Lolita Owens, a home health aide for Liberty Resources Inc., did not want to be among the first to get a COVID-19 vaccine.
Like many of her coworkers, she worried that the shots were developed too fast. “Are you sure they’re not trying to kill us all?” she wondered. “I had all kinds of theories.”
Owens, 50, also had high blood pressure, asthma, and obesity — conditions that raise risk for serious illness from COVID-19. Her two clients are medically fragile and want to be vaccinated. Owens kept an open mind as she attended Zoom meetings on the vaccine sponsored by her union, United Home Care Workers of PA. They put the risks in perspective. “I’d rather have a little side effects than being in somebody’s hospital on a ventilator,” she decided. “It was broke down to me like I was 5 years old, and I said, ‘You know what? I’m going to stop playing.’ ”
She got her shot at the Pennsylvania Convention Center a little over a week ago and took a coworker with her. Now she’s talking to others about the value of vaccinations.
Owens’ vaccine journey is a textbook example of how health care leaders hope to improve employee vaccination rates. Few things, they said, can change minds better than a trusted peer.
Many minds still need changing.
More than three months into the nation’s vaccination campaign, surprising numbers of people who witnessed the agony of the pandemic from the front row — those who staff hospitals and care for frail elders — still have not received their shots even though they were given top priority. A new national poll from the Kaiser Family Foundation and the Washington Post found that only 52% of all frontline workers had gotten a dose of vaccine by early March. Several local providers reported higher numbers, but many employees remain unvaccinated at a time when cases are again rising.
Health care leaders traced the relatively low vaccination rates to a combination of attitudes and access.
Many workers, they said, share Owens’ worry about the speed of vaccine development or fear side effects. Some young people have heard false reports about an impact on fertility. Employees wonder how vaccines will interact with their particular medical conditions and allergies. Some have fallen for false reports of implanted microchips.
While hospital employees can get vaccinated easily now, people who work for long-term care providers or home care have much less access. The federal program that brought vaccines to nursing home employees and residents has finished, and there’s no plan for easily vaccinating employees who change their minds or new residents and staff, industry advocates said.
At Redstone Presbyterian SeniorCare, a retirement community near Pittsburgh, 99% of residents and 78% of staff were vaccinated in February, said Vicki Loucks, vice president and chief operating officer. But now, because of turnover, the rates have fallen to 87% of residents and 67% of staff. “It’s very discouraging,” she said.
Home care agencies never had a special vaccination program and employees don’t work in a central location. A few agencies have managed to arrange employee vaccination clinics, but many have not. For the most part, new nursing home employees and home health aides battle for appointments in the same scrum as the rest of us. As a result, less than 20% of employees at some home care agencies have gotten a shot.
According to the Kaiser poll, employee vaccination rates were 66% in hospitals, 50% in nursing homes and assisted living facilities, and 26% in home health. About 12% of those polled said they were undecided about shots and 18% did not want one.
The American Health Care Association and LeadingAge, which represent senior residential care providers, have said they want 75% of staff vaccinated by the end of June.
Area health systems reported higher numbers than the Kaiser poll among hospital workers. The percentage vaccinated stands at 76% at Temple University Health System, 72% at Einstein Healthcare Network, 71% at Main Line Health, 70% at Penn Medicine, 68% at Jefferson Health (73% at Thomas Jefferson University Hospital), and 63% at Virtua.
Jaya Aysola, a Penn physician who helps plan Penn’s vaccination program, said the system’s rates are growing by 1 to 2 percentage points a week. Catherine Hughes, Virtua’s chief nursing officer, said its rate is growing by a point every two weeks.
In long-term care centers, residents were enthusiastic early adopters. Vaccination rates of 90% and above are routine. But Adam Marles, president and CEO of Leading Age PA, said many facilities report employee vaccination rates of 50% to 60%.
Genesis HealthCare facilities here generally reported rates in the mid-60s to mid-70s on their websites.
At Gracedale Nursing Home in Nazareth, which offered employees $750 bonuses to get a shot, just 48% of staff have done so. “It’s not good enough for us,” said Lamont McClure, Northampton County executive. “It pains me that you could work for a nursing home and not be vaccinated.” Shots will be required for new hires.
Ninety percent of employees at Kendal-Crosslands Communities in Kennett Square have been vaccinated. CEO Lisa Marsilio attributes that partly to residents who told workers how the polio vaccine changed their lives.
New Jersey-based Juniper Communities mandated vaccines for employees, with some exceptions, and 96% have complied. Forty, or 3%, quit rather than get a shot, said Lynne Katzmann, founder and CEO. A small, but growing group of senior-living providers now require vaccines for employees. Sunrise Senior Living joined the list last week.
