Thousands of Pa. nursing home residents are behind on their COVID vaccine boosters

Tens of thousands of Pennsylvania nursing home residents aren’t up to date with their COVID-19 booster shots.

The state’s vaccination rates put Pennsylvania behind 25 other states and territories, including New Jersey, in how many nursing home residents have received the latest bivalent booster shot designed to provide better protection against the COVID strains now circulating.

An Inquirer review of federal data highlights a gap in COVID protections for a population particularly vulnerable to the resurgent virus.

Since the start of the pandemic, about 75% of U.S. COVID deaths have been among people 65 or older. More than 161,000 nursing home residents nationwide have died of COVID, according to the Centers for Medicaid and Medicare Services, about 15% of all Americans killed by the virus. Early protective measures such as social distancing and masking did little to prevent deaths from mounting among these elderly and medically fragile residents living in close quarters. Death rates finally abated when a vaccine became available in late 2020.

Now almost three years into the pandemic, nursing home residents — like the rest of the nation — are showing little interest in yet another round of COVID booster shots.

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“There’s this COVID fatigue, there’s mask fatigue, and there’s this kind of feeling that we’re done with that,” said Ilene Warner-Maron, an assistant professor of geriatrics at Philadelphia College of Osteopathic Medicine and executive director of the Eastern Pennsylvania Geriatrics Society.

About 14% of Americans 5 or older have received the new vaccine, which has been available since September, the Centers for Disease Control and Prevention reported. In Pennsylvania, roughly a third to 40% of people 65 and older have taken the bivalent shot.

Eric Tate is among those weary of more shots. A resident in Philadelphia’s Inglis House, a facility for people with physical disabilities, the 52-year-old had his last COVID shot in early 2022.

“I just got a little skeptical,” he said. “I made sure I got all my shots originally.”

Two weeks ago, Tate caught COVID for the third time, an infection that led to a hospitalization.

As the cold-weather months now see a rise in viral illness, most nursing facility residents are not completely unprotected against COVID. The Pennsylvania Health Care Association (PHCA), an industry organization, reported almost 90% of residents were up to date with their shots as recently as February. But experts say the additional vaccine doses are particularly important for seniors, whose immune protections wane more quickly. Residents in long-term care facilities are also more likely to have other medical conditions that increase their risk of becoming seriously ill with COVID.

So far this year, deaths in nursing homes have not spiked as in prior winters, but 200 to 300 nursing home residents nationwide have died of the virus each week since late October. In Pennsylvania, nursing home deaths have plateaued since May, according to state data.

Residents refusing to get additional shots is a significant obstacle to keeping them up to date with their vaccines, the Philadelphia Department of Public Health found in a fall review. About 50% of nursing home residents have impairments that prevent them from making their own decisions about their care, Warner-Maron said, and families are increasingly reluctant to approve additional shots.

In Pennsylvania, officials say they are seeing improvements from a mix of efforts to promote the new bivalent booster.

Edgehill Nursing and Rehab Center in Glenside has one of the highest vaccination rates in the region, with almost 93% of all residents up to date with their shots. Leaders attributed their success to being a small facility in close communication with residents and their families.

“Members of our leadership team personally reached out to each resident and/or their family members to obtain consent and answer any questions they may have about the new bivalent vaccine before our in-house clinic,” Gloria Keyes, the administrator of the 60-bed facility, said in a statement.

The increased federal messaging on vaccination in nursing homes recently has helped, said Zachary Shamberg, president of the PHCA. He noted an increase statewide in residents who are up to date with their COVID vaccinations since October.

Simpson House, a Philadelphia home with nearly 98% of residents up to date with their shots, has also been conscientious about communicating with residents, said Sylvia Bolden, an 80-year-old resident and president of the home’s council.

“This facility makes sure that we get everything in a timely fashion,” said Bolden, who has received her bivalent shot. “I’m well-protected.”

Experts say more concrete steps are needed as well. Last week, the White House issued an action plan to prioritize getting the boosters to more nursing home residents to guard against COVID’s harm this winter. The plan includes a call for hospitals to encourage patients to receive the latest COVID shots before being discharged.

This week, the CDC also loosened restrictions on who can give COVID vaccine shots, permitting nursing home staff to administer doses directly. The PHCA said that nurses have already been administering shots in nursing homes.

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Some advocates say more flexibility is still needed. Many nursing homes don’t have the refrigeration units needed to store COVID vaccines, so they still rely on pharmacies to run vaccine clinics for residents. Ideally, homes could store the vaccines themselves, then administer doses when residents want them, rather than wait to schedule a facility-wide clinic.

“As long as they can get refrigeration,” Warner-Maron said. “I think it would really increase the access.”