'There's fear out there.' Not all nursing home staff want to get COVID vaccine

Jan. 8—RALEIGH — In November, Principle Long Term Care asked the full-time staffers across its 36 state nursing homes whether they felt comfortable taking a COVID-19 vaccine.

A stark answer came back: About 25% said yes.

The reasons varied, said Lynn Hood, president and CEO of Principle, which operates three long-term centers in the Triangle. But for much of the staff, reluctance dated to the infamous Tuskegee Institute studies, in which Black patients were recruited for a decades-long syphilis experiment without their consent and were never given adequate treatment.

As COVID-19 vaccines make their slow debut across North Carolina, health care officials statewide and nationally say skittishness over the medicine remains a firm obstacle — even among health care workers and those who work in nursing homes.

"It's true there's fear out there," Hood said. "It's true the history in this country has created this anxiety."

Dr. Mandy Cohen, N.C. Department of Health and Human Services Secretary, said Friday she has heard anecdotal reports about nursing home staff refusing the vaccine. She told The Associated Press this week that the rate could be greater than 50%, even as they stand first in line to receive it.

But NC DHHS as well as nursing home owners and associations are working through those concerns, and reluctance is not universal. Nursing home staff and residents are part of Phase 1a, which also includes frontline healthcare workers and staff who work directly with COVID-19 patients.

The federal government has a partnership with CVS and Walgreens to administer vaccine to long-term care facility residents and staff in the state. As of Friday, the pharmacies have received 165,900 doses of North Carolina's total allocation of the Moderna vaccine, according to NC DHHS, but 23,965 doses have been administered in the past three weeks to patients and staff — just over 14%.

Cohen said at a Friday news conference that the state isn't getting the data it needs to understand why the number of vaccine administered to nursing homes is lower than expected. She said there could be a lag in data being reported.

"We do see the fact that we aren't seeing the kind of numbers that they were hoping for," Cohen said.

Long-term care staff can also make an appointment to receive the vaccine at local health departments or hospitals.

To address concerns, Principle started a vaccine-promotion campaign, including a 24-hour hotline for questions and concerns, and large and small-group meetings. The company then set up a clinical antibody trial with pharmaceutical company Eli Lilly, treating its active COVID-19 patients.

Hood and some of Principle's top staff, many of them people of color, appeared in videos taking the vaccine. And the anxiety slimmed down. At one Louisburg care center, Hood said, 84% of full-time staff have been vaccinated. At another in Henderson, participation is at 81%.

It's a positive start to help a population that's been among the most vulnerable to get the coronavirus — and to succumb to it. For much of the pandemic, nursing homes and other long-term care facilities have been hot spots for coronavirus outbreaks, resulting in the majority of cases and deaths earlier in the pandemic.

In North Carolina nursing homes, 2,627 residents and staff have died, according to Friday's data from NC DHHS. That number is 749 among residents and staff at residential care facilities, which includes adult care homes.

Overall, 83% of the state's deaths have been among people who are 65 and older. Sixty percent of those are older than 75.

For many, the vaccine is what will put an emphatic stop to the spread among residents and staff, and save lives.

Reluctance not widespread

Hattie Davis, owner and founder of Gracie Sturdivant Care Homes in Knightdale and Raleigh, was surprised to learn of workers refusing to take vaccine.

"In my house, everybody is on board," she said. "As as matter of fact, the families are asking me. I'm just trying to get on a list somewhere. There's nobody in my system who's not going to take it."

But Lauren Zingraff, the executive director of Friends of Residents of Long-Term Care, said she also has heard reports that about 50% of long-term care facility staff are not taking the COVID-19 vaccine. Friends of Residents of Long-Term Care is a Raleigh-based non-profit that advocates for people who live in nursing homes and other long-term care facilities.

"We absolutely share Dr. Cohen's concerns that if our direct care staff at nursing homes are not going to get the vaccine, then getting control of COVID when it comes to long-term care is not going to be successful in the way that long-term care advocates want it to be," Zingraff told The News & Observer.

Despite those concerns, North Carolina has not considered mandating that any group of people take the COVID-19 vaccine, Cohen said during a Wednesday press conference. Instead, the state health secretary pointed to the facts that more than 100,000 North Carolina residents have taken their first shot of either the Pfizer-BioNTech or Moderna vaccine without any reports of serious side effects, that the vaccine is 95% effective and that it has gone through clinical trials.

