Nebraska rates No. 8 in vaccinating nursing home residents, but middle of pack on staff – Kearney Hub

When COVID-19 vaccines arrived in January, Greeley Care Home & Assisted Living in Greeley, Nebraska, had just been through its only outbreak of the pandemic.

About 90% of the home’s residents and more than half a dozen staff members were infected by mid-December 2020. Three residents died.

With those illnesses and deaths still fresh, the home’s residents and staff lined up for the vaccine shots when they became available, said Dorene Spies, the home’s administrator.

By July, 100% of the 25 residents in the home and attached assisted living center were fully vaccinated, as were 100% of its 30-plus employees.

That gave the small facility in largely rural Greeley County — where 44% of residents 5 and older are fully vaccinated — the distinction of being the first in the state with all residents and staff fully vaccinated, according to a World-Herald analysis of federal Centers for Medicare & Medicaid Services data.

“We just don’t want anyone to be sick,” Spies said. “And we want to have our life.”

Nebraska, in fact, has done well overall in vaccinating its vulnerable nursing home residents, which helped reduce both cases and deaths among that group. While nursing homes accounted for 40% of the state’s deaths before vaccines rolled out last winter, both cases and deaths plummeted here and elsewhere after the shots became widespread.

Only six states have lower rates of COVID-19-related deaths in nursing homes than Nebraska. The vast majority of the state’s 900 nursing home deaths during the pandemic occurred before widespread vaccination.

For a time after vaccinations wrapped up in most facilities, cases and outbreaks were quite low, said Dr. M. Salman Ashraf, who as medical director of the Nebraska Infection Control Assessment and Promotion Program has been working with long-term care facilities to prevent and contain virus outbreaks. But after the highly contagious delta variant arrived this summer, health officials began seeing more cases and outbreaks in long-term care facilities.

Unlike the previous surge, those cases and outbreaks have resulted in fewer hospitalizations and deaths, thanks to a combination of residents’ high vaccination rates and the state’s monoclonal antibody program, Ashraf said.

Another piece of good news: Booster shots for residents and staff already appear to be having a positive effect. Even with cases in the state on the upswing, cases among nursing home residents have declined in the past three to four weeks, Ashraf said. Facilities that have boosted residents and staff are not seeing large outbreaks.

“Boosters probably play a role in that,” he said. “Boosters are already working.”

Nebraska nursing homes are doing a good job of offering boosters, he said, although work remains to complete the job.

To get ahead of outbreak threats, the federal government moved to mandate vaccines for some 17 million health care workers, including those in nursing homes. How that will play out in Nebraska, however, now is in the hands of the courts. A federal judge on Monday blocked the mandate for health care workers in Nebraska and nine other states that had brought the first legal challenge against the mandate.

The 10 states alleged that the federal mandate put health care workers’ jobs at risk and threatened to exacerbate a worker shortage that’s especially worrisome in rural areas. Another set of 12 states filed a second suit on Nov. 15.

Nebraska Attorney General Doug Peterson said he expects the federal government to seek a quick review of the judge’s ruling, although he said he was confident the trial court’s analysis would be upheld.

Vaccination rates among nursing home staff in Nebraska in early November fell in the middle of the pack among states, in contrast to the high vaccination rates among residents.

By Nov. 7, two more facilities — Tabitha at the Landing in Lincoln and Litzenberg Long Term Care in Central City — had joined the Greeley home in having 100% of both staff and residents fully vaccinated.

The three were among 41 homes in the state with 100% of residents fully vaccinated by early November. That was enough to rank Nebraska No. 8 among states, with 93.3% of its nursing home residents fully vaccinated, according to CMS. Iowa, with 94% of residents fully vaccinated, came in at No. 7. Both Nebraska and Iowa are well ahead of the U.S. average of approximately 86%.

Nebraska’s average staff vaccination rate in early November, on the other hand, was 75.8%, a figure that inched up from 73.6% over the preceding month and put Nebraska 22nd among states. Iowa’s staff vaccination rate crept up to 72%, ranking it No. 30. The U.S. average, which also has increased, stands at 74.4%.

