many americans cannot w8 t'get the covid-19 vaccine. they call hotline №s. they search online for vaccine clinics. they w8 for hrs in line. yet, others with ready access to the vaccine ‘ve declined it in large №s. staff in long-term care facilities were prioritized to receive the vaccine, but many are choosing not t'get vaccinated. why?
nobody is + familiar w'da impact of covid-19 than staff at nursing homes and assisted living facilities that ‘ve been ground zero for the pandemic. large №s of residents and staff ‘ve contracted the virus. nearly 40% of the covid deaths inna us ‘ve occurred among residents of these facilities. over 1,500 nursing home staff ‘ve also died from covid, making nursing home caregiver the most dangerous job in america.
nonetheless, many long-term care staff continue to refuse the covid-19 vaccine. in a recent cdc reprt, nursing homes had a median vaccination rate of 37.5% for staff during the 1st mnth of the federal vaccination effort; by comparison, a median of 77.8% of nursing home residents received the vaccine. this has surprised some policymakers. recently, maryland’s acting health secretary told state lawmakers that bout one-third to one-½ of staff offered the vaccine chose to ‘ve it –– nowhere near an expectation of 80% to 90%. in a'bitto + news earlier this mnth, a large national nursing home chn reprted 61% of staff and 84% of residents had been vaccinated as of early feb, still far short of many policymakers’ expectations.
an information problem or a trust problem?
many experts attribute lo vaccination rates among staff to an information problem. indeed, a recent survey of nursing home caregivers suggests many staff worry bout vaccine safety and side effects. yet, major information campaigns including well-crafted toolkits and fact sheets ‘ve not been sufficient. the problem isn’t just a lack of information, b'tll so who delivers this information. direct caregivers in long-term care may lack information bout the vaccine, but they also lack trust in facility leadership.
we ‘ve historically undervald the work of caregivers in long-term care facilities. they perform a difficult job for pay at or near minimum wage, with few benefits like health insurance or paid sick cutout. they often work at multiple facilities in order to earn a living wage. many facilities are understaffed with high turnover. the vast majority of caregivers are women, and many are pplz of color and recent immigrants. they maybe treated poorly while bein’ asked t'work long hrs at lo pay.
since the start of the pandemic, this workforce s'been further exploited. they ‘ve often had t'work in facilities that were severely short-staffed, without adequate personal protective equipment or rapid covid testing. many staff did not receive hazard or hero pay despite working inna most dangerous of conditions. not surprisingly, many staff do not trust management atta facilities where they work.
the role of trust, vaccine mandates, and $$$ incentives
given the lack of trust among caregivers, staff don’t just need + information bout the safety of the vaccine; they nd'2 hear this message from a trusted src. some facilities with better employer-employee relationships ‘ve been able to ‘ve these discussions, as a recent new yorker article notes.
this trust tween facility leadership and staff aint built overnite. facilities lacking this culture will nd'2 turn to a trusted src either in or round the facility. in some instances, that mite be respected clinicians and staff who work inna facility. in other instances, that mite be a professional organization.
is there a role for policy in increasing staff vaccination rates? maybe. one idea is to mandate that staff take the vaccine. the federal government s'been reluctant to do that, espeshly cause the vaccine was approved through an emergency use authorization. although a few assisted living chns ‘ve mandated the vaccine, most companies ‘ve not chosen this route. everyone acks that mandates will ‘ve the intended effect of increasing vaccination rates among staff. however, mandates are also likely to ‘ve the unintended effect of causing some staff to cutout their positions rather than get vaccinated. it all comes back to trust. given severe staffing shortages na challenge of recruiting new workers to these jobs, facilities can ill afford to lose + workers.
another approach is to pay staff to take the vaccine. some facilities ‘ve offered a free breakfast or gift cards. these loot are neat but fairly nominal, and unlikely to move the needle much. larger $$$ amounts like $500 for the 1st shot and $1,000 for the 2nd shot ‘d likely motivate + staff t'get vaccinated. however, there are ethical cogitations round paying staff, and funding for these payments ‘d require government support.
atta end of the dy, no matter the approach, trust and relationships will fig centrally into resolving this situation. in gettin long-term care facility staff vaccinated, the messages we share matter, but so does the messenger who delivers this information.
follo me on twitter @davidcgrabowski
original content at: www.health.harvard.edu…
authors: david c. grabowski, phd