Closeup image of older adult patient in bed being checked by doctor with stethoscope; Credit: Getty Images

The milestone — and millstone — of two million confirmed nursing home resident COVID-19 cases is at hand, according to the latest data from the Centers for Medicare & Medicaid Services, with more than 1,980,000 confirmed cases.

As the days of constant crisis during the height of the COVID-19 pandemic fade further into memory, the challenges providers face managing the virus continue to evolve. Although less obvious to some, they remain a critical issue.

Nursing homes were the single most deadly setting for COVID-19. More than 170,000 residents have died from the virus since 2020.

Skilled nursing leaders and medical experts discussed the sector’s successes and ongoing struggles with McKnight’s Long-Term Care News.

A common theme among them was optimism that increased immunity and a changing virus are causing fewer serious illnesses and hospitalizations.

“If you look at populations in general,” said Jeremy Cauwels, MD, chief physician for Sanford Health, “the virus is putting less people in the hospital, which makes many people feel better.”

The improvement is cause for real relief, according to Mark Parkinson, president and CEO of the American Health Care Association.

“Things are so much better than in years past,” Parkinson said in a speech last week. “We had a horrendous experience in 2020 … and then really since the vaccine came in, it’s been pretty much under control…. I think we can say that the clinical nightmare of COVID is certainly behind us.”

Despite these reasons for cheer, however, a false sense of optimism exists, said David Gifford, MD, chief medical officer at AHCA.

“I think it has lulled people into a sense of confidence that this is not that serious of a virus. And I think that’s a danger and concern that I see,” he said. “It is true that because of vaccinations — because of other treatments and the changing virus and prior immunity, it’s not as serious as it was before. However, it remains as bad and probably slightly worse than influenza.”

The Centers for Disease Control and Prevention estimated that more than 50,000 people died per year from influenza before the pandemic hit, the vast majority of them 65 and older.

Cauwels agreed with Parkinson’s assessment, describing vaccines as “still our best tool” for preventing COVID complications. 

“We’re dealing with the highest risk population in the country… In long-term care, it’s still really important to do everything we can to protect those folks,” Cauwels told McKnight’s.

A fatigued community

While the number of nursing home COVID cases continues to rise among both residents and staff — total staff cases are only about 100,000 behind residents — vaccination rates have waned significantly since the earliest rounds of shots.

Only 40.4% of residents are up to date on their COVID boosters. Putting that in perspective, nearly 95% of all Americans over the age of 65 completed the initial two-dose series of vaccines. In fact, the general population of 65-and-up adults now has an up-to-date vaccination rate 3% higher than that of nursing home residents.  

“Patients have gotten vaccine fatigue and their families have gotten vaccine fatigue,” said Neil Pruitt, chairman and CEO of Atlanta-based provider PruittHealth. 

Pruitt told McKnight’s that the politicization of COVID and vaccines has been another obstacle to increasing vaccination rates. He also said that long-term care is “not where we need to be. If we really want to stop variations of COVID, we really need to have a zero-tolerance for it, especially in medical settings.”

“A lot of the decisions are made by family members,” Gifford explained. “What goes on in the community spills into the nursing home … we’re finding vaccination rates are related to what’s happening in the community.”

Addressing vaccine hesitancy

With total cases set to cross 2 million in the coming weeks, some experts warn that even with COVID’s deadliness currently lessened, vaccination rates are still a key protection against possibly more deadly future variants

Since the start of 2024, more than 70,000 nursing home residents have tested positive for COVID and nearly 1,500 have died in total, according to data from the Centers for Disease Control and Prevention.

The experts agreed that the key to promoting vaccinations is building trust and open communication between care professionals and residents and their families.

“If you have a good relationship between your patients, your physicians or other providers… you really can move a lot of things.” Cauwels said. “People still, regardless of the politically charged nature of COVID, primarily listen to their doctors … That has benefitted us a great deal in many of these smaller, more rural communities.”

The Good Samaritan Society, an affiliate of Sanford Health, has seen unusual success with these strategies — with vaccination rates exceeding 50% for residents on average, according to Cauwels. Some of Good Samaritan’s facilities in South Dakota have even exceeded 90%.

Ultimately, addressing the still-present dangers of COVID in nursing homes will require a collective effort from the healthcare community, according to Gifford.

“To overcome this reluctance… requires us all to work closely together to do this,” he told McKnight’s. “About 85% to 90% of our admissions come from the hospital or directly from the community, yet only about 10% of them have been vaccinated prior to being admitted to the nursing home…. When they come in, they ask ‘Why do you say I need to be vaccinated when all the other places didn’t push the vaccine?’ So this has to be a collective effort. That’s really key.”