A Million Nursing Home Workers Remain Unboosted as COVID Cases Climb Again

More than half of staff and almost a third of residents nationwide are without the protection, a new AARP analysis shows

Emily Paulin, AARP

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Published May 12, 2022

More than a million U.S. nursing home workers and more than 350,000 residents haven’t received a first COVID-19 booster dose, a new AARP analysis of federal data shows, even though the extra shots were recommended to this population by the Centers for Disease Control and Prevention (CDC) last year. The analysis also shows another wave of infections has begun in U.S. nursing homes, even as facilities recently reported their lowest COVID-19 death count for any four-week period on record.

Booster coverage, while continuing to increase, “isn’t where it should be,” says Ari Houser, coauthor of AARP’s new analysis, “particularly in some states.” Nationally, 54 percent of the nursing home workforce had not received a first booster as of April 17 (11 percent of this group — or some 220,000 workers — are also not fully vaccinated), even though a booster was recommended to them by the CDC last November. In Alabama, Florida, Indiana, Kentucky, Louisiana, Missouri, Mississippi, Oklahoma and Tennessee, less than 30 percent of nursing home workers had received one.

Booster rates among nursing home residents were higher, with 70 percent of residents nationwide having received an initial booster as of April 17. Still, this rate is concerning, given that residents were first recommended for boosters back in September and have recently been recommended for a second one, after studies showed that booster effectiveness wanes after four months.

doctor placing a bandage on a woman's arm after administering the coronavirus vaccine

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Second booster shots: Who should get one and when?

Second boosters are “especially important” for people over 65 and for people over 50 with chronic health problems, said CDC Director Rochelle Walensky, M.D., in April. Both of those demographics are highly represented in the nursing home population. Yet in Arizona, Florida and Nevada, first booster rates among residents are still only around 55 percent, the analysis found. Data on second booster shots is currently unavailable.

Weekly COVID-19 cases among both staff and residents increased throughout the four-week period analyzed by AARP. Also, reports from the CDC, which at the time of writing capture two weeks of more current data than AARP’s analysis, shows a continued rise, with cases increasing by another two-thirds between the week ending April 17 and the week ending May 1. The true increase is likely even higher, as the CDC numbers are often revised upward for several weeks as facilities submit more data.

“This steady increase in cases is a clear sign of another wave,” AARP’s Houser says.

Booster requirements increase uptake

In states that have mandated boosters for nursing home workers — including California, Connecticut and Massachusetts — upward of 80 percent of workers had received at least a first booster as of April 17, AARP’s analysis found.

While the federal government is mandating full COVID-19 vaccination for staff of Medicare- and Medicaid-funded health care facilities — which includes the vast majority of the country’s nursing homes — booster doses aren’t part of the requirement. As of April 17, 89 percent of workers nationwide were fully vaccinated, while only 46 percent were boosted.

AARP called on nursing homes to require boosters in January, amid the omicron variant surge. “The message from recent data is clear: Nursing home residents and staff need booster shots now,” Susan Reinhard, AARP senior vice president and director of the AARP Public Policy Institute, and Houser, a senior methods adviser at the institute, wrote at the time. “A booster is necessary to remain protected.”

A recent CDC study of national nursing home vaccination data found that residents with an additional or booster dose of a COVID-19 vaccine had 47 percent greater protection against infection during omicron’s prominence than those who had only received a primary series.

A federal government-led campaign quickly inoculated the nursing home population when COVID-19 vaccines first became available in late 2020, but the distribution of boosters has been left to individual facilities or to state or local health departments. Vaccine hesitancy, confusion and pandemic fatigue are also likely contributing to slower booster uptake.

“After an intense media spotlight on the tragedy that was taking place in nursing homes, it is fair to say the attention has shifted,” says Tricia Neuman, senior vice president and executive director of the Program on Medicare Policy at the Kaiser Family Foundation.

“In some respects, this makes sense because deaths among nursing home residents and staff have declined. At the same time, it is important to do all that we can to keep the momentum going when it comes to vaccinations and boosters,” she adds. “Unfortunately, we’re not out of the woods yet.”

Death rate drops in facilities

More than 200,000 residents and staff of long-term care facilities — including nursing homes, assisted living facilities and residential care settings — have died from COVID-19 throughout the pandemic, accounting for roughly a fifth of all COVID-19 deaths in the U.S. More than 170,000 of those deaths are tied to nursing homes.

Check the vaccination rates of your nursing home

You can now find vaccination and first (not second) booster rates of both residents and staff at any Medicare-certified nursing home and compare it with state and national averages on Medicare.gov’s Care Compare website.

Find a nursing home’s profile via the home page’s search function
Visit the “Details” section of its profile
Click the “View COVID-19 Vaccination Rates” button

AARP’s analysis did show, however, that nursing homes facilities reached their lowest COVID-19 death count for any four weeks on record. Over the four weeks ending April 17, about 300 resident deaths from COVID-19 were reported nationwide. That death rate — of roughly one COVID death per 4,000 residents — represents a 14-fold decrease, compared with the deaths reported in the four weeks ending Feb. 20, when omicron deaths in nursing homes peaked. It also represents a 76-fold decrease from the highest death rate recorded during the pandemic, which occurred in during the winter of 2020 and 2021.

AARP’s analysis, conducted by the AARP Public Policy Institute and the Scripps Gerontology Center at Miami University in Ohio, draws primarily on data acquired from the Nursing Home COVID-19 Public File by the Centers for Medicare & Medicaid Services. Most nursing homes are federally certified and required to submit data to the government each week.

The ongoing analysis captures data only from federally certified nursing homes, not from all long-term care facilities — such as assisted living, independent living, memory care and others — as some other tallies do. An updated analysis will be released next month as new federal data becomes available. Read more about the analysis.

Emily Paulin is a contributing writer who covers nursing homes, health care, and federal and state policy. Her work has also appeared in Broadsheet, an Australian lifestyle publication.

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