By ANNIKA MERRILEES, St. Louis Post-Dispatch
ST. LOUIS (AP) – Nursing homes in Missouri with the vast majority of staff vaccinated tend to have rates of COVID-19 cases among residents, according to federal records, a trend that may offer broader lessons on the virus and how it can be slowed down.
Many state nursing homes had six, seven or even eight in 10 employees vaccinated, but still recorded relatively high cases of the virus among residents this year. But all homes with 90% or more of their staff vaccinated have seen the number of cases – and deaths – drop to near zero, reports the St. Louis Post-Dispatch.
âIn November and December, when a person had turned positive, you knew you were going to find other positive people in the house. Because there was no protection, before the vaccination, âsaid Dr Charles Crecelius, medical director of two nursing homes in the region and senior care specialist for BJC Medical Group. âNowâ¦ I can’t say it’s not happening. But the average epidemic, there are a few people, and you are suppressing it. “
âWe have shown, in nursing homes: vaccines work,â continued Crecelius. “They really drastically reduce the case rate and the death rate.”
Retirement homes are at a crossroads. In the coming weeks, the federal government will issue a rule requiring all employees to be vaccinated at facilities certified to receive Medicare and Medicaid dollars, but nursing home executives fear some staff may resign in the face of such a mandate. At the same time, the most contagious delta variant of the coronavirus is spreading rapidly in the United States and – although case rates are well below devastating levels last year – nursing homes are still reporting outbreaks.
Missouri nursing homes with very high staff immunization rates generally had low case rates during 2021, according to a post-submission analysis of infection, death and immunization data from the Centers for Medicare and Medicaid Services of the United States.
Local researchers analyzed the data and found similar patterns. Looking at the records of more than 500 Missouri nursing homes between May 24 and August 29, “as the percentage of staff vaccinated increased, the risk of COVID-19 infections among residents decreased dramatically,” researchers, including lead author and St. Louis University professor Enbal Shacham, wrote in an article submitted for publication this week.
The data did not always provide a clear trend, suggesting that other factors played a role. For example, some nursing homes with very low vaccination rates have also reported very low resident case rates. And Shacham’s study found that nursing homes with more residents had a higher risk of infection, and also that increasing case rates in the surrounding county increased the risk of infection among residents. of the nursing home.
But the United States also indicated that staff immunizations played a significant role in residents’ infection rates: In a press release earlier this month, the Centers for Medicare and Medicaid Services, known as of CMS, said US nursing homes had 75% or less staff immunizations. rates have higher rates of preventable COVID-19 infections.
Vaccinations began for residents and staff of Missouri nursing homes on December 28. At this point, nursing homes statewide had reported nearly 19,000 cases of COVID-19 and nearly 3,000 deaths, according to federal data, or about 44% of the total viruses reported by the state. death.
Throughout the remainder of the winter and into the spring, the weekly number of cases and deaths in Missouri nursing homes declined.
Momentum has grown towards vaccination mandates for nursing home workers, with a sweeping federal demand expected in the coming weeks. More than 84% of nursing home residents are now immune in Missouri.
But seniors still represent 15% of state cases and 81% of deaths. And despite months of effort, only about half of the state’s nursing home workers have been vaccinated, making Missouri the third worst in the country, behind Florida and Louisiana.
Maries Manor, a 98-bed retirement home about 25 miles northwest of Rolla, has a 100% vaccination rate among residents. Most were immunized during the facility’s first COVID-19 vaccination clinic, administrator Josh Cross said recently. But getting the employees vaccinated was more difficult.
Cross said that over the past eight months he has consistently tried to educate, alleviate fears, and provide incentives. At one point, he offered $ 25 to unvaccinated employees to get a first dose. Cross spoke to employees over and over again, before each monthly immunization clinic.
âSlowly but surely it worked,â Cross said. “I shocked so many people who weren’t going to get it.”
As of August 22, 82% of facility staff were fully immunized and Cross said 91% had received a first dose.
Since the start of the pandemic, Maries Manor has reported 18 cases of COVID-19 among its residents, and three deaths, according to CMS data. All cases and deaths were reported by January 24.
Cross said he would prefer all visitors to be vaccinated as well, “but we know in rural Missouri it’s very, very unlikely.” In Maries County, 35% of the population received a first dose of the vaccine and 32% were fully vaccinated, according to state data.
