Every long-term care resident deserves to enjoy these festivities to the fullest without the risk of acquiring a respiratory virus that may land them in the hospital, or worse. As highlighted during the pandemic, what happens in the outer community is the major driver of viral spread into long-term care centers. So, it is incumbent upon all of us to ensure that our population is equipped to fight off common respiratory viruses, such as influenza, RSV and COVID-19; however, the challenge lies in convincing our nation’s seniors, healthcare workers, and the general public to roll up their sleeves and get vaccinated. 

As a geriatrician and current chief medical officer at the nation’s largest organization representing long-term and post-acute care centers, I have witnessed both the devastating impact these viruses can have and the incredible strides the global medical community has made in developing effective vaccines. We know that these vaccines may not necessarily prevent infection, but they do reduce the risk of severe illness and a potential trip to the hospital or worse — death. 

A need to double-down

Despite these major advancements and historic milestones, we are seeing a decline in the number of individuals willing to receive these vaccines. “Vaccine fatigue” and hesitancy are rampant throughout our society but especially when it comes to the COVID-19 and RSV vaccines. 

A recent KFF survey found that more than half (51%) of all adults say they “definitely” or “probably” will not get the latest COVID-19 shot and two-thirds of the general public are not worried about getting the virus. Meanwhile, only 16% of adults 60 years and older report having received the RSV vaccine. These surveys are consistent with what we’re seeing unfold. 

Recent data from the CDC shows low vaccination rates in the community. While we are seeing the same trends in long-term care settings, it is encouraging that our uptake is higher than in the community. Nonetheless, we need to double-down on our efforts to increase those numbers. 

Much has been written about challenges with vaccine availability or why we should hold more clinics to vaccinate our residents. These are not the reasons we’re seeing slow uptake. While initially the new COVID-19 vaccine was hard to access because it was first sent to commercial pharmacies serving the general public, the vaccine is now more widely available through the pharmacies serving nursing homes. National regulations require nursing homes to educate and offer every resident and staff member the COVID-19 vaccine. 

Harmful ripple effects

The primary issue is that the majority of residents or their family members who are making decisions for them either no longer believe the COVID vaccines are necessary or express fear and skepticism about getting the new shots. We are hearing similar concerns related to the RSV vaccine, despite evidence that it is most effective among the elderly, individuals with chronic diseases, and those who live in a long-term care setting. 

I’m also concerned that this vaccine fatigue and hesitancy is impacting interest in the influenza vaccine, which is lower this year than in pre-pandemic years. 

In addition, there are administrative and insurance reimbursement challenges that need to be addressed. In long-term care, we need vaccines to be readily available to order when a current resident or new admission wants the vaccine. Additionally, those orders need to come with a guarantee that we, as providers, or the pharmacy receives reimbursement from all insurance providers — not just Medicare. Cutting the red tape around reimbursement can help ensure that long-term care providers have access to the vaccine and remain focused on encouraging uptake. One way federal policymakers could take this a step further would be to offer a pool of free vaccines available to long-term care providers. This would eliminate the administrative burden and streamline access to vaccines for residents and staff. 

While free vaccines would be ideal, most importantly we need effective and consistent public health messaging, which is the major driver of the current vaccination rates. We need every provider in every healthcare setting — from the physician’s office, commercial pharmacy, adult day care, hospital and beyond — to discuss the importance of the vaccines with the elderly and their family and address each person’s concerns. 

We’ve come a long way, but … 

Unfortunately, many new admissions arrive to a nursing home or assisted living community without having been offered or received the vaccine during their encounters with clinicians in other healthcare settings. 

Using nursing homes as a stopgap to vaccinate all individuals is ineffective and insufficient. Seniors and families need to be offered the vaccine before they’re admitted to a long-term care facility — and at every subsequent interaction, especially since primary healthcare providers are seen as trusted advisors. Long-term care staff can then help pick up those missed or continue to work to convince hesitant or skeptical residents to get vaccinated. By increasing our education efforts throughout the healthcare community, we can work together to encourage more individuals — residents and staff alike — to get vaccinated.

We’ve come a long way since 2020: COVID-19 is no longer a pandemic, and the mortality rate among nursing home residents remains at record lows. Vaccines are a major reason why, but after three years of battling this virus, Americans have a hard time acknowledging vaccines are still necessary. 