Both vaccines require two shots with the Pfizer vaccine given 21 days apart and the Moderna one 28 days apart.

For now, Cohen wants to make sure accurate information is being shared about the vaccine to help people feel confident taking it. She also hopes to see hesitancy decline as people see their colleagues or friends take the vaccine without experiencing adverse reactions.

"We think all of that is going to help folks feel more comfortable and to make sure that we're reducing that vaccine hesitancy as we go forward," Cohen said.

Zingraff agrees with the lack of a mandate, saying staff members should be allowed to make their own decisions about whether to get the vaccine. The hesitancy of many is understandable, Zingraff said, especially with widespread misinformation about the vaccine.

To combat that lack of trust, she suggested health departments help social workers who enter nursing homes to become trusted messengers. Educate them, Zingraff suggested, and hopefully they can help ease concerns about the shot.

Zingraff hopes that enough long-term care staff will take the vaccine that employers don't feel the need to mandate vaccinations.

"But I would understand if the (virus) cannot be gotten under control," Zingraff said, "and if that's the only way to keep long-term care residents alive and safe from the virus, then that's a decision that the industry has to make."

Making hesitancy a priority

The national group that represents more than 14,000 nursing centers and assisted living communities said Wednesday that vaccine hesitancy remains a primary focus.

"We call on public health officials, social media companies and members of the media to combat misinformation about the vaccine to aid in this effort," said Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, in a statement. "We remain hopeful that uptake for the vaccine will improve."

In December, the AHCA/NCAL launched a campaign to encourage vaccination with buttons, banners and posters showing the hashtag #GetVaccinated.

"While delivery of a vaccine is an important milestone, it will only work if people take it," said Parkinson in a press release. "By working with our members to provide staff, residents and family members with the facts and information they need, we can hopefully begin to put this threat behind us."

Part of combating vaccine hesitancy is understanding where it's coming from, said Kezia Scales, the Durham-based director of policy research for PHI, a national firm that researches the eldercare workforce.

To that end, Scales suggested that state officials launch a rapid survey of workers who are not taking the vaccine, aiming to better understand their concerns and whether there are other barriers to not getting the vaccine, such as not having time during a hectic work day.

"It really is about identifying what the concerns are and developing a sort of multifaceted campaign to address those concerns with more education and information that's really tailored to this workforce and what the realities of their work are," Scales told The News & Observer.

Scales also echoed Cohen's hope that as workers see their colleagues and other people successfully take the vaccine, they will be more inclined to do so themselves. That hope, Scales said, is part of the reason she believes it is too early for employers to mandate vaccinations among their care workers, a step that could potentially lead to people leaving an already strained workforce.

"If their concerns stem from the safety of it, from the side effects, that side of things, then as they see successful examples of vaccinations, I think that really will make a difference," Scales said.

Nursing home residents response to vaccine

At Woodland Terrace in Cary, residents went under quarantine in March when their community saw one of the first coronavirus cases in Wake County. They stayed upbeat then and remain so as the vaccine rolls out.

"I don't know anybody who's not going to get the vaccine," said Robert Carter, a resident who has served on the board there. "We're all looking forward to it." As to the staff, he said, "They're going to be vaccinated jointly. I don't think they have much choice."

At Principle's centers, residents are taking the vaccine at a rate of 85%, Hood said. The vaccine has only arrived at three of the homes in the Triangle so far.

Early on in the pandemic, Principle dedicated one of its centers in Raleigh, Tower Nursing and Rehabilitation, exclusively to COVID-19 patients.

Once a resident from another care center tested positive, Principle worked with the family to move them there to avoid affecting others. At the Tower facility, Hood said, residents could receive specialized treatment such as blood thinners if they were having problems with clotting or receive a regimen of vitamins. Staff there saw the virus up-close.

Full-time staff at Tower are taking the vaccine at only 34%, Hood said. But she thinks workers there are so accustomed to working with COVID-positive residents that they trust their PPE, or personal protective equipment. The survival rate at Tower is at 97%, Hood said.

"The main message I would like to give is the vaccine is brand new," Hood said. "We found out early there was a lot of fear. ... We're doing this to show you we're not afraid. We have the world's most vulnerable within our walls."

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