James M. Berklan
James M. Berklan

Premier long-term care policy investigator Brian McGarry, Ph.D., and his team of dedicated researchers have contributed mightily to the burgeoning COVID-19 research machine.

Google his name — or the likes of partners Karen Shen, Ph.D., Michael L. Barnett, M.D., M.S., David C. Grabowski, Ph.D., and Ashvin D. Gandhi, Ph.D. — and you’ll fill your computer screen with plenty of erudite findings. This scholarly squad has received plenty of attention, and rightfully so.

Thursday they added to their cache with a research Letter in the journal JAMA Internal Medicine. As my colleague Danielle Brown writes today, the research team quantified the extent of certified nursing aides’ refusal to get vaccinated amid the worst public health emergency in a century. They also identified associated factors with which facilities would have higher or lower vaccination rates.

When they started their noble investigation, the federal government hadn’t yet publicized nursing home staff vaccination rates. So in a sense, the feds scooped them this time. We’ve known for some time now, for example, that senior care staff have shockingly low vaccination rates. We just might not have known how low, or what actual effects facility ownership status might be associated with COVID rates.

But in their most recent research, McGarry, et. al. identified solid associations for higher or lower vaccination rates in facilities. Among the positives? Higher 5-Star ratings, longer tenured staff and nonprofit ownership.

On the other hand, if you want better odds that a place has a low vaccination rate? Look for high infection rates in the surrounding community, or where Republican ideology is more firmly rooted, the researchers said, reflecting on numerical correlations.

The latter factors are outside a nursing home’s control and hard to work around.

“You’re probably not going to educate or outreach your way out of those, at least not in the timeframe needed, given the spread of delta and other variants,” McGarry conceded in our conversation Thursday.

So what’s the point of all the digging, you might ask? As it turns out, these latest findings may be prepping the foundation for something that will really set off alarm bells. Next up will be a look at what low staff vaccination rates mean in terms of infections and deaths.

In other words, there will be direct lines drawn to low staff vaccination rates. Try running a nursing home — no matter how thoroughly staffed — where non-vaccinated employees demonstrably lead to more infections and deaths.

Early bets are that’s what we’ll be reading about soon.

The implications are huge for a nation tiptoeing toward a slugfest over the soon-to-be-issued federal vaccine mandate for healthcare workers.

The way out

Thursday’s research already makes a case for vaccination mandates for long-term care employees, McGarry emphasized. The “good” influences are more likely in places with a healthy workplace culture.

How to improve the quality and culture in nursing homes, in general, becomes the necessary goal. An operator must first keep its residents and staff safe from the virus and then figure out staffing levels and needs. After all, fitting every window with a screen with holes in it won’t keep flies out of the house.

The ultimate answer, of course, is figuring out how to make nursing home jobs, particularly CNA positions, more attractive. The obvious route is better pay, better benefits and more shows of respect for direct caregivers.

“It was true before the pandemic and probably even more so because of the pandemic,” McGarry notes.

And where should the resources come from for higher salaries and benefits? For nursing homes, the answer is clear: their patron and rule-setter, and number-one payer, Medicaid.

Some wise investor once said you get what you pay for, and that’s certainly fitting now. Especially when you’re the one calling all the shots.

Follow Executive Editor James M. Berklan @JimBerklan.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.