A snapshot of vaccine and booster rates in nursing facilities as new boosters become available


Keeping nursing facility staff and residents up to date on their COVID-19 vaccines is an important tool to reduce deaths from COVID-19. This is particularly relevant now since KFF analysis found that more than one-fifth of all COVID-19 deaths in the United States have occurred in long-term care facilities and death rates from to COVID-19 increases for people aged 65 and older, which includes most residents of nursing care facilities. . The number of COVID-19 deaths per month among people aged 65 and over doubled between April 2022 and July 2022, exceeding 11,000 for the months of July and August.

Although the initial vaccination rates for both groups were quite high, the uptake of boosters was lower. These are troubling numbers as a recent CDC report found that receiving a second booster dose of COVID-19 was 90% effective against death and 74% effective against severe COVID-19 related outcomes for residents of nursing homes. This data note describes COVID-19 vaccination rates for residents and staff in nursing homes between August 2021 and the week ending September 18e, 2022. We briefly explore how federal policy actions have affected vaccine uptake so far, and what this might mean for uptake of the new bivalent boosters. Federal policy may be important in promoting adoption of these reminders, as the September 2022 KFF COVID-19 Vaccine Monitor shows that half of adults have heard little or nothing about the new reminders.

The uptake rate for the first series of vaccines has been relatively high, with more than 85% of residents and staff having completed the primary series as of September 18, 2022 (Figure 1). Among nursing facility residents, 87% have completed a primary vaccine series, which includes either 2 doses of the Pfizer-BioNTech, Moderna, or Novavax vaccines; or a single dose of the Janssen vaccine. There has been little change in this rate over the past year among nursing home residents – as of August 2021, 83% of residents had completed their primary series. Among staff in nursing facilities, 88% completed a series of primary vaccines by September 18, 2022. This rate increased from 62% in August 2021 to 88% in March 2022 and has remained stable since.

Booster uptake has been lower: only 74% of all residents and 51% of all staff had received one or more booster shots as of September 18, 2022. Among the population who completed the initial series of vaccines and were eligible for a booster, 86% of residents and 57% of staff had received one or more boosters. The CDC began recommending booster shots for nursing facility residents in September 2021, after data indicated that vaccinations become less effective over time, especially in older adults. Initial uptake among residents was rapid, and the percentage of residents who received a booster shot increased from 1% in September 2021 to nearly 60% in January 2022. Since then, the percentage of residents who received a booster shot has increased but at a much slower rate, rising to 74% in September 2022. The use of callbacks was much lower among nursing home staff. Between September 2021 and September 2022, the percentage of vaccinated personnel who received a booster rose from 1% to 51%. Any booster dose given to residents or nursing facility staff after September 1, 2022 is the new dual booster.

Vaccination and booster rates vary widely by state, and in 30 states, less than half of all staff had received one or more booster shots as of September 18, 2022 (Figure 2). Vaccination rates for nursing facility residents range from 76% in Arizona to 97% in Vermont. Recall rates are lower, ranging from 59% in Arizona to 92% in Vermont. Among staff, the vaccination rate ranges from 78% in Ohio, Idaho and Missouri to 100% in New York and Maine. Percentages who received a recall range from 32% in Missouri, Alabama and Mississippi to 96% in Massachusetts.

Going forward, federal policy and local outreach efforts may be important in promoting adoption of the new bivalent boosters among residents and nursing home staff. One of the likely reasons for the rapid initial uptake of vaccines and boosters in 2021 among residents and nursing facility staff was that there were three on-site vaccination clinics at all long-term care facilities. participating in the Federal Pharmacy Partnership for Long-Term Care. Care program. (Other factors contributing to the high participation rates include the very high death rates from COVID-19 among people in nursing care facilities and the fact that they were the focus of the initial vaccine rollout.) Facilities can always ask for additional clinics, but it’s unclear how many facilities do so or how many partner pharmacies continue to participate. Current CDC guidelines encourage facilities to inform residents and staff about opportunities to receive vaccines in the community. It is possible that lower use of boosters reflects increased difficulty in getting vaccinated in the community rather than on site. Among nursing facility staff, initial uptake of COVID-19 vaccines was low until the health care worker immunization mandate required providers who participate in Medicare and/or Medicaid to be vaccinated. Combined with other factors, this mandate has led to increased use of the primary series among nursing facility staff and early evidence suggests that it has not increased the frequency of staff shortages.

Creating new opportunities for on-site vaccinations and updating the healthcare worker vaccination mandate to reflect current CDC guidance could increase the number of residents and nursing facility staff who are at risk. day with their COVID-19 vaccinations. The CDC recently updated the definition of “up-to-date” immunization status for long-term care facilities to align with the definition of “up-to-date” that the CDC has rolled out more broadly nationwide. From September 2n/a across the country and September 26e for long-term care facility reporting/monitoring purposes, the CDC’s new definition of “up-to-date” means having received a bivalent booster or having received a last injection of the original vaccines less than 2 months ago. Nursing facilities may have been subject to this deferred definition of “up-to-date” to better align with quarterly reporting periods. As such, they began reporting the percentage of residents who met the new “up-to-date” standard from September 26.e2022. Once there is enough data available using the new definition, KFF will update this analysis and provide state-level results on State Health Facts.

This analysis uses federal staffing data reported weekly by facilities to the CDC’s National Healthcare Safety Network (NHSN) and reflects weekly data through the week ending September 18.e2022. This data is updated regularly to reflect revised data from previous weeks, so future versions of this dataset reflecting the same time period may produce different values.

Each week, approximately 15,200 nursing facilities submit data through the NHSN. CMS performs data quality checks to identify facilities that may have entered incorrect data before releasing that data for public download. Institutions that submitted incorrect data will see an “N” displayed in the column titled “Quality Assurance Check Passed”. Our final sample of nursing facilities in this analysis excludes facilities that CMS flagged in their data quality check, as well as facilities that lack shortage measures. This analysis reflects data from anywhere between 14,118 nursing facilities (93% of all facilities) and 15,043 nursing facilities (99% of all facilities) each week.


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