Entering the Winter Season, How Many Nursing Facility Residents and Staff Were Up-To-Date With Their COVID-19 Vaccines?

Moving into the holiday—and COVID-19/flu —seasons, KFF finds that only 45% of nursing home residents and 22% of staff were up to date with their COVID-19 vaccines as of the Sunday before Thanksgiving. This is concerning because people in nursing facilities are at higher risk of having worse outcomes if infected with COVID-19 and one-fifth of all U.S. COVID-19 deaths occurred among residents and staff in long-term care facilities. Keeping nursing facility residents and staff current on their vaccines is an important tool for reducing deaths from COVID-19 and especially important this holiday season when risks may be compounded by high rates of other respiratory viruses. Public health experts predicted that the U.S. will see higher than-normal cases of flu, RSV, and COVID-19 and hospital capacity may be reduced. Preliminary data support these predictions, showing that flu hospitalizations have hit their highest levels for this time of year in a decade. Similarly, COVID-19 hospitalizations increased by 17% in the week leading into Thanksgiving. The Biden Administration has been encouraging Americans to get their COVID-19 boosters prior to the holiday season, but take-up of boosters has been lower when compared to the primary vaccination series.

Long-term care facilities now report the share of residents and staff that are up-to-date with their COVID-19 vaccinations using the CDC’s definition of up-to-date: “having received a bivalent booster or having received a final shot of the original vaccines less than 2 months ago.” This issue brief analyzes data on the share of nursing facility residents and staff who are up-to-date with their COVID-19 vaccines as of the week ending November 20th, 2022, in the 14,400 nursing facilities that reported data (out of 15,200 total). Going into Thanksgiving, we find that less than half (45%) of all NF residents were up to date with their vaccines, ranging from 24% in Arizona to 73% in South Dakota. Less than a quarter (22%) of staff were up to date with their COVID-19 vaccines, ranging from 10% in Alabama to 48% in CA (Figure 1).

Federal vaccine clinics and health care worker vaccine mandates contributed to high initial vaccination rates among nursing facility residents and staff, but without ongoing federal initiatives, fewer people may stay up-to-date with their vaccines. Nearly 87% of nursing facility residents and staff completed their primary vaccination series, but only 45% of residents and 22% of staff are currently up-to-date with their vaccines. The high take-up rate of the primary vaccine series reflects several factors, including the high death rates among nursing facility residents and the focus on nursing facility residents during the initial vaccine roll-out.  Quicker initial take-up of vaccines and boosters in 2021 is also attributable to the three on-site vaccination clinics held at all long-term care facilities participating in the Federal Pharmacy Partnership for Long-Term Care Program. Facilities are still able to request additional clinics, but it’s unclear how many facilities are doing so or how many pharmacy partners continue to participate. Among nursing facility staff, initial take-up of COVID-19 vaccines was low until the health care worker vaccination mandate required providers that participate in Medicare and/or Medicaid to be vaccinated. The vaccine mandate does not require boosters, so booster take-up among staff may remain low.

Looking ahead, current rates of COVID-19 deaths among nursing facility residents and staff remain relatively low, but death rates spiked immediately following the 2021 holiday season. In the week ending November 20th, 2022, the death rate among nursing facility residents was at 19 deaths per 100,000; however, last year, there was a spike in deaths following the holidays. Specifically, the death rate went from 35 deaths per 100,000 in mid-November 2021 to 131 deaths per 100,000 in mid-January 2022. That spike raises concerns about the potential for a similar spike in preventable deaths among nursing home residents in the upcoming post-holiday season. Creating new opportunities for on-site vaccinations and updating the health care worker vaccination mandate to reflect current CDC guidance could increase the number of nursing facility residents and staff who are up-to-date with their COVID-19 vaccinations and decrease preventable deaths. More generally, without continued communication and education, there may be more people who are vaccinated and boosted but not “up-to-date” as vaccination immunity wanes.

Methods
This analysis uses federal data on staffing reported weekly by facilities to the CDC’s National Healthcare Safety Network (NHSN) and reflects weekly data through the week ending November 20th, 2022. These data are updated regularly to reflect revised data from previous weeks, so future versions of this dataset reflecting the same time period may output different values.

Each week, approximately 15,200 nursing facilities submit data through NHSN. CMS performs data quality checks to identify facilities that may have entered incorrect data before publishing this data for public download. Facilities that have submitted erroneous data will have an “N” displayed in the column titled “Passed Quality Assurance Check”. Our final sample of nursing facilities in this analysis excludes facilities that CMS flagged in their data quality check, as well as facilities that are missing data for the “up-to-date metric”. Data do not break out the specific share that have received the bivalent booster.

On September 26, 2022, nursing facilities adopted the CDC’s new definition of up-to-date vaccination status for reporting purposes: “having received a bivalent booster or having received a final shot of the original vaccines less than 2 months ago.” Prior to September 26, nursing facilities used an older definition of up-to-date that accounted for residents’ age, number of boosters, and brand of vaccine (Pfizer, Moderna, etc.). Studies using the newer data are not comparable with older studies that relied on the older definition of up-to-date.

The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.