A letter addressed to Becerra on December 22nd.

Since the arrival of Covid four years ago, over 170,000 nursing home residents have passed away. However, following the extensive efforts to vaccinate elderly individuals in 2020 and 2021, America’s most susceptible citizens are now primarily responsible for their own well-being.

Sloan provided Becerra with a list of tasks aimed at aiding the homes: enabling them to place small orders for vaccines to meet decreasing demand, involving hospitals in the vaccination effort, allowing for higher Medicare reimbursement for administering the shots, and devising an effective messaging strategy.

The following day, during the second meeting, Becerra did not present any new assistance, but did emphasize the federal regulations that mandate homes to provide vaccinations.

Over the past three years, we have addressed all of these tasks, but I do not believe they have made a significant impact. A senior official from the administration, who wished to remain anonymous while discussing the response, stated that the agency will review the current requests and continue to collaborate with the nursing home industry. However, they expressed doubt that granting these requests would result in a drastic change in the outcome.

The official stated that simply checking off all the boxes on this letter will not magically increase the vaccination rate.

“We are aware of their ability to accomplish it.”

Due to their advanced age and underlying health issues, individuals residing in nursing homes are at a heightened risk for contracting Covid-19.

In late 2020, government-run clinics began administering the first Covid shots to nursing homes. Nearly all residents opted to receive the vaccine, bringing a sense of relief due to the high number of deaths in these facilities up until that point.

“The [management] had the primary drugstores that were participating. They organized for the clinics to be held at the nursing homes, and for the most part, the residents were able to receive their vaccinations,” recounted David Grabowski, a health care policy professor at Harvard Medical School.

However, this success has diminished as the overall vaccination effort has declined.

There is no definitive explanation for this, but experts in both the industry and the government have identified two potential contributing factors.

Initially, there was a decrease in interest towards getting vaccinated as it was found to be ineffective in stopping the spread of diseases. Additionally, there have been conflicting opinions on who should receive a yearly vaccination, despite experts agreeing that it is necessary for elderly individuals.

Additionally, the administration ceased purchasing and overseeing the distribution of the vaccinations when the revised version was released in September of last year.

The decision to transfer responsibility for managing other vaccinations to private health care organizations, such as insurers, pharmacies, and doctors’ offices, was made at the same time as the end of the public health emergency, as justified by the administration.

For nursing facilities, this implies that they must obtain the vaccinations and oversee their administration, which can present logistical and reimbursement difficulties.

Though government and industry leaders agree that a number of other factors could also be at play, the result is clear: Only 38 percent of nursing home residents have gotten the most recent shot — a significant drop from the initial vaccination campaign.

The vaccination rates for nursing home residents vary greatly among states. While both North and South Dakota have reported over 60% of their nursing home residents being vaccinated, only 20.1% of nursing home residents in Arizona have received the vaccine.

As the year 2024 begins, the ongoing Covid-19 pandemic continues to take lives in residential settings. In just the first two weeks, there were almost 600 reported deaths. As of January 14, over 14,700 confirmed cases of Covid-19 have been recorded among those living in nursing homes during this winter season. This is a significantly lower rate compared to previous years.

Officials in the government cite variations among states as evidence that providers have the capacity to do more.

In certain households, the majority of individuals have received vaccinations, while in others, hardly anyone has. As a result, Becerra reminds executives of nursing homes that it is their legal obligation to provide the option of getting vaccinated to their residents.

According to an official from the administration, they believe that they are capable of achieving this task and that there is room for improvement.

The government can highlight facilities, like those in the Dakotas, that have administered vaccinations to the majority of their residents.

Dr. Jeremy Cauwels, who is in charge of the long-term care provider at Good Samaritan Society, which is based in South Dakota and is part of Sanford Health, emphasized the importance of trust in this situation.

According to him, strong, long-term relationships with patients can help overcome doubts about vaccines. He also mentioned that in certain facilities owned by Sanford, the percentage of people choosing to get vaccinated is over 90 percent.

‘Bully pulpit’

Sloan recognized that certain homes have been more successful than others in administering vaccinations to their residents. More than half of the residents at LeadingAge facilities have received the most recent shot, demonstrating the potential for these facilities to increase trust in the vaccination process.

However, she also pointed out that she has observed a decrease in efforts from the administration to encourage Americans to receive the COVID-19 vaccine compared to previous actions.

“We discussed with the secretary the potential for HHS to utilize its influential platform as the primary source of public health communication in the nation,” stated Sloan. “In my opinion, this would be a significant and vital role.”

Mandy Cohen, Director of the Centers for Disease Control and Prevention, stated to POLITICO in October that ensuring nursing home residents receive the COVID-19 vaccine is a primary concern for her organization due to the high level of risk they are exposed to.

“Prior to the current virus season and during the autumn months, the CDC collaborated with other government agencies, state and local health departments, and healthcare partners in efforts to address concerns regarding vaccine accessibility and promote acceptance. We anticipate seeing progress,” stated a representative from the agency via email.

However, others within the government believe that it is fitting for the transition from a government-controlled distribution system to one controlled by private entities to also result in a decrease in the government’s involvement in promoting vaccination during the pandemic.

The senior official suggested that it could be more effective for messaging about vaccines to come from manufacturers and private entities, instead of the government’s strong push which may be contributing to skepticism in certain communities.