COVID-19 vaccination rates still big concern at long-term care facilities

Pandemic restrictions are in effect across Oregon, and many residents of long-term care facilities continue to be impacted by the dangers of COVID-19. The latest vaccination numbers from the Oregon Health Authority show a slight increase over the last few months, but the goal for staff vaccinations is still not met. The report provides the most recent, available data since many facilities have residents and staff that fluctuate frequently. OHA aims to monitor the vaccination rate over time, says Rebecca Pierce, manager of the Healthcare Associated Infections Program at OHA. We hear from Pierce on how to interpret these vaccination numbers. We also hear from Fred Steele, Oregon’s long-term care ombudsman, on how long-term care facilities can better serve their residents during times of crisis.

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Note: This transcript was computer generated and edited by a volunteer

Dave Miller: Places like nursing homes, assisted living and memory care facilities, early on in the pandemic, were some of the sites with the highest COVID rates and death rates. They were also some of the first places where vaccine doses were made available. We now have more data about vaccination rates in these facilities. As of nearly a month ago, in the most recent data the State has provided, 88% of residents but only 67% of staff were fully vaccinated. For more on the situation inside these facilities, I’m joined by Fred Steel Oregon’s long term care ombudsman and Rebecca Pierce, the Manager of the Healthcare Associated Infections Program for the Oregon Health Authority. Starting at the beginning of June, the State began requiring that all long term care facilities report both resident and staff vaccination levels to the Oregon Health Authority. Reporting was voluntary before that. What have you learned since reporting became mandatory?

Rebecca Pierce: We have seen some increases in vaccination rates in these settings and tremendous progress when it comes to resident vaccination rates, with 88% of residents in these settings being completely vaccinated. We have seen some increases in staff vaccination rates since our interim report was released in June, going up from 62% to 67% of staff but there is still work to do to improve the staff vaccination rates.

Miller: There are still plenty of facilities where at least when I looked at the map on one of the OHA dashboards specifically for this, I didn’t see any vaccination levels for staff or residents reported. This is after almost three months since it seems like they were required to report this. Am I missing something?

Pierce: No, you’re not. As of the most recent round of reporting from July 26, 98% of nursing facilities have reported data and 72% of assisted living facilities and residential care facilities. This reporting is required. It’s mandatory in Oregon under the Department of Human Services administrative rule. Facilities that are not in compliance with the requirement may face potential regulatory action depending on the facility, compliance history and the circumstances of noncompliance. So DHS may initially provide some technical assistance before advancing to more progressive enforcement. And that is important because our facilities are facing tremendous pressures to control COVID-19, to report data to the federal government and to the state government. There are a lot of asks [being made] of our facilities right now. So we do think that the technical assistance piece and providing ongoing support to our facility, is an important step.

Miller: Maybe I’m confused by what technical assistance means here. It seems like this would be as simple as ‘how many residents do we have, how many have been vaccinated, do some quick division and send it to the State. Is it more complicated than that?

Pierce: It can be, yes. One of the big focuses of the early voluntary reporting was making sure facilities were all using the same definitions for the variables we’re collecting. So again, it does sound simple. But making sure we’re all defining staff in the same way and we’re looking at the same time period [means] we’re comparing apples, not comparing apples to oranges. That was so important and required a lot of training and conversation with facilities. We are continuing to see improvements in our reporting rates. In June, we saw about 62% of facilities had voluntarily reported over that period. That’s now increased to 78% overall. And we’re going to continue to see increases on this front as we go.

Miller: Fred Steele, what stands out to you most in the vaccination numbers that you do have access to right now?

Fred Steele: The number that you’ve just pointed out. There are approximately 140 buildings that have still not reported, at least based on what’s available to us. I think it is a reflection of the complexities of running a care facility and particularly assisted living residential care facilities, not to defend the facilities. My role is to represent the residents and I want to see compliance but do recognize the complexities of running a 24/7 operation where individuals live. This is their home, where they reside, where they receive care and various levels of care, each individualized. And then of course, you have staff that are providing direct care or maintenance and food.

So there are complexities that, when an additional layer of reporting is put on the facility, it can be difficult to report. However, being almost three months in, that information really needs to be provided very, very quickly. In my opinion, there are residents and family members wanting to visit their residents and loved ones in care facilities who will have been asking for this information for months. It’s great that it’s available now and they will want to rely on it to know whether they’re walking into a safe environment or whether their loved one lives in a safe environment through vaccinated staff and residents.

Miller: What does the staffing picture look like right now in long-term care facilities? This is an issue we’ve talked about recently in terms of hospitals.

Steele: From our work that we do on behalf of residents, I don’t know if I want to use dire, but there are significant staffing shortages in long-term care. One owner I’ve spoken to recently, with the number of buildings that he has in Oregon, would typically be staffing at around 400 total staff. He is down at least 100. So about 25% that he’s short for staff. What we’re seeing on behalf of residents and in particular why we’re seeing this in our offices is because of delayed care to residents or missed care. So the assistance that residents need and are paying for, is being missed or just not provided in a timely fashion. It’s also resulting in difficulty for visitors being able to come in and visit or just the overall operations as it relates to the daily life for the individual who lives in these settings.

Miller: Looking at the map of vaccination rates and these facilities in terms of staff and residents, some places really stand out. At Forest Glen Senior Living in Douglas County, only about a third of residents have been vaccinated and only 12% of staff. Now that the State has this data, what’s it going to do with it?