Nursing home providers cannot shoulder the responsibility of combating these deeply held beliefs all on their own. As a country, we need to focus on collectively increasing vaccination rates among the general population and avoid isolating or placing blame on specific communities or individuals. 

Long-term care providers should be applauded for achieving higher vaccination rates than in other settings, but we need a collective endeavor to take this further. 

By having the entire healthcare community and public health system collaborate, we can overcome vaccine skepticism and hesitancy and achieve even better vaccination rates among our residents. In turn, we can better protect our most vulnerable community members. 

David Gifford, MD, M.PH, is the chief medical officer of the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL). 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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The CDC said that low uptake of vaccines for COVID-19, respiratory syncytial virus (RSV) and flu are to blame for putting Americans at risk for severe illness and hospitalization this winter. 

“Low vaccination rates, coupled with ongoing increases in national and international respiratory disease activity caused by multiple pathogens, including influenza viruses, SARS-CoV-2 [the virus that causes COVID-19], and RSV, could lead to more severe disease and increased healthcare capacity strain in the coming weeks,” a CDC statement said. “In addition, a recent increase in cases of multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection in the United States has been reported.”

Compared to last year, about 7 million fewer adults were vaccinated this year. The vaccination rate is 36% for adults and children. In terms of the COVID-19 shot, 17% of adults (and 36% of them older adults) and 8% of children received their latest shots. About 16% of people over the age of 60 have received the RSV shot.

“We are seeing too few folks get vaccinated this season,” CDC Director Dr. Mandy Cohen said during a briefing this week with the American Medical Association, CNN reported. “The voice of the physician matters so much in whether or not folks decide to get vaccinated.”

The CDC cited a survey in their advisory to explain why people aren’t getting vaccinated in large numbers. Survey data said that doctors aren’t recommending the shots enough, and there are concerns about side effects from vaccines, while others forget to get vaccines. 

“About 70 to 80% of American adults over the age of 18 have at least one condition that puts them at higher risk of a bad outcome,” Cohen said. “Getting vaccinated decreases your risk of hospitalization and death at every age, including 18 to 64, but it also decreases your risk of long COVID.”

Emergency department visits and hospitalizations for respiratory diseases are increasing among all groups of people, the CDC said.

In the past four weeks, hospitalizations increased 200% for flu, 51% for COVID and 60% for RSV, according to the CDC advisory. There have also been 30 reports of MIS-C, a rare complication in children infected with COVID that typically surfaces a month after infection.

“These tools that protect us — vaccines … testing and treatment and washing hands and ventilation and masks — all of these things are layers of protection that help make sure that we can weather this season,” Cohen said.

“Something new this year is that two new vaccines were recently approved by the FDA to protect against pneumonia due to respiratory syncytial virus (RSV) in adults age 60 and over,” said Erica Johnson, chair of the Infectious Disease Board of the American Board of Internal Medicine. 

“While there has been a fair amount of media attention surrounding the new vaccine [for seniors], it may prove to be a bit more challenging to incorporate into the core group of routine vaccines we are accustomed to,” warned Erin Marriott, RPh, director of clinical and regulatory support at Guardian Pharmacy Services.

Erin Donatelli, PharmD, vice president of clinical and consulting services for Remedi SeniorCare, stressed that treatment options and outbreak procedures for COVID and flu should follow a tight timeline after symptoms or a positive test.

Pharmacists and others expressed confidence in the preparation and efficacy of new COVID boosters and vaccines. Still, work remains to be done..

“As a country, we are still dealing with misinformation, mandates and some poor communications from government leaders,” said Chad Worz, PharmD, chief executive of the American Society of Consultant Pharmacists. “It will take a huge effort by doctors, nurses and pharmacists to rebuild confidence in vaccines.”

Meanwhile, experts are mixed about a repeat of drug shortages. Andrew Agan, a spokesperson for Guardian Pharmacy Services, said “drug shortages remain a huge issue impacting skilled nursing. From atropine to lidocaine, there’s a large list of drugs currently in shortage.”

As for parting advice, experts have plenty.

“Get ahead of potential outbreaks,” said Worz. Vaccinate and evaluate residents in anticipation of needed antiviral treatments that could involve possible interactions with other medications.

And finally, “work collaboratively with your pharmacy partner on securing access to any of the needed vaccines,” said Marriott.