As Omicron spreads, some nursing homes are struggling to increase the population
At Sea Crest Nursing and Rehabilitation, a large nursing home overlooking the Coney Island boardwalk, more than 100 residents have died of Covid-19 since the pandemic began.
However, as a more contagious variant of the coronavirus hits a new high in New York, the nursing home is struggling to provide what medical experts consider to be one of the most powerful forms of protection against this latest wave of the virus: a booster dose.
Of the 274 residents of the nursing home, only 52 – fewer than one in five – received a booster vaccination, according to the state from last week.
Causes of the low booster rates at Sea Crest and other nursing homes include hesitant vaccination of residents or their families and non-participation of residents because they recently received a second dose of vaccine or monoclonal antibodies.
But as Omicron spreads, health experts point out an additional problem: New York, like much of the country, has been slow to bring boosters to market before the new variant hit the market a few weeks ago, and the administration of the third dose largely left to long-term care facilities themselves, some of which are struggling with the task.
Now that the new variant is spreading rapidly in almost every region, health experts are calling on the city and state to do more to ensure the most vulnerable – especially those living in nursing homes – are given boosters quickly.
New York reported 49,708 new cases on December 24th and 36,454 new cases by Christmas, more than any other state in the country, as Omicron continued to spread rapidly across the country, and infections also in Washington, DC, New Jersey, and Puerto Rico Florida increased.
“The city and state should work together to ensure that everyone in nursing homes is funded,” said Dr. Tom Frieden, a former city health officer and former CDC director. He called nursing homes “Ground Zero for Covid”.
Nursing home residents boosters are considered vital during the Omicron surge, as nursing home residents were at a significantly higher risk of dying from Covid-19 for much of the pandemic. Many nursing home residents were vaccinated in the early days of the vaccination campaign and their immunity has deteriorated, public health experts say.
At the same time, initial data and laboratory studies indicate that although the vaccines still offer significant protection against serious diseases, they are much less effective in preventing the new variant from being infected without a booster vaccination. Boosters are also expected to provide additional protection against serious illness.
There have been multiple reports of outbreaks in nursing homes in the city and its suburbs, industry officials said. Since the pandemic began, New York state has seen more than 14,000 coronavirus-related deaths among nursing home residents, while nationally, more than a third of Covid-19 deaths in 2020 occurred among nursing home residents and employees.
Across New York City, approximately 56 percent of nursing home and assisted living residents have received a booster vaccination, which is above the national rate of about 50 percent, according to data from the New York State Department of Health. But in dozens of facilities, fewer than half of residents have received a refresher. And in about 20 nursing homes, less than a quarter of residents have received a booster vaccination, according to the data.
In total, more than 19,000 residents in New York nursing homes and assisted living facilities have not received a booster vaccination.
“It would be very surprising if we didn’t see excessive mortality rates in long-term care, the institutionalized population that was not replenished,” said Dr. John Rowe, Professor of Health Policy and Aging at Columbia University’s Mailman School of Public Health.
And adding more nursing home residents could help prevent congestion in hospitals in the coming weeks by reducing the number of seriously ill patients. Many hospitals are already facing staff shortages as a result of the pandemic, as well as vaccine mandates that have resulted in thousands of employees being laid off or laid off.
Thanks in part to mandates introduced by Mayor Bill de Blasio, about 72 percent of New York City residents are fully vaccinated – more than the national rate of 62 percent.
But while it’s again an epicenter for Covid infection, the city hasn’t been quick to push residents to get boosters or develop special programs to support nursing homes and other facilities to provide them. For example, the city only extended its $ 100 vaccination incentive to boosters last week.
As of Wednesday, New York City had administered 1.85 million boosters, which is roughly 27 percent of the adult population. Across the country, approximately 25 percent of adults have received refresher courses.
When a booster vaccination was approved for people over 65 in September, nursing homes across the state were ordered to make the vaccinations available to residents. The state directive stipulated that nursing homes should administer the syringes themselves or rely on pharmacies.
Some homes moved quickly and benefited most of their residents. But others made little progress. Hoping to increase the rate, the state health ministry sent a letter on Nov. 24 when a new variant became known to remind nursing homes to ensure that residents “have the opportunity to get a booster dose receive”. .
