Vaccination rates for the newest bivalent COVID booster among nursing home staff in Maine are lagging behind the residents they care for and the population at large, according to federal data, as the state endures its third pandemic winter.
The wide disparity exists despite efforts by state and federal health officials to encourage nursing home caregivers to get the latest booster shot.
Only 18 percent of nursing home staff have the updated shot, according to the U.S. Centers for Disease Control and Prevention. That is lower than the national average of 22 percent of staff — and far below the rate among the residents. The CDC defines being up to date with vaccinations against COVID-19 as having the updated shot.
Maine is one of the most vaccinated states in the country with 83 percent of eligible people having received their initial shot, according to the CDC. But only 27 percent received the updated bivalent booster, which came out this fall and is designed to protect against the omicron variant.
The figures show 63 percent of residents over age 65 have had a booster shot. Nursing home residents have a 51.6 percent booster figure, according to Dec. 18 data from the CDC, the most recent totals available.
Long-term care stakeholders say the lack of a federal requirement makes it difficult to increase rates, but such a measure could create additional staffing challenges in an already strapped industry. While no vaccine is guaranteed to completely protect against the virus, a December study from the CDC found the newest booster prevented hospitalizations 83 percent of the time among people over 65. And nursing homes residents are some of the most vulnerable to the illness because of their age and often having co-existing health risks.
Federal data show Maine saw cases spike after the Thanksgiving holiday and climb through December, going from 847 weekly cases on Nov. 30 to 1,178 weekly cases on Dec. 21. The following week saw reported cases drop by 20 percent, but case reports are often delayed during the holiday season or due to bad weather, such as the two storms that hit Maine in the days before Christmas. The number of reported cases jumped the first week of January to 1,091.
Hospitalizations have been on the rise nationally but uneven in Maine. After the seven-day average saw a small increase during the last week of December, it dropped by 23 percent last week.
State and federal authorities are working to increase rates through targeted campaigns and clinics. But while Maine and the CDC require nursing home workers to get the initial two-shot regime, there has been no requirement for follow-up shots. Such action may be necessary if rates are to improve, said Jabbar Fazeli, the medical director at Durgin Pines in Kittery.
‘’[Staff] being vaccinated is the first line of defense, not resident vaccinations,” he said.
Durgin Pines has the second-highest percentage of bivalent-boosted staff in the state, according to the CDC, with the Dec. 18 data showing 68.9 percent of staff and 94 percent of residents being up to date. Fazeli said that figure is likely closer to 72 percent now.
The home’s leadership could not require boosted vaccinations without a federal mandate, Fazeli said, but they created different tiers of personal protective equipment requirements for staff. For example, unboosted staff have to wear N95 masks.
That strategy has encouraged some staffers, but Fazeli said the home also appealed to staff by asking them to consider the health of their residents, who are elderly and more at-risk of getting seriously ill from the virus. Many of them are contracted staffers with no requirements by their agencies to be boosted, which Fazeli said gives Durgin Pines even less leverage because they are in such high demand due to ongoing staffing shortages in the industry.
That scarcity was a major discussion in 2021 when Gov. Janet Mills required health care staff to be vaccinated, making Maine one of the earlier states to do so. The state’s nursing homes and hospital industry groups pushed for and helped craft that requirement, but it was met early on by resistance from some conservative politicians and workers. A lawsuit that went to the U.S. Supreme Court was rejected last year.
The focus on health care workers was due in part to the staggering challenges the industry faced as worker illnesses stretched the ability to provide care. The workers come in contact with vulnerable populations due to the nature of their job — in particular, long-term care facilities were the sites of some of the earliest and severe COVID-19 outbreaks because of how quickly the virus spread among residents.
A federal requirement would prevent homes from having to compete for a narrow pool of workers who might not want to get vaccinated, Fazeli said.
“It’s hard to make it a state’s problem when the federal government has no guidelines,” he said.
The Center for Medicare and Medicaid Services isn’t mandating boosters, but it is making homes submit their vaccination levels for staff and residents, and watching those closely. On Thursday a CMS administrator, Chiquita Brooks-LaSure, said the agency would offer more resources such as on-site clinics for homes with lower rates, according to McKnights, a news site that covers the long-term care industry.
“We know that many of you have been working to increase the take-up of the new vaccines,” Brooks-LaSure told nursing home stakeholders. “The rates have been steadily climbing but this number is still too low.”
There is a similar philosophy behind the Power of Care campaign from the Department of Health and Human Services, encouraging caregivers for the elderly or disabled to get booster or flu shots. It features testimonials from industry workers and links to immunization sites.
That campaign was created in conjunction with the state’s long-term care ombudsman, said DHHS spokesperson Jackie Farwell. She noted Maine is doing well in complying with current federal vaccination requirements for nursing home staff. At 97.7 percent, only New York and Rhode Island have higher staff vaccination rates.
Those rates can vary widely among homes. At least 35 homes reported that under 10 percent of their staff had received the new booster, according to the CMS data.
Some, like MaineGeneral’s Gray Birch rehab center, have 100 percent of staff vaccinated but only 40 percent are up to date with the newest booster. A statement from Paul Stein, chief executive officer of MaineGeneral Long Term Care, said they encourage all staff to get boosted.
Maine Veterans Homes, which is not affiliated with the Veterans Administration but provides specific care for veterans, saw bivalent booster rates as high as 57 percent at its South Paris location and 20 percent at its Caribou facility. A spokesperson confirmed those rates but did not respond to a follow-up question about boosters.
Angela Westhoff, the president of the nursing home lobbying group Maine Health Care Association, said the organization is engaging in a campaign focused on getting resident boosted rates increased. She said the lag in uptake may be because people are confused about whether the shot is supposed to be administered annually, like the flu shot, or more frequently.
Others might simply be tired of vaccine talk and the pandemic in general, she said. Westhoff encouraged more education on the importance of staying up to date on vaccinations but doubted a mandate could help. After nearly three years, many health care staffers have had COVID-19 before, attitudes around the country are different, and providers have more resources available to fight the virus, she said.
Plus, there is the danger of losing more workers in an already strapped industry, Westhoff said. The Maine Health Care Association estimated in 2022 that 10 percent of long-term care workers left since the pandemic began.
“To do anything more at this point that would discourage people from work, especially in our field, would be problematic,” she said.