Vaccinations are vital for Kansas long-term care facilities. But only half of staff have gotten shots.

Andrew Bahl
Topeka Capital-Journal
Staff at Midland Care's Program of All Inclusive Care for The Elderly, 2134 S.W. Westport Drive, help those receiving care get around the facility on Thursday.

Nothing is small about Lakeview Village.

Between its roughly 800 residents and another 586 staff members, the number of people on the campus of the Lenexa long-term care facility each day rivals some Kansas counties.

That has created problems during the COVID-19 pandemic. The facility had multiple outbreaks over the course of the last year. Meanwhile, staff has been forced to call in sick because of infections on a near-constant basis, said Pam Hermon, Lakeview Village's chief operating officer.

Vaccines, however, have changed everything.

Nearly 100% of residents and 74% of staff have been vaccinated, putting the facility far ahead of the statewide average. No staff cases have been reported since January, Hermon said, and visitation rules have been relaxed — something which is expected to continue.

"The residents will tell you, they have a sense of hope, when the vaccines came out, that life was going to return to normal," Hermon said. "And what they're seeing is normalcy coming back. They're getting to socialize with people. They're getting to visit their families. They're getting to do things that they hadn't done for a year. The socializing is so much for them."

Similar success stories are being reported statewide.

Phillips County Retirement Center in northwest Kansas, was in the midst of an outbreak at the beginning of 2021. But Nate Glendening, the facility's director, said there have been no additional positive cases in more than three months.

"We're seeing some smiling faces around here now," Glendening said. "It's been something we've been looking forward to for a long time."

Long-term care facilities have been the hardest hit by the pandemic, nationally and in Kansas. While the vaccine rollout in nursing homes caused confusion in the state early on, partnerships between the federal government and CVS and Walgreens distributed over 80,000 vaccine doses in the state.

This has improved matters considerably. Data from the Kaiser Family Foundation showed zero new COVID-19 cases in Kansas long-term care facilities between April 1-11, a marked decline from where the state was a year ago.

But ensuring positive gains can continue may be easier said than done. The Federal Pharmacy Partnership ended on April 26, despite the fact that a good chunk of those in the long-term care world haven't been vaccinated.

Only 55% of staff have gotten both doses of the COVID-19 vaccine, according to April 6 data from the Centers for Medicare and Medicaid Services, which was provided to Kansas long-term care advocates.

Those numbers focus only on those who got their vaccine via the federal pharmacy partnership, which most, but not all, long-term care facilities participated in. Some smaller facilities opted to work with KDHE and those numbers aren't captured in the data, as are staff members who elected to go elsewhere to get their shots.

For residents, the numbers are much better. Statewide, 90% of residents have gotten at least one dose of the vaccine and some facilities have even better numbers. Lakeview Village, for instance, has 99% of residents immunized.

But long-term care providers say the underlying point remains the same — hesitancy is posing a problem for their efforts to return to a new normal.

"Very curiously and unfortunately, staff at nursing homes and skilled nursing facilities are fairly low uptake,” Lee Norman, secretary of health and environment, said earlier this month.

COVID-19 vaccine hesitancy bleeds over into long-term care

Skepticism over getting the shots isn't unique to the long-term care world. Statewide, 42.3% of all residents have gotten at least one dose of vaccine.

 A majority of counties have turned back their regularly scheduled doses due to a lack of demand in recent weeks. And in some western Kansas counties, the rate of vaccinated residents is only 20%.

It is unsurprising, then, that this has had an impact on the tendency of long-term care staff to get the shots.

"When I talk to my western Kansas colleagues and they say only 20% of the people in their county are vaccinated by choice, that does tend to influence staff since they are a part of that local culture," said Debra Zehr, executive director of LeadingAge Kansas.

This type of hesitation among long-term care workers has been a national phenomenon. When the federal pharmacy partnership ended on April 26, the Centers for Disease Control and Prevention reported a little over 1 million workers had been vaccinated, which accounts for about a third of all long-term care staff nationally.

Despite robust vaccination, outbreaks still persist

The gaps in vaccination have caused nursing home outbreaks nationally, as well as in Kansas.

In Kentucky, an unvaccinated staffer who wasn't showing signs of COVID-19 infection brought a COVID-19 variant into a nursing home, infecting 19 vaccinated residents, with one death.

Last week, Mount St. Mary's nursing home in Wichita confirmed an ongoing outbreak in the facility was linked to an unvaccinated staff member, the Wichita Eagle reported. The home reported no new COVID-19 infections as of Tuesday.

"We have and continue to follow all Health Department and CDC safety protocols in order to protect all who live and work at the center," Mount St. Mary's wrote in a Facebook post this week. "This includes having staff temperatures taken at the start of each shift, and using personal protective equipment including gloves, masks, and gowns."

