LISBON, Maine — For nearly a year, Adrianna Sirois, a certified nurse’s assistant at the Lamp Memory Care Center in Lisbon has been coping with uncertainty, change and a lot of stress in her workplace as she cares for some of Maine’s most vulnerable residents.
“Every week was different,” she said. “In the beginning, we were allowed to wear cloth masks. Then all of a sudden it changed to medical masks. Face shields. Isolations. Then a lot of COVID testing that we do weekly. It was a lot to get used to.”
Given all that — as well as deadly outbreaks of the disease in congregate care facilities around the state — it would seem that for Sirois, 22, and other nursing home workers, it would be an easy choice to opt to be vaccinated against COVID-19.
But it wasn’t.
“When the vaccine first came out, I was not for it,” she said. “I thought it was too new and I didn’t want anything to do with it.”
Ultimately, Sirois changed her mind and is now fully vaccinated. But national statistics indicate that this kind of hesitancy is not unusual. A recent report from the U.S. Centers for Disease Control and Prevention showed that nursing home staff had a median vaccination rate of just 37.5 percent during the first month of the federal vaccination effort, compared with 77.8 percent for nursing home residents.
While it may seem surprising that staff members in congregate care facilities — who know the human cost and pain of COVID-19 better than most — have such low vaccination rates, it doesn’t come as a shock to experts such as Rick Erb, the president and CEO of the Maine Health Care Association.
“I think what we’re seeing is probably a reflection of people’s feelings on a national level,” he said. “We’ve seen a third of Americans are uncertain about whether they would take the vaccine.”
That’s the case for one 25-year-old traveling CNA who works for a smaller private care facility in Maine. He said he’s opting against inoculation until he sees how colleagues and others respond to the vaccine.
“I just don’t know much about it,” he said. “I might get it later.”
Snow falls outside the Maine Veterans Homes (left) in Scarborough on Friday. Cheryl Power (right) is the long-term care unit nursing manager at the Maine Veterans Homes in Scarborough. There was never any doubt in Power’s mind that she would get the coronavirus vaccine when it became available. Credit: Troy R. Bennett / BDN
Low vaccination rates among staff at long-term care facilities might be connected to a lack of trust in their workplaces, according to Harvard Health Publishing. Caregivers in such facilities have been “historically undervalued,” according to Harvard Medical School professor David C. Grabowski, and perform a difficult job for low pay and with few benefits such as health insurance or paid sick leave. Since the pandemic, things have not improved, he said.
“They have often had to work in facilities that were severely short-staffed, without adequate personal protective equipment or rapid COVID testing,” he wrote. “Not surprisingly, many staff do not trust management at the facilities where they work.”
And while some may wonder why nursing homes and other long-term care facilities do not make vaccination a requirement for their employees, it’s not that simple, Erb said. Taking such an approach likely would anger or distress workers and ultimately backfire. Facilities are already facing severe staffing shortages, and forcing staff to get the vaccine likely would exacerbate that problem.
So they’re trying to educate their staff members — not pressure or force them to be vaccinated.
“Most facilities view vaccination as an individual choice and are strongly encouraging, but not mandating, it,” Erb said.
Asking, not telling
A BDN phone survey of 25 facilities in Maine indicates there is great variation in the percentage of nursing home staffers who have opted to be vaccinated — and in some cases, room for improvement. According to anecdotal data gathered in that survey, which show vaccination rates ranging from 55 percent to 100 percent, Maine is doing better than the national median vaccination rate, which is a relief to people such as Kate Hills, the sales and marketing director at Dirigo Pines in Orono.
At her facility, 67 percent of staff members have opted to be vaccinated.
“We actually feel pretty good about it,” she said. “Of course, we were hoping that everyone would take advantage of it …. It’s all about just being able to give people all of the resources necessary so that they feel they can make their own informed decisions. I think that’s why it turned out to be a pretty fair number.”
(Clockwise from left) Signs calling for coronavirus precautions hang outside the Lamp Memory Care Center in Lisbon; Snow falls outside the facility; and Adrianna Sirois, 22, stands outside Lamp Memory Care Center, where she helps care for 28 residents. Credit: Troy R. Bennett / BDN
At Dirigo Pines, one of the key factors was for management to have candid conversations with staff members regarding their concerns and questions.
“Anybody can understand that the feeling of someone telling you what to do is a lot different than someone asking you to do something,” Hills said.
The remaining 25 percent just don’t want to do it, according to Sarah O’Sullivan, community outreach staff at Durgin Pines. That’s the case even though those who have been vaccinated would not be required to wear face shields all summer — which are very hot, she said — and would be surveillance tested for COVID-19 at lower frequencies than those who haven’t been vaccinated.
“If you’ve worn an N95 mask and a face shield for an eight-hour shift, you would think that would be super motivating,” she said.
Voices from the front lines
Allison Goscinski of Belfast, the food service director of a midcoast nursing home, also was initially skeptical about taking the vaccine. For her, the speed of vaccine development was uncomfortably linked to politics.
“Originally, I wasn’t real gung-ho,” she said.
But then she did her own research and changed her mind, deciding it was riskier not to get the vaccine.
Some of the people she works with have made a different choice, however, including a person of color with a deep-seated distrust of government. Other co-workers wanted to wait so they could see how other people did with their first shot.
“I do understand people’s struggle,” Goscinski said. “They felt it was something slapped together. They felt it was a mandate: ‘How dare you tell me what to do with my body,’ essentially.”
That concern resonated strongly for her. When one of her co-workers asked why she changed her mind, she was happy to explain. But in no way did she want the vaccine to feel forced on someone.
“I want people to get vaccinated,” she said. “I just don’t want to tell them, ‘You have to.’”
Some Maine long-term care center workers never questioned whether they would get vaccinated.
Cheryl Power, the nurse manager of the long-term care unit at the Maine Veterans Home in Scarborough, oversees the nursing care of 31 residents. She got her first dose in December and the second in early January.
“Seeing firsthand the devastation of the virus and the pandemic on our residents, it was a no-brainer,” Power said.
For Sirois, the Lisbon CNA, her concerns about the vaccine included a fear that it could affect female fertility. This claim has made the rounds of social media, but is unfounded, according to experts interviewed by the BBC.
“That was one of the things that made me not want to get it in the beginning,” she said.
But she did her own research, and talked to the clinical director at the Lamp Memory Care Center to get facts — not rumors — about the vaccine. Ultimately, she chose to be vaccinated. And she’s startled that so many other health care professionals have made a different choice.
“We have this great opportunity,” Sirois said. “Health care workers are one of the first groups to get this. It’s so surprising that people don’t take the opportunity to stop the spread and do anything to slow this down a little bit.”
BDN writers Nick Schroeder and Troy R. Bennett contributed to this report.