Vaccination Mandates On August 18, President Joe Biden announced the mandate to vaccinate nursing home staff. On August 26, Illinois Governor JB Pritzker announced vaccine requirements for workers in high-risk settings, including nursing homes and schools.
And on September 9, Biden announced that the requirement would be extended to hospitals, home health agencies, dialysis clinics and other federally funded health care facilities.
Some nursing homes in the area already require vaccines for staff. BJC HealthCare’s Memorial Care Center in St. Clair County requires employees to be vaccinated as part of BJC health system requirements. St. Luke’s Surrey Place also requires vaccines for its employees, as part of the mandate of employees at St. Luke’s Hospital. Bethesda Health Group, a St. Louis County-based chain with 14 communities, announced on Aug. 23 that all of its employees, volunteers, and vendors should be vaccinated by Nov. 1.
But Nikki Strong, executive director of the Missouri Health Care Association, a trade group for long-term care facilities, told a Missouri Capitol hearing Tuesday that she believed the vaccine mandate would exacerbate staff shortages. existing in nursing homes.
âWe don’t believe that a simple warrant is the appropriate way to get a full vaccination in our facilities,â Strong said.
Strong said 83 of Missouri’s 275 nursing homes in a recent poll said they would expect to lose 25 to 49 percent of their staff if there were a tenure, and 91 said they s ‘would expect to lose 50% or more.
âThe personnel crisis is not improving. We don’t have the resources to pay and compete with fast food outlets, convenience stores, Walmarts, whatever, âStrong said.
Strong said she did not expect the federal rule to be finalized until mid-October, so the details of the mandate are still unknown. It is not known how it will be applied and whether there will be an option for employees to get tested regularly if they do not want to be vaccinated.
Representative Peter Merideth, D-St. Louis, said during the hearing that he believed that a vaccination warrant could be a factor in staff shortages, but that the focus should be on improving the wages of nursing home workers and increasing reimbursement rates.
âYes, we are adding another requirement on them,â Merideth said. “It may have been the straw that broke the camel’s back, but the hard work they’ve had over the past two years for the low pay is undoubtedly a bigger factor in the workforce crisis, not isn’t it? “
Lavetta Richardson, a certified medical technician who worked for 13 years at the Mary, Queen and Mother Center in Shrewsbury, said she supports a warrant because without one people won’t get vaccinated.
Richardson caught COVID-19 in the summer of 2020 and was ill for about six weeks with body aches, headaches and loss of appetite. Her husband also caught the virus and was hospitalized.
âIt was just miserable,â Richardson said.
She received her first injection in January and now she talks to her colleagues about the vaccines as the union’s designated âsafety representativeâ for the nursing home. She said she recently met with her colleagues and told them about her experience with COVID-19.
âA lot of people get the misinformation and carry it with them,â Richardson said. âIt’s hard to change your mind. “
Nursing home administrators and doctors told the Post-Dispatch that immunization incentives have helped some, but that real progress in increasing staff immunization rates has been made through one-on-one conversations. -head on employee concerns.
Lincoln County’s Elsberry Missouri Healthcare Center has a 100% vaccination rate among residents and 93% among staff, and has reported only one case – a false positive, staff said . Administrator Linda Haake said there are many things that are helping to keep the case rate low. The facility paid employees when they stayed at home while awaiting the test result. He encouraged open-air visits. And only vaccinated visitors were allowed to visit residents in their rooms.
But she also worked hard to get staff vaccinated: She said she would put aside employees who were not getting vaccinated or who were about to get vaccinated, ask them questions and concerns, and try to find experts who could answer it. The establishment also offered $ 100 gift cards.
Dr David Carr, a geriatrician and professor of medicine and neurology at the University of Washington, said the vaccine’s effectiveness was clear.
“I have no doubt, without the vaccination, that we would have had a huge number of epidemics that would have just continued,” said Carr, who is also the medical director of Parc Provence, a dementia care facility in Creve Coeur. .
Carr believes nursing homes have survived the worst of COVID-19. They now benefit from the vaccination of at least some of their employees, and most of their residents. But he fears that with other mutations in the virus there will be more waves of cases.
âI hope nothing that we had before,â he said. “But I think we’re going to continue to be in danger here, through winter and spring.”
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