Nursing Home COVID-19 Vaccination Rates Are Declining, But Many Facilities Are Still High Performing

Recent COVID-19 vaccination coverage in nursing homes has not matched the success of the initial vaccination campaign in 2021.  Lagging up-to-date vaccination rates, as reported in this month’s release of the AARP Nursing Home COVID-19 Dashboard, are a significant concern because updated vaccines are necessary to protect against waning immunity and new virus variants.

Vaccination rates lag after early success

The most recent Dashboard update finds that, as of May 2024, only 30% of residents and 10% of staff were up to date on COVID-19 vaccination, the third consecutive year of decline in both rates, leaving most residents and nearly all staff without full protection.

Percent of Nursing Home Residents and Staff Up to Date on COVID-19 Vaccination

This is a significant reduction from the success of early vaccination efforts in nursing homes. The initial campaign in 2021 was extraordinarily successful, vaccinating more than three-fourths of residents and half of staff within months.  Driven by a federally supported rollout for residents and mandates for staff, initial vaccination ultimately reached 88% of residents and 89% of staff by early 2022.

Nursing home residents are perhaps the most vulnerable population to COVID-19, which makes the low current vaccination rates for residents and staff particularly concerning. Compared to the general population, residents are older, frailer, and have more chronic conditions; and living in a congregate setting, often in shared rooms, and getting daily hands-on care from staff means that there is a high risk of spread within the facility.

Early in the pandemic, before vaccines were available, nursing homes and other long-term care facilities accounted for more than 40% of all COVID-19 deaths in the United States despite residents comprising less than 1% of the total population. Even now, death rates in nursing homes continue to be much higher than in the community: About 3,000 residents have died from COVID-19 through the first five months of 2024. Staying up to date on COVID-19 vaccination continues to be critically important for the health and safety of nursing home residents.

High-performing nursing homes exist across the country

Despite the decline in resident and staff vaccination rates over the last three years, there are still hundreds of nursing homes that are strong performers.

Using data from the last update of the AARP Nursing Home COVID-19 Dashboard, about 1 in 4 facilities had at least 50% of their residents up to date as of May 2024, while only 1 in 13 had at least 75% up to date, and a little more than 2% at least 90% up to date.  In total, 322 nursing homes across 44 states, Puerto Rico, and Washington DC exceeded the 90% threshold for COVID-19 vaccination.

Nationally, fewer than 1 out of 16 nursing homes had even half of their staff up to date on vaccination.  But nearly as many facilities achieved high staff vaccination rates as achieved high resident vaccination rates:  4% reported least 75% of staff up to date, and 2% achieved a staff vaccination rate of at least 90% up to date.  Across the country, 296 facilities in 41 states, Puerto Rico, and Washington DC reached the 90% threshold for staff vaccination.

Number and Percent of Nursing Homes by COVID-19 Up to Date Vaccination Rate, May 2024

Combining both resident and staff vaccination rates, there were nearly 100 facilities across 29 states and Puerto Rico that had at least 90% of residents and at least 90% of staff up to date on vaccination.  A list of these facilities, organized by state, is available here.

States with at least one nursing home with at least 75% of residents and 75% of staff up to date on COVID-19 vaccination as of May 2024
 

_{^{Source: AARP Public Policy Institute analysis of CMS COVID-19 Nursing Home Data Public File, downloaded on June 14, 2024.  Created with mapchart.net.}}

Vaccination matters

Nursing homes with higher staff and resident vaccination rates have fared better during the pandemic.  To illustrate this, consider the vaccination rates for the week ending Nov. 19, 2023 alongside the rates of resident deaths, resident cases, and staff cases during the three months covered by the March release of AARP’s Nursing Home COVID-19 Dashboard, a time period that includes the annual winter surge with the highest rates of deaths and cases. 
 

_{^{Source: AARP Public Policy Institute analysis of CMS COVID-19 Nursing Home Data Public File, downloaded on June 14, 2024}}

Nursing homes with higher resident and staff vaccination rates had lower rates of resident cases and much lower rates of resident deaths than facilities with lower vaccination rates.  This relationship was strongest for staff vaccination rate, with a clear benefit as low as 25% up to date (for cases) and 50% (for deaths).  Facilities with at least one quarter of staff up to date on COVID-19 deaths had 13% fewer COVID-19 cases than those with less than one quarter vaccinated (9.7 per 1000 residents per week vs 11.1), and facilities with at least half of staff up to date had 56% fewer deaths than those with less than one quarter vaccinated (8.4 per 100,000 residents per week vs 19.0). In short, an increase in staff vaccination rate saved lives among residents.

Benefits also accrued for nursing homes with at least three-quarters of residents up to date on COVID-19 vaccination. Compared to facilities with less than three-quarters of residents up to date, these facilities had 13% fewer cases per resident (9.6 per 1000 residents per week vs 11.1) and 36% fewer deaths per resident (12.3 per 100,000 residents per week vs 19.2).

The experience of higher-vaccinated nursing homes this past winter strongly suggests that even a moderate improvement in facility-level vaccination rates to at least 50% of staff and 75% of residents can significantly reduce the impact of COVID-19 on residents during future waves and save thousands of lives.

During the winter of 2022-23, AARP talked with nurse leaders at high-performing facilities, who shared strategies for boosting vaccination, such as counseling and logistical access, as well as other recommendations from the front lines for COVID-19 prevention and treatment.  Now entering the fifth year of the pandemic, facilities across the country with high vaccination rates continue to show that high rates can be achieved, and that boosting resident and staff vaccinations is a life-saving intervention.