Pierce: An effective vaccination effort is going to take an effective collaboration between, not just facilities, but State and local officials, pharmacy partners, community and industry partners as well as staff and residents in these facilities. So looking at those individual vaccination rates for facilities, yes, we can conclude something about the need to improve that facility itself. But I think it gives public health - all of our other partners involved in the vaccination efforts - some action steps about where we need some improvement and potentially more [inaudible].

Miller: Governor Brown recently announced a full vaccine mandate for health care workers. They will no longer be able to get out of that mandate by doing weekly COVID tests. Do staff at these facilities all qualify as health care workers?

Pierce: Yes, it’s meant to apply broadly to long term care settings. And I think this is so important, particularly in relation to what Fred mentioned before. Vaccinating our healthcare workforce is a workforce issue. Our long term care facilities provide an absolutely essential service to our community. So we need the staff to stay healthy and able to serve the residents in these facilities. So getting everyone vaccinated is only gonna improve those workforce issues as we go.

Miller: So, still, when you look at a number like 12% of staff at this one particular facility in Douglas County, I mean, what goes through your mind?

Steele: With the reporting that’s now available [on] this dashboard, that’s information we will want to ensure that family members are aware of or prospective residents, when they call our office or family members looking to place a loved one in a care facility. But it’s a direct reflection of what we’re seeing now with the increase of COVID cases in long-term care, despite the robust vaccination that occurred at the end of December through March in our care facilities in Oregon. So the vaccine was available.

It ideally would have been all staff, all residents being vaccinated but they weren’t. And so what we see now, as of last night (Monday, August 23), there were 240 buildings and care facilities, out of the 690 in the state, that had at least eight COVID-connected cases. There are a number of those that have three or more cases. What we are seeing is, because of the vaccination efforts that did occur earlier in the year, obviously not seeing the egregious outbreaks that we were seeing last November, December and January. As of last week’s Oregon Health Authority report that I rely on to see what the outbreak numbers are,

there were 19 facilities that had 10 or more cases. That includes residents and staff and others that may be connected to the facilities. But outbreaks are occurring. There are concerns with breakthrough cases um and given the vulnerability of the population, we just very much need to get as many staff and ideally the residents, even though it’s a more personal choice for them, but something we recommend in our office whenever we speak to residents. Get vaccinated and protect themselves and others who live in these settings.

Miller: We talked, in the past, about vaccination efforts at nursing homes and other long term care facilities. Is that still the case? Do staff and residents at these facilities have easy access to vaccine doses onsite.

Steele: I’m not aware of it being on site but would defer to Dr. Pierce if she is aware of what that looks like for the facilities and availability for staff.

Miller: Dr. Pierce?

Pierce: It really varies based on facility. Early vaccination efforts were largely accomplished through partnerships with pharmacies and that may continue to be true going forward. Truthfully, it’s a local response and we want to make sure that these vaccines remain accessible to our facilities either through pharmacy partnerships, local or state efforts, especially as we consider third dose and booster efforts.

Miller: I was going to ask you about that. We’re gonna be talking more deeply about that effort and the science behind the ethics behind it. But it seems, based on just the timeline of the first cohort of people that got their first shots, that people in nursing homes and assisted living facilities will once again be at the front of the line for third shots. Are there conversations happening right now about the logistics about how to make that happen in Oregon?

Pierce: There are. So first and foremost, I just want to mention that it’s critically important that unvaccinated and partially vaccinated people get their primary series of vaccines to reduce the risk of COVID and it’s severe outcomes. As we all know, the vast majority of hospitalizations and deaths are occurring among the unvaccinated. However currently, as third doses are recommended by CDC for those with moderately to severely compromised immune systems and plans are underway to administer boosters, pending an evaluation by the FDA and issuance of recommendations by the advisory committee of immunization practices, there are discussions underway presently.

Miller: Just to take a bigger picture, we’ve been hearing for the last year and a half, and we heard it just yesterday when we were talking about prisons, about the idea that the pandemic has created new problems in all kinds of systems. But it’s also laid bare existing ones in all kinds of institutions and systems. Do you find that that’s true for long-term care facilities as well?

Steele: Absolutely. I appreciate the question. Our offices work on behalf of the 45,000 Oregonians who live in long-term care settings and throughout the state. I recognize that there are deficiencies in the way that their care is provided, in the activities that are provided to them. I think, in many ways, the way the state is structured to regulate this industry and it really is a national problem as much as a state problem as well. But as mentioned previously, the Department of Human Services tends to take a technical assistance approach first when there are deficiencies or problems, even if that might present potential harm or even have some actual harm to residents and care facilities.

And it takes a while to get to that progressive, stronger regulatory enforcement. And the way that’s played out with this pandemic in this past year is that as an example, approximately nine months in, back at the height of COVID outbreaks in care facilities in November December January. Our office, myself included, if we visited a facility, if there was a resident problem and just absolutely required a visit, we were repeatedly seeing staff not following the prevention protocols that were known. And that’s just an example of the deficiencies in providing care in these settings. We need to have a serious look back and almost [an] auditing of our infrastructure to identify how we’re going to keep individuals that are very vulnerable and need this care safe and living with dignity and having their rights protected all at the same time, going forward.