Certified nursing assistants are the least likely among nursing home workers to be fully vaccinated against COVID-19 even though they provide the bulk of direct care to residents, new research published in JAMA Internal Medicine revealed.

The findings mean that high staff vaccination rates throughout their facilities will likely be hard for skilled nursing operators to achieve “without a large-scale policy intervention” like the impending federal mandate, study authors suggested. 

Average vaccination rate among CNAs was 49.2%, while the rate among registered and licensed practical nurses was 61%. The highest vaccination rates were among therapists, at 70.9%, and physicians and independent practitioners at 77.3%. 

The overall study looked at the association between vaccination coverage and multiple facility characteristics. Investigators analyzed facility-level data through the week of July 18 through the federal National Healthcare Safety Network, along with other publicly available data sets. 

Brian E. McGarry, Ph.D.

“These results should help SNF operators conceptualize the impending federal vaccine mandate,” Brian E. McGarry, Ph.D., PT, study co-author and University of Rochester assistant professor, told McKnight’s Long-Term Care News on Thursday. “We find the vaccine acceptance is quite low, particularly among CNAs, and that a number of factors, including several that are clearly outside SNFs’ control, that contribute to low vaccination rates.” 

Findings revealed that nursing home staff and residents under for-profit ownership were less likely to be fully vaccinated when compared to nonprofit facilities. 

Higher Medicare star rating was also associated with higher vaccination coverage in facilities, while facilities that had more non-white residents were associated with lower vaccination rates. 

Facilities that had longer-tenured staff also had higher rates among residents and staff. 

“This suggests that facility culture, including factors that might allow facilities to do better retaining staff overtime, may play a role in achieving better vaccine acceptance,” McGarry said. “SNF operators may want to focus on these factors as they work with unvaccinated staff to get vaccinated in light of the new mandate.” 

The full findings can be found here.