Summary
Summary: Maximizing vaccination coverage among nursing home staff and residents is critical because of the extreme vulnerability of this population to COVID-19, but little is known about which nursing homes have been successful at achieving high vaccination coverage. Using federal National Healthcare Safety Network facility-level data through the week ending July 18, 2021,combined with other publicly available data sets, authors examined the percentage of completed COVID-19 vaccinations among nursing home residents and different staff types at each facility, including all health care personnel eligible to work in the nursing home in the prior week, registered nurses and licensed practical nurses, certified nursing assistants (CNAs), therapists, and physicians and independent practitioners. Estimated means and medians were weighted by the relevant population size.
Authors examined the associations between weighted group vaccination coverage and facility characteristics using multivariate linear regressions. The regressions included state fixed effects to account for the state variation in vaccine availability and other policies. Various facility characteristics included ownership status overall quality rating, demographic characteristics of residents and staff and more, as well as county-level information including adult vaccination coverage and the 2020 presidential election Republican vote margin.
Findings: Among the more than 14,900 nursing homes reporting vaccination data by July 18, 2021, 60% of staff and 81.4% of residents were fully vaccinated on average. Average vaccination coverage was lowest among CNAs (49.2%) and registered nurses and licensed practical nurses (61%) with higher coverage noted among therapists (70.9%) and physicians and independent practitioners (77.3%). Authors found that nonprofit and nonchain nursing homes, facilities with higher Medicare star ratings, and facilities with longer-tenured staff achieved greater vaccine coverage, suggesting that organizational characteristics, including ownership structure, quality, and ability to retain staff, may be key in facilities' ability to vaccinate residents and staff.
However, findings suggest that facilities are also subject to broader challenges to vaccine acceptance in the community because facility coverage were strongly associated with county-wide vaccination coverage and staff coverage was strongly associated with 2020 presidential election voting patterns.
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