Given the current rate, several public health experts said it was not enough to rely on nursing homes to vaccinate their own residents.
“Send a team of health workers or mobilize the National Guard to vaccinate these people,” said Dr. Kitaw Demissie, Dean of the School of Public Health at SUNY Downstate Medical Center in Brooklyn. “That would be very good.”
Governor Kathy Hochul has insisted that nursing homes be equipped to administer boosters. She has also suggested that the problem is not with the nursing homes but with recalcitrant family members or residents who are unable to give consent due to cognitive decline.
“The numbers are not where they should be,” she said on Friday.
The city’s health commissioner Dave A. Chokshi said on December 19 that the city would send vaccination teams if there was no pharmacy in nursing homes to give boosters. A health department spokesman said Saturday that the city had “set up vaccination clinics for those who do not have pharmacy partners,” but did not provide any further details.
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Nursing homes also struggle to vaccinate their employees. Nursing homes lost more than 4,000 employees after the New York vaccination mandate went into effect in late September, and many operators fear that the need for a refresher will result in more layoffs.
Today, New York is among the lowest ranked states when it comes to giving boosters to nursing home workers, with only 17 percent of those workers receiving the syringe. According to the American Health Care Association, which represents 14,000 nursing homes and assisted living communities nationwide, this is below the national average of 22 percent.
Industry officials say they are making progress on taking booster vaccinations. The Greater New York Health Care Facilities Association, which analyzed state data, found that the more than 1,100 long-term care facilities across the state had nearly 4,800 refresher clinics on-site and 619 refresher clinics for residents in pharmacies or doctor’s offices in mid-December.
The organization estimates that about 12 percent of fully vaccinated nursing home residents had not yet qualified for a booster dose because they had recently received a previous dose of the vaccine or monoclonal antibody. Another 21 percent had either refused a refresher or the nursing home had not yet received approval from relatives.
“It’s a constant effort to promote boosters,” said Stephen Hanse, president of the New York State Health Facilities Association, which represents 350 nursing homes across the state.
Nursing home operators said that with Omicron’s surge, they believe limiting visitor numbers is even more important than persuading their residents and employees to get boosters.
The Centers for Medicare & Medicaid Services now require nursing homes to allow visits because of the severe physical and emotional stresses that isolation puts on residents. These visitors do not need to be vaccinated, but they do need to wear masks and pass a health exam.
However, nursing home operators who have recently reported outbreaks say visitors are bringing the virus into their facilities, said Michael Balboni, executive director of the Greater New York Health Care Facilities Association. He said he knew of five nursing homes in New York City and its suburbs that had recently suffered outbreaks.
“I get hectic calls from my operators,” said Mr Balboni. “We shouldn’t have visitors. If the hospitals can limit visiting hours, why can’t we? “
In response to concerns from nursing homes, the Centers for Medicare & Medicaid Services issued a “clarification” on December 23rd that allows nursing homes to restrict visits, e.g.
In order to get permission to top up more residents, nursing homes have started trying new techniques, such as sending bulk text messages to residents’ families asking them to call the facility if they want their relatives to do the Get a refresher.
At the Crown Heights Center for Nursing and Rehabilitation in Brooklyn, that strategy helped add about two dozen residents to a vaccine clinic held on Wednesday, said the facility’s assistant nursing director Vanessa Dorsainvil. The home also struggled to fully vaccinate all residents, and the booster vaccination rate was among the lowest in the city.
At Sea Crest Nursing in Coney Island, staff are still trying to convince more residents to get the syringe, said Mr Balboni, who also serves as spokesman for Sea Crest’s for-profit parent company, Cassena Care.
The nursing home, which agreed to accept Covid-19 patients earlier in the pandemic, had a higher death toll than many other nursing homes during the pandemic. Mr Balboni said staff encountered “cultural challenges” when trying to convince residents – many of whom are from Eastern Europe – to get a booster because many families did not trust it.
“You can offer it and offer it,” said Mr Balboni. “But if you don’t want to take it, you don’t take it.”
James Thomas contributed to the reporting and Kirsten Noye contributed to the research.