Many of the Nebraska facilities with the lowest staff vaccination rates are in rural areas. Nineteen had rates below 50%.

Ashraf said the state is slowly getting more staff vaccinated. “But I think we can do much better on that,” he said.

Heath Boddy, CEO of the Nebraska Health Care Association, said some of the group’s member facilities are concerned that the federal requirement will affect their ability to staff their homes. Some operators have told him they’re concerned they could lose up to 10% of their employees at a time when health care workers are hard to find.

Other facilities, Boddy said, already have mandated employee vaccines on their own and found the impacts weren’t as bad as they had anticipated.

The American Health Care Association and the National Center for Assisted Living recently reported that federal labor statistics indicate that nursing homes have seen their employment level drop 14% since the start of the pandemic, equating to 221,000 lost jobs.

Boddy said the Nebraska association and home operators have worked hard to educate staff members and answer questions about the vaccines. Staff members’ beliefs often reflect those prevalent in the communities where they live.

“This is a very deep-seated personal decision for many people,” Boddy said. “We’ve worked our tails off to help people get to ‘yes’ on vaccines. There are some folks who just aren’t going to get there.”

At the same time, nursing homes are imposing fewer restrictions on activities than during the prior surge. Residents, visitors and staff members now are coming and going from the facilities, and Ashraf said this fall’s outbreaks have been traced back to all three sources.

Indeed, CMS on Nov. 12 removed most restrictions on visits and advised facilities that they must allow indoor visitation at all times for all residents. The agency still advised homes to follow COVID infection prevention principles such as screening visitors and masking and distancing in accordance with federal Centers for Disease Control and Prevention guidance.

The agency acknowledged that staff vaccination rates remain significantly lower than resident vaccination rates. The agency issued its vaccine mandate for health care workers to address the gap.

Before boosters were widespread, Arbor Care Center-Valhaven in Valley had an outbreak in September and early October that included five resident deaths. All residents were vaccinated when the outbreak began and 75% of staff had all of their shots. That figure had increased to 84% by Nov. 7, according to CMS data.

Joe Kezar, director of operations for Arbor Care Centers, said the outbreak represented the first time a Valhaven resident had tested positive since the pandemic began.

“They had done very well with that,” he said. “The staff has worked very hard there. It’s just a great staff. It was unfortunate, but the realistic truth for everyone, not just nursing homes … COVID is not just if, it’s when. I don’t think it’s 100% avoidable for anyone out there.”

Kezar said he doesn’t think a staff vaccination mandate would stop all cases in nursing homes, although it could help. He expects Valhaven’s staff vaccination rate to increase further when the next batch of CMS data is available.

Nursing home staff members, Kezar said, are required to wear masks in clinical areas. Residents, though, are not, although mask-wearing is highly encouraged. Some residents, based on their medical conditions, may not understand — or remember — why they need to do so.

“It really comes down to that community transmission rate,” Kezar said. “That definitely makes a big difference with what we see happening in facilities.”

Kezar said he is concerned the company, which owns and operates nine facilities in Nebraska, could lose some staff to the federal mandate, depending on how the 10-state lawsuit plays out.

Some nursing home operators, like some hospitals, already have required staff vaccination on their own. The Good Samaritan Society in July mandated vaccines for employees at 200 locations, setting a Nov. 1 deadline. The group, which is part of Sanford Health, has services in 19 Nebraska communities, including 16 skilled nursing facilities. The list includes the Litzenberg center in Central City, which in early August had a 63% vaccination rate among staff.

Aimee Middleton, Good Samaritan Society executive director, said the organization now has a 100% compliance rate with its mandate. That includes staff who are fully vaccinated, those on their way to being vaccinated and others with an approved religious or medical exemption. Employees who receive exemptions are subject to regular testing, per CMS guidelines.

Employees who hadn’t started their vaccine series by Nov. 1 or who didn’t have an approved exemption were furloughed for up to 60 days without pay and removed from work schedules, she said. Fewer than 2% of employees have been furloughed across the group’s 22-state footprint.