Long-term care officials acknowledge the risk of similar outbreaks is always there when individuals aren't vaccinated. Similar struggles exist on a yearly basis when many workers opt not to get their flu shot.

Moreover, due to federal privacy laws, residents are unable to know if the staff caring for them have gotten the shots.

"It's a risk we are going to take, unfortunately, and there is not much we can do about it," Hermon said. "Our residents would love to see everybody vaccinated to the same percentage they. So would I, as a person that has been through dealing with COVID for the last year. But it is a choice that people have to make."

A long-term care worker administers doses of the Moderna vaccine during a public vaccination clinic at Lakeview Village in Lenexa.

Facilities take steps to counter hesitancy

None of the half-dozen nursing homes interviewed for this story say they are considering mandating the vaccine for their staff members.

While the idea might be allowable under federal law, it almost certainly would draw the ire of state legislators, some of whom have pushed to ban employers from making the shots a condition of employment.

More:Lawmakers introduce bill that would block employers from requiring vaccines against COVID-19, other diseases

Treva Greaser, executive director for Schowalter Villa in Hesston, said a requirement would likely never be feasible, as it would impact their ability to recruit and retain workers.

"We have some exceptional team members who have been long-term employees who do an amazing job but didn't choose to be vaccinated," Greaser said. "And we don't want to lose them."

Instead, facilities are coming up with a range of tactics to boost vaccine uptake. Some, in Kansas and nationally, have provided financial incentives for staff to take the plunge.

Schowalter Villa, for instance, offered a $100 bonus for those who got the shots and Greaser said she was sure "it played a role" for some.

With federal partnership ending, vaccine access a worry

A range of concerns have arisen, many of which are similar to those voiced by all Kansans. That includes worries the vaccine was rushed to market and anxiety about potential side effects.

Others are more specific to long-term care, where workers tend to be more likely to younger and female.

Glendening, the Phillips County nursing home executive, said some staff came to him uncertain about the impact on pregnant women or those who are looking to conceive, although research has shown no signs of adverse effects from the vaccine.

"I think a lot of it was it hasn't been out long enough for somebody to have been vaccinated, go the full term of a pregnancy and have a child and then see what the long term effects were, if there were any at all," Glendening said. "It just was so new that I think they question the studies or the reliability to be able to prove that there weren't going to be any issues there."

And now that the federal pharmacy partnership has wound down, staff who want to get vaccinated will have to go out into the community and seek out the shots. While supply is ample in most parts of the state, workers can still be confused about where to go and what to do.

"It's not a well-oiled system," Zehr said. "It's not a smooth system at this point. There are avenues. But just like you and I, have to hunt around for a vaccine ... It's not a wholly seamless process at this point."

Paul Schwartz, 63, helps staff at Midland Care Pace Program of All Inclusive Care for The Elderly, 2134 S.W. Westport Drive, on Thursday by wrapping silverware. Schwartz said he was vaccinated for COVID-19 and only felt a little soreness in his arm as a side effect.

Home health care workers have additional barriers

The process was even more complicated for home health care workers, or individuals who help care for older Kansans in their homes.

By and large, those groups didn't participate in the federal pharmacy partnership. Instead, home health workers were part of Phase 1 of the state's vaccination plan, meaning those workers were at the front of the line but had to know where to go and how to document their employment.

For Midland Care in northeast Kansas, the process was relatively smooth — 80% of staff have been vaccinated, with roughly half of those individuals doing so at the first available opportunity, CEO Shawn Sullivan said.

He credited a robust effort to answer staff questions, as well as to set up appointments on behalf of employees and remind them of what they needed to do.

"We tried to take that off of our employees' hands as much as possible and make it as easy as possible," Sullivan said.

Hope further incentives will push staff ‘over the hump’

Other facilities have gone even further. 

In Lenexa, Lakeview Village sought and received approval to be a vaccination site, not just for residents and staff but also for family members and the general public.

More than 2,400 doses have been distributed over two clinics, with a third set for the coming days, Hermon said.

The move is intended not just as a public service but also as a way of making it easy for wary staff members to be vaccinated.

"Staff aren't going to go out of their way to do it if they didn't do it the first time around," Hermon said. "It's like they all of a sudden woke up and, for some reason, today, they decided they're ready. If it's not as easy and as convenient as possible for that staff member, they are not going to do it."

There could be another ace in the hole to help convince staff.

Sullivan said discussions were underway about how vaccination will impact the level of personal protective equipment someone will be required to wear. It is possible less gear will be mandated in the future for those who have gotten their shots.

No change has come in terms of guidance from federal regulators. But Glendening said it was possible new recommendations will come sooner rather than later — and could help facilities tackle the remaining group of vaccine skeptics.

"It just seems that's the trajectory we're going on," Glendening said. "And I don't know if you wear a mask for eight or 12 hours a day, but it's pretty miserable. And that might be the thing that pushes us over the hump."