key: cord-0967099-jd3np9n4
authors: Ritter, Ashley Z.; Kelly, Jennifer; Kent, Robert M.; Howard, Pamela; Theil, Robert; Cavanaugh, Priya; Hollingsworth, James; Duffey, Joseph S.; Schuler, Mary; Naylor, Mary D.
title: Implementation of a COVID-19 Vaccination Condition of Employment in a Community Nursing Home
date: 2021-08-07
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2021.07.035
sha: 82a15ddd45c007ae4d331b3d3b9e36086317ad2f
doc_id: 967099
cord_uid: jd3np9n4

The rate of COVID-19 vaccination uptake by U.S nursing home staff remains low despite the increased risks of viral transmission and related morbidity and mortality in this setting. This study describes vaccine uptake activities including a COVID-19 Vaccination Condition of Employment (COE) policy in one community nursing home. This case study summarizes the timeline of vaccination uptake activities, staff vaccination rates over time, and stakeholder perspectives around the implementation of a COVID-19 Vaccine COE. Organizational data were used to calculate vaccination rates from January 1st, 2021 until May 1, 2021 among all nursing home staff. Interviews were held with the executive leadership team, human resources leadership, and nursing home staff to understand the process of implementation. During a 4-month period, nursing home leaders provided 8 written handouts about COVID-19 to all staff, hosted 5 on-site vaccination clinics in partnership with area pharmacies, conducted 2 virtual presentations for staff in addition to individual outreach and internal communications. Fewer than half of the staff were vaccinated prior to the decision to pursue a Vaccine COE on February 9th, 2021. The decision to pursue a COVID-19 Vaccine COE was supported by executive leadership and nursing home staff to protect the health and safety of each other and their residents. By May 1st, 2021 a total of 221 of the 246 (89.8%) nursing home staff members received a COVID-19 vaccination. The facility reached 100% compliance with the Vaccine COE policy with 18 people who chose to resign and 7 people who were exempt or on a leave of absence. In combination with frequent, personalized outreach, a COVID-19 Vaccine COE resulted in high staff vaccination rates and minimal staff turnover. This case study provides a detailed summary of vaccination uptake activities within an organizational context to inform efforts at other healthcare facilities.

resulted in full vaccination for more than 4.9 million nursing home staff and residents. 5 44 Uptake of the vaccine among nursing home staff remains sub optimal to prevent future 45 COVID-19 outbreaks in this high-risk setting, with roughly 42% of nursing home staff 46 unvaccinated as of July 2021. 6-8 Low COVID-19 vaccination rates among nursing home staff and 47 persistent circulation of variants of SARS-CoV-2 in the community threaten recurrent COVID-19 48 outbreaks in nursing homes that jeopardize the delivery of care, the financial stability of this 49 setting, and most importantly residents' lives. 9 50

Thoughtful consideration of vaccination uptake activities is required to protect the 51 safety of residents and staff in nursing homes to protect against future deaths and disruptions 52 in care. This case study documents the implementation of vaccination uptake activities and 53 

the institution, adequate time for preparation and information gathering, and transparent 250 communication. Further investment in vaccination uptake strategies and activities including a

COVID-19 vaccination COE will help to stabilize nursing home care delivery and upholds the 252 responsibility of nursing homes to keep staff and residents safe

Conflict of Interest Statement: The authors of this paper have no conflicts of interest to report. for Medicare and Medicaid Services. Covid-19 Nursing Home Data

Nursing home care in the wake of COVID-19

Front-line nursing home staff experiences 263 during the COVID-19 Pandemic

Understanding the Pharmacy Partnership 266 for Long-Term Care Program

Willingness of long-term care 272 staff to receive a COVID-19 vaccination: A single state survey

Someone like me": Understanding COVID-19 275 vaccine hesitancy among staff in skilled nursing facilities

282 Variation in SARS-CoV-2 prevalence in U.S. skilled nursing facilities

Key guidelines in developing a pre-emptive 285 COVID-19 vaccination uptake promotion strategy

Behaviorally informed strategies for a 288 national COVID-19 vaccine promotion program

US public attitudes toward COVID-19 vaccine 291 mandates