Home care is the biggest challenge. Teri Henning, CEO of the Pennsylvania Homecare Association, said a survey of members in March found that 56% of employees wanted the vaccine — up from 50% in January — but only 32% had been able to get it.
At Liberty, where Owens works, about 100 of 600 home health aides have been vaccinated. The numbers are improving now with help from Jefferson.
Dave Totaro, chief government affairs officer of Bayada Home Health Care, a large New Jersey-based provider, said just 16% of Bayada’s 36,000 employees have been vaccinated. That includes 25% in New Jersey and 13% in Pennsylvania. In South Jersey, where the company was able to hold dedicated clinics for employees, the rate is 34%.
Nancy Fitterer, president and CEO of the Home Care and Hospice Association of New Jersey, said the state worked with Rite Aid in December and January to create special clinics for home health workers, but the program soon “fell apart” as links were shared and “people over 65 ended up taking all the slots.”
Meanwhile, Penn Asian Senior Services in Philadelphia has vaccinated 80% of its home health aides. Im Ja Choi, the agency’s CEO, said she sent multiple letters to city health commissioner Thomas Farley. She also contacted Mayor Kenney and city council members. Finally, she got on-site vaccine clinics for her workers and helped them sign up. “I really think that it was about being persistent,” said Ken Yang, executive director.
Unvaccinated health workers can still protect themselves and others with the right equipment, but they are at higher risk for contracting the virus outside of work and will need to quarantine — and miss work — if exposed. Some also must work so closely with patients that transmission is extremely difficult to prevent. Nursing home employees are often the source of deadly outbreaks in their facilities.
What would change minds?
Health leaders said some patients, family members, and long-term care residents are starting to ask if the people who care for them or their loved ones have been vaccinated. This kind of pressure, they said, could increase vaccination rates as employees see that those who’ve gotten their shots are in higher demand.
But it could also backfire, if employees see it as “privileged, entitled patients making demands,” said Alison Buttenheim, a public health researcher at Penn Nursing who studies vaccine acceptance. “I don’t think it’s going to be pretty.”
Main Line Health president and CEO Jack Lynch said the system’s managers are forbidden from asking employees whether they’ve been vaccinated, and he doesn’t think workers should have to “take a bunch of lip from a patient” about a personal decision. “To show disrespect for their decision not to get a vaccine is wrong,” he said.
As for mandates, many health leaders are reluctant to require employees to get a shot that is not yet fully approved by the Food and Drug Administration. Some found Gracedale’s approach to new hires more appealing.
Officials said that what public health experts gently call vaccine “hesitancy” is diminishing now as people have seen a diverse group of celebrities, role models, and friends be vaccinated and live to tell about it. The AHCA said a new poll from OnShift found that the percentage of long-term care employees who opposed vaccination dropped from 39 in December to 23 in March. Fifty-three percent said they had already gotten a shot and an additional 9% said they would when they could.
Repeated polls have shown Black Americans have been especially concerned about COVID-19 vaccines. At Main Line Health, 81% of white employees and 79% of Asians have been vaccinated compared to 70% of Hispanic and 45% of Black employees. “That gap is closing,” Lynch said. Some leaders said they have not seen racial differences in vaccine uptake.
Aysola said some employees don’t use email much and can’t get shots during standard business hours. When Penn talks directly with these employees and makes appointments easy and convenient, vaccination rates improve.
Health leaders said some vaccine resisters are impervious to discussion, but many others are still paying attention to education, example and patient, respectful, one-on-one discussions about their concerns.
Whitney Cabey, an emergency medicine physician and bioethicist at Temple University Health System, said vaccine hesitancy usually stems from fear, which often doesn’t respond to logic or pressure.
“Even gentle pushing can feel like coercion if you’re already coming at it from a very fearful place,” she said.
The first step to “getting people out of their brain stem and up into their cortex,” she said, is really listening to their concerns and expressing understanding. Then they’re more open to facts.
Kendal’s Marsilio said she and her staff approach conversations with compassion and empathy. “We all had fears,” she said. “I remember getting the vaccine, and I was shaking because it was something new being introduced.”
Health care workers who have already passed up multiple opportunities to be vaccinated are unlikely to respond now to placards on buses or flashy slogans, Buttenheim said. What’s needed is the slow work of personal conversation. A Black Penn doctor she knows makes a point of talking to three hesitant coworkers about vaccination during each shift she works. “Some of them, she’s on conversation number five,” Buttenheim said.
She also said health care leaders need to address barriers. For example, it helps for people to know they can get paid time off if they have serious side effects.
It’s also helpful, she said, to harness the “fresh-start effect.” Create markers for an attitude reboot, like Mondays or when a certain number of doses have been administered. “A lot of folks didn’t say no. They said, ‘I’m going to wait,’ ” she said. The question now is, “What are you waiting for?”