday. 

Staff at those facilities had a 62% vaccination rate as of May 9, the report found. In comparison, the statewide vaccination rate of adults was about 54% at that point.

But that falls short of the state’s goal to have at least 75% of both staff and residents vaccinated to rein in outbreaks at facilities. That goal is higher than the state’s overall target of a 70% vaccination rate among all adults 18 and older. Oregon is creeping towards that goal, which Gov. Kate Brown set as a condition to reopen the state more and eliminate capacity restrictions on businesses and entertainment venues.

A representative of the long-term care industry blamed the relatively low staff vaccination rates on vaccine hesitancy fostered by misinformation spread via social media.

Long-term care facilities serve senior citizens and adults with disabilities, a vulnerable sector of the population that has been hard hit by the pandemic. Senior citizens and people with breathing problems and other health issues are more susceptible to serious COVID-19 illness, including hospitalization and death. 

Long-term care facilities and other residential care settings face the risk of the virus sweeping through residents as well as staff who can bring the virus into facilities without displaying symptoms. That's why they were first in line for vaccination: A federal program run by Walgreens, CVS and other pharmacies, which was launched in December, has been in charge of vaccinating staff and residents in these facilities.

So far, public health officials have tied 1,353 deaths to congregate care settings, which includes long-term care facilities and adult foster homes, which can have up to five residents, according to the state’s weekly outbreak report issued last week. Those deaths include staff, residents and people who came into close contact with the facility, such as family members. 

In the current active outbreaks at 20 facilities statewide, there are 122 COVID-19 cases and four fatalities. An outbreak remains active until a facility goes 28 days without a new case.

“Nursing, assisted-living, and residential care facilities continue to be at risk for spread of the virus that causes COVID-19 given their size and congregate nature,”  said Rebecca Pierce, manager of the Healthcare-Associated Infections Program at the OHA Public Health Division. “Residents in these settings are at elevated risk for serious health consequences from the virus. Vaccination remains our No. 1 tool to prevent spread and serious illness from COVID-19 in these settings.”

Even the 84% vaccination rate has caveats. The report only represents data self-reported by 62% of the long-term care facilities in Oregon, which includes nursing homes, assisted living facilities and residential care facilities. Further, while the overall rate is 84%, the rate varies from one facility or region to another.

In short, the disparities in vaccination rates throughout the wider Oregon population also crop up in varying rates at long-term care facilities.

For example, the eastern region, which covers the entire border along Idaho, had the lowest vaccination rate of staff and residents: 70% for residents and 46% for staff. 

That echoes a broader state trend of lower vaccination rates in rural Oregon. The region encompassing the tri-county Portland area had the highest rates: 91% for residents and 71% for staff.

“There’s still a ways to go to get necessary numbers of staff vaccinated to stop COVID from entering the care facilities,” said Fred Steele, Oregon’s long-term care ombudsman. 

COVID-19 impacts more than those who contract it in long-term care settings. A single COVID-19 case will lead to the state restricting admissions. About 55 long-term care facilities have a restriction on admission, state data show. During outbreaks, indoor meetings are not allowed between residents and visitors. Just one staff member with COVID-19 can cause restrictions to go into place, Steele said.

In a statement, the Oregon Health Care Association, which represents the senior and long-term care industry, said there is vaccine hesitancy among staff at facilities.

“Vaccine hesitancy, particularly amongst staff, remains a challenge in meeting the goal of 75% vaccine levels for long term care staff,” 

said Linda Kirschbaum, senior vice president of quality services for the association, in a statement. “Our staff are exposed to the same vaccine misinformation online and in their daily lives as other Oregonians, which is having serious impacts on our state’s vaccination rates.”

Kirschbaum said another reason for the difference between staff and resident vaccination rates is the advanced age of residents -- usually 80 or older.

“Oregonians in this age group are getting vaccinated at higher rates than other age groups so it makes sense that long term care residents have higher vaccination rates than staff,” Kirschbaum said.

More Data To Come Out 

Currently, long-term care employers are prevented by law from mandating that employees get vaccinated.

Asked by reporters, Pierce said she wasn’t aware of any authority efforts to ask the Legislature to make vaccines mandatory for staff in long-term care facilities. However, she said she thinks there’s “going to be a focus on mandates in the future.” 

The Centers for Medicaid and Medicare Services began requiring nursing homes to report vaccination data on a weekly basis this month. Data on individual nursing homes is public. But that’s just one segment of the long-term care industry. Oregon has about 130 nursing homes along with about 560 other facilities, including assisted living and residential care homes.

Steele, the ombudsman, said the state needs to make vaccination rate data from individual facilities available so families can make informed decisions.

The one exception to this would be for adult foster homes, which only have up to five residents. Publishing individual vaccination rate data for those homes would be more difficult because of medical privacy rules, Steele said.

Pierce said the authority will be collecting this information and keeping an eye on trends. She said the state plans to “release more granular data” about facilities but was unable to commit to a specific date.

“We're hoping as soon as possible,” Pierce said, adding that consumers deserve the information to make choices. “I can't give a firm date on that."

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1

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