Nursing home giant Genesis HealthCare (NYSE: GEN) last week announced greater-than-average COVID-19 vaccine uptake among its residents and staff, but the company’s top clinical official emphasized that the work isn’t over — both because of continued gaps in acceptance among people of color, and an uncertain future after the end of the federal vaccination program.
“This is a complicated problem, and very few complicated problems in health care have simple solutions,” Genesis chief medical officer Dr. Richard Feifer told SNN last week. “So there is no magic bullet. There’s no one thing.”
The Kennett Square, Pa.-based company was fresh off disclosing a 61% staff vaccination rate through the first of two required on-site clinics at its more than 300 facilities, along with 84% acceptance for residents — exceeding national median numbers of 37.5% and 77.8%, respectively, reported by the Centers for Disease Control & Prevention (CDC).
Hesitancy among workers has been a serious problem amid the ongoing vaccine rollout in long-term care, with no one single cause: Operators have worked to combat misinformation, address employees’ health concerns head-on, and rebuild trust in authority left tattered by a year of sickness, death, and confusion in the nation’s long-term care sector.
Leaders across the country have also raised concerns about racial disparities in both access to and acceptance of the vaccine. Communities of color have been hit disproportionately hard by the COVID-19 pandemic, both generally and within post-acute care: The proportion of African-American residents at a given facility emerged as an early indicator of elevated outbreak risk, illustrating how historic underfunding of health care infrastructure in non-white neighborhoods can have a deadly impact in times of crisis.
“Nursing homes are often a reflection of the neighborhoods in which they are located,” R. Tamara Konetzka, a professor at UChicago’s Department of Public Health Sciences, said during a hearing held by the Senate Special Committee on Aging back in May. “Consistent with the pandemic generally, nursing homes with traditionally underserved, non-white populations are bearing the worst outcomes.”
Overall CDC vaccination data has shown that Black people account for 5.4% of all those who have received the shots so far, ABC News observed last week, despite representing 13% of the overall population.
That discrepancy has a variety of drivers, the report noted, from historical mistrust of the health care system at large to socioeconomic factors such as lower technology use among older Black Americans — with many state and local health departments relying on online portals to manage vaccine appointments, navigating the system the old-fashioned way represents a significant roadblock for people without internet access at home, for example.
“Medical professionals have to understand that the fear of COVID-19, which is this invisible looming foe, that fear does not always outweigh the very clear and well-documented danger of going to a health care system that has proven itself to be as deadly as disease,” clinical epidemiologist Gabrielle Perry told STAT News last month, pointing to historic wrongs such as the forced sterilization of Black women for decades in the last century.
The access problem shouldn’t be an issue for nursing home residents and employees, who have seen the vaccines come to them in clinics run by CVS and Walgreens on behalf of the federal government, Feifer noted. But even still, he raised concerns about the patterns that emerged at Genesis, where Black staff members had a 15% lower vaccination rate than the company-wide average.
The company also observed a correlation between pay level and willingness to roll up their sleeves, Feifer said.
“Aides, for example, are accepting the vaccine at a much lower rate than, for example, registered nurses, or physical therapists, or administrators,” Feifer said.
Genesis’s plan thus far has focused on honest conversations with all of the people concerned about taking the shots.
“Step one, which applies to hesitancy among any subgroup, is to respect the point of view of any person, for whatever reason — to start out by respecting their point of view, inviting them to share it, and engaging in dialogue,” Feifer said. “Because if we don’t show respect and openness to the discussion, then we’re not going to convince anyone to change their minds.”
The next step is making sure the message has resonance with the intended audience, often by making sure that the messenger truly understands the root causes of the concerns.
“Wherever possible, we’re leveraging people from within the health care system and from within our organization, who have that shared experience, to be part of the conversation with different subgroups,” Feifer said. “Also, we can and should be looking outside the health care system for community leaders — church leaders and others — who have similar backgrounds and can be part of the dialogue and support vaccination as we seek to correct misinformation and replace it with the facts.”
Finally, at the facility level, Genesis has looked to peer influencers to provide additional support for the often top-down vaccine education process.
“We need to ensure that influencers have have the right information, help them understand what the facts are around vaccination, and help them become advocates and proponents, because a local peer influencer can be one of the most powerful tools in the toolbox,” Feifer said.
Looking ahead, Feifer raised concerns about what will happen once CVS and Walgreens reach the third of three planned total clinics per facility.
Operators across the country have noted that uptake can increase from the first to the second on-site vaccine event, as previously hesitant workers were able to see that their coworkers and residents suffered no ill effects from the shots. But there is currently no unified plan for what happens if a worker or resident decides to get that first shot during the third clinic, with no further support from the retail giants or the federal government’s long-term care vaccine program on the horizon.
“We now have this window and a very big gap where there is no plan. Some states are stepping in to try to create one on the fly,” Feifer said. “But most states don’t have a plan, and we have a gap.”