Low staff vaccination rates inside many NC nursing homes, new data show

The rate of nursing home staff vaccinated against COVID-19 in Mecklenburg County is slightly higher than the local population — but not high enough, says one expert whose job during the pandemic has been looking out for vulnerable residents.

In many places statewide, vaccination rates for nursing home staff lag, contributing to continued outbreaks among residents 18 months into the pandemic.

Figures from the Centers for Medicare and Medicaid Services (CMS) show how many residents and employees inside long-term care facilities have been vaccinated. The data includes facilities that receive federal funding. Nationally, the Associated Press has reported, only about 64% of nursing home staff are vaccinated, on par with the adult population in the U.S.

Online at data.cms.gov, the federal government updates the database weekly and provides an interactive map showing how each facility is doing.

Based on CMS data through Sept. 19, the average vaccination rate among nursing home staff was 60.7% in Mecklenburg, while residents’ average vaccination rate is 91.4%.

As of Tuesday, 56% of Mecklenburg County residents are fully vaccinated against COVID-19, slightly lower than the statewide average of 58%.

Hillary Kaylor, a regional ombudsman with Centralina Area Agency, says mandates need to get tougher and facilities should increase vaccine incentives.

If they don’t, COVID-19 could become a seasonal issue in nursing homes — where the state’s most vulnerable population lives.

“It’s been very strange,” she said. “And it’s been scary, especially here in North Carolina, where we have always been a retirement place and have tons of facilities from coast to coast.”

Kaylor serves as an advocate for nursing home residents living in Mecklenburg County.

Staff nursing home vaccination rates lag in some nearby counties, too. In Iredell County, 47% the county is vaccinated, compared to only a third of nursing home staff, according to the CMS data.

The numbers are similar in Cabarrus County. While 49% of residents have gotten their vaccine, the percentage is smaller among nursing home staff — 40.5%.

In Gaston, Lincoln, Catawba, Stanly, Rowan and Union counties, the nursing home staff vaccination rates are higher than total population rates.

‘Much more slow going’

Kaylor expected to see more of a change by now.

She’s has been studying COVID-19 trends locally and statewide for months now, and she’s disappointed to see the current numbers.

President Joe Biden last week announced a new measure in vaccine mandates he pushed in September — private-sector businesses that have 100 or more employees and institutions that accept Medicare and Medicaid reimbursement will have to require vaccination or mandatory weekly testing.

But Kaylor said that’s not enforceable yet.

Unless an enforceable mandate is imposed, Kaylor said she thinks COVID-19 might continue to be a seasonal problem in nursing homes.

Novant and Atrium, the two largest healthcare systems in Mecklenburg County, mandated the vaccine for healthcare workers in August. The workers who remain have gotten vaccinated, and those who haven’t, have left, Kaylor said.

“We’ve not seen anything that really works for everybody,” she said. “The frailest of the world population lives in nursing homes and they’re going to get it and get really sick.”

Since the start of the pandemic, the bulk of deadly outbreaks have been in long term care facilities.

Health care workers and those staff, such as nurses, inside long-term care facilities were some of the first to be eligible for COVID-19 vaccines this year.

Although there are outliers, the federal data on nursing home vaccinations show generally the more vaccinated the staff, the lower the case rate. The rate of deaths in facilities with higher vaccination rates among staff is slightly lower.

The Charlotte Observer and The (Raleigh) News & Observer recently analyzed the federal nursing home data. The data include diagnosis of cases and deaths from each facility going back to May 24, 2020.

For 66 North Carolina nursing homes where staff was under 50% vaccinated, the median confirmed cases per 1,000 residents was 775 and median death rate was 98 per 1,000.

For 143 homes where staff was between 50 and 74% vaccinated, the median confirmed cases per 1,000 residents was 656 and the median death rate was 91 per 1,000.

For 70 homes where staff was 75% or greater vaccinated, the median confirmed cases per 1,000 residents was 490 and median death rate was 88 per 1,000.

Locally and statewide, the data show residents in nursing homes are much more likely to be vaccinated compared to staff.

“Their rates have been extremely high from the beginning,” Kaylor said. “The residents really wanted it, because they want to protect themselves. But with the staff, it’s been much more slow going.”

That’s why Kaylor deduces most infections are being brought into the facilities from the outside through the staff. She says it’s both a cultural issue and a lack of education — even in healthcare professionals.

“I can even see a difference in urban to rural counties in North Carolina,” Kaylor said. “Their vaccination rates are super low. I don’t know why. It’s just they don’t trust vaccinations, and you see all the stuff that goes across social media... that’s just not really accurate information. And I think they see it and believe it.”

Sharon Towers nursing home in south Charlotte has one of the highest staff vaccination rates in Mecklenburg County. With more than 93% of its staff vaccinated, it’s one of the few nursing homes with a larger share of their staff vaccinated than their residents. More than 91% of their residents are vaccinated.

Incoming CEO Angela Rigsbee said the facility managed to get to those numbers through education and constant communication, and the facility imposed a vaccine mandate for its staff in the spring.

“Throughout this time, we’ve adjusted the timing of our reactions to what’s going on with the state. We decided early on that we were going make the vaccine mandatory prior to flu season,” she said. “I think that helped us get ahead of the curve.”

Though they’ve had five COVID-related deaths among their residents, Rigsbee said those came early on in the pandemic, before the vaccine was available.

Wilora Lake Healthcare Center in Charlotte has the lowest vaccination rate among staff in Mecklenburg County, data through September show. They’ve had nine residents die from COVID-19, while 38 have been infected since last May. While nearly 60% of its residents are vaccinated, less than 20% of its staff is.

Keon Breeden, a social worker at Wilora Lake, said during his short time at the nursing home, he’s noticed the decision to get vaccinated has been entirely left up to staff.

“It’s just personal preference,” he said. “You come across people who just don’t believe in vaccines because of their religion.”

Kaylor noted that some nursing homes have been designated COVID-19 facilities, meaning all residents with COVID-19 in that system have been transferred to one facility. That means the case rate and possibly death rate among residents could be disproportionately higher there, if there’s a concentration of infections among an already-frail population.

“We have to take a community stand. I just don’t know their apprehension. I try to be empathetic… and I know there are exceptions in the world, and I understand those exceptions,” she said. “But that’s not the numbers that we’re seeing.”

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