Many Americans can’t wait to get the COVID-19 vaccine. You call hotline numbers. You are looking for vaccination clinics online. They wait in line for hours. Still others who have access to the vaccine have turned it down in large numbers. Long-term care workers have been given priority to get the vaccine, but many choose not to get vaccinated. Why?
Nobody knows the effects of COVID-19 better than the staff at nursing homes and assisted living facilities who have zeroed in on the pandemic. A large number of residents and employees have been infected with the virus. Almost 40% of COVID deaths in the US have occurred among residents of these facilities. Over 1,500 nursing home workers have also died from COVID, making nursing home caregiver the most dangerous job in America.
Still, many long-term carers continue to oppose the COVID-19 vaccine. In a recent CDC report, nursing homes had an average vaccination rate of 37.5% for staff in the first month of federal vaccinations. By comparison, a median of 77.8% of nursing home residents received the vaccine. This surprised some policy makers. Most recently, Maryland’s Acting Secretary of Health told lawmakers that about a third to half of its employees have offered the vaccine – nowhere near an 80% to 90% expectation. In some positive news earlier this month, a major national nursing home chain reported that 61% of staff and 84% of residents had been vaccinated in early February, still far below the expectations of many policy makers.
An information problem or a trust problem?
Many experts attribute low employee vaccination rates to an information problem. A recent survey of nursing home carers found that many employees are concerned about the safety of the vaccine and the side effects. However, key information campaigns, including well-designed toolkits and fact sheets, were not enough. The problem is not just a lack of information, but who is providing that information. Long-term care direct caregivers may not have information about the vaccine, but neither may they have confidence in the facility’s management.
We have historically undervalued the work of caregivers in long-term care facilities. They do a difficult job when paid at or near the minimum wage, with few benefits like health insurance or paid sick leave. They often work in multiple institutions to earn a living wage. Many facilities are understaffed with high turnover. The vast majority of carers are women, and many are colored people and new immigrants. They can be treated badly while being asked to work long hours on low wages.
This workforce has continued to be exploited since the beginning of the pandemic. They often had to work in facilities that were severely understaffed, without proper personal protective equipment or quick COVID testing. Despite working in the most dangerous conditions, many employees did not receive any danger or hero compensation. Unsurprisingly, many employees do not trust management at the facilities where they work.
The role of trust, vaccine mandates, and monetary incentives
Given the lack of trust from caregivers, staff not only need more information about the safety of the vaccine. You must hear this message from a trusted source. Some institutions with better employer-employee relationships have had these discussions recently New Yorker Article Notes.
This trust between facility management and staff is not built overnight. Institutions lacking this culture must turn to a trusted source either in or around the institution. In some cases, these may be reputable clinicians and staff working in the facility. In other cases this could be a professional organization.
Is there a role for policy in increasing staff vaccination rates? May be. One idea is to oblige the staff to take the vaccine. The federal government was reluctant to do this, particularly because the vaccine was approved through an emergency permit. Although some assisted living chains have mandated the vaccine, most companies have not chosen this route. Everyone recognizes that mandates will have the intended effect of increasing vaccination rates among employees. However, mandates are also likely to have the unintended effect of causing some employees to leave their positions instead of getting vaccinated. It all comes back to trust. Faced with severe staff shortages and the challenge of attracting new workers to these jobs, institutions can hardly afford to lose more workers.
Another approach is to pay staff to take the vaccine. Some establishments offer free breakfast or gift cards. These rewards are nice, but pretty nominal, and the needle is unlikely to move much. Larger amounts of money such as $ 500 for the first shot and $ 1,000 for the second shot would likely motivate more employees to get vaccinated. However, there are ethical considerations in paying staff and funding these payments would require government support.
Ultimately, regardless of the approach, trust and relationships will play a central role in resolving this situation. When it comes to vaccinating long-term care workers, the messages we share matter, but so is the messenger that delivers that information.
Follow me on Twitter @ DavidCGrabowski