They’ve seen the death and suffering up close. As COVID-19 has ripped across Georgia, caregivers at nursing homes and other senior care facilities have had to struggle to contain the virus, break news to families when loved ones test positive and seen beds emptied as residents they’ve cared for over months succumb.
Just this week, the state surpassed 4,000 resident deaths in long-term care, with 709 of those deaths in January, the deadliest month to date. More than 25,000 residents have been infected.
Their caregivers haven’t escaped the toll, either. More than 14,000 have been infected. At least 29 have died of COVID as of mid-January, federal nursing home reports show.
Yet now that vaccines offer hope of ending the crisis, large swaths of the long-term care workforce are refusing the shots. That is confounding industry leaders as they race to fortify against more contagious strains of the infection. It is also threatening hopes of reopening senior care facilities that have been on lockdown since March.
“Because of the amount of death we’ve seen already, we want this to end,” said Deke Cateau, CEO of A.G. Rhodes, operator of three nursing homes in the Atlanta area. “I personally was looking at the vaccine as the light at the end of the tunnel. That was kind of a ray of light initially, but that ray has become a glimmer.”
Credit: Curtis Compton / Curtis.Compton@
Credit: Curtis Compton / Curtis.Compton@
Other health care providers are facing similar dilemmas. Even as demand for the vaccine in the state has far outstripped the supply during the first weeks of the rollout, the reluctance of a sizable percentage of frontline health workers to be inoculated has laid bare the challenges ahead to vaccinate the broader population and gain herd immunity.
Inoculations are hovering around 30% among workers in many health care facilities, particularly outside metro Atlanta, state health officials say they have been told.
Nationally, while close to 80% of nursing home residents have had shots during the first month of the inoculation campaign, little more than a third of workers have taken them, a new CDC report says.
“Some people, it’s just not even something they will consider,” said Neil Pruitt, CEO of Norcross-based PruittHealth, which operates nursing homes across the Southeast and has had workers die from the disease. “We feel like we’re talking people into saving their own lives by taking the vaccine. For me, the stakes are very high.”
When two vaccines were granted emergency authorization in December, with priority given to health care workers and residents and staff at nursing homes, administrators were expecting some reluctance. To overcome it, they knew they would have to educate those in their facilities about the shots and safeguards followed during their development.
They did that. But workers resisted from the start.
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com
Only a handful of PruittHealth facilities have 50% of staff vaccinated. Many are below 30%, according to data it posts on its website detailing each home’s vaccination rates.
At the company’s Palmyra nursing home in Albany, where 27 residents have died from the virus, only 9% of the staff have taken the vaccine.
To persuade more to step up, nursing homes have ramped up incentives, offering cash and other perks to try to encourage immunization.
“Some people, it's just not even something they will consider. We feel like we're talking people into saving their own lives by taking the vaccine. For me, the stakes are very high."
They’ve also doubled-down on education and outreach. PruittHealth has used its coronavirus call center to reach out to employees who have declined the vaccine. Some facilities have posted videos on social media when their executives and others at a facility receive the shots. They’ve held town halls with employees to hear their concerns and answer questions, while others have conducted surveys to understand employees’ views on the vaccine.
The Georgia Department of Public Health also recently launched a campaign to encourage health care workers to get vaccinated.
“Even heroes need COVID-19 vaccine,” their posters say, below the faces of healthcare workers. “Our best shot at ending COVID begins with you. Protect yourself. Protect your patients.”
Credit: Curtis Compton / Curtis.Compton@
Credit: Curtis Compton / Curtis.Compton@
Other efforts are targeting African Americans, who fill many jobs at long-term care facilities and hospitals. Former U.S. Health and Human Services Secretary Dr. Louis Sullivan has been enlisted to work with African American religious leaders in Georgia and other parts of the country to encourage their worshippers to get vaccinated, stressing that the vaccines are safe and effective.
“Shortcuts have not been taken,” Sullivan said, when asked about the widespread vaccine hesitancy of health care workers. “We have, from what I see, a scientific victory.”
Still, the message hasn’t broken through to many on the frontlines.
“There was a supposition that a lot of people would be willing to take the vaccine given what things have been like the past 11 months,” said Tony Marshall, president of the Georgia Health Care Association, the state’s largest nursing home trade group. “I think there’s a significant fear of the unknown...We’re still hopeful in terms of achieving a high level of vaccination rate.”
Doubts persist
Why are so many balking? Some believe vaccines were developed too quickly to be safe or cite religious objections or distrust in government. A legacy of medical experimentation that harmed minority communities weighs on others. Some just don’t want to be the first to take the vaccine without knowing long-term effects.
Shavon Lashley has worked as a traveling nurse during the pandemic, going to Texas and New York to help treat COVID-19 patients. The 37-year-old Henry County resident thus far has passed on opportunities to get the shot and knows many nurses who have done the same.
“Everybody has to make their own decision as far as what they’re going to do,” she said.
She said she wants more hard data and research to understand potential side effects. She said she’s also following a path she preaches to her patients: Choose what you feel is right when making personal medical decisions. To that end, she has requested case studies and other information on the vaccine program from the National Institutes of Health to understand the effects of the vaccines.
“We are setting the example for people, to be mindful of what they put in their body, like we’re trained to do as healthcare providers,” she said.
Others have come around.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
Chad Hamilton, a PruittHealth hospice nurse in Cordele, sees the impact of COVID on a daily basis as he makes his rounds to nursing homes in South Georgia. He also works part-time in the emergency room at a local hospital.
“There are days that you just get in the car, when you’re heading home, and you just cry,” he said.
He didn’t know what to believe with all the news and information swirling around when the vaccines were released. When one of his in-home patients, an 89-year-old retired school teacher, told him last month that she was getting the vaccine, he told her he didn’t trust it and had already made up his mind to decline.
She made a heart-felt appeal for him to reconsider. He did and got his second dose last week. Now, colleagues call and ask his advice: Should they get it?
“I’ve said if you’re not going to do it for yourself, do it for your patients,” he said. “I guess it just kind of opened my eyes. You just got to take that chance and trust and hope that it works out for the best.”
Keita Devero, director of nursing at PruittHealth’s The Oaks Athens, got the vaccine even though she had come through her own brutal bout with the virus.
She said she tested positive for COVID-19 last month on the day she was supposed to be vaccinated. Later, she had trouble breathing and wondered at times if she was going to make it.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
She got her first shot last week and said she did it in part to serve as an example for her staff, many of whom remain skeptical of the vaccine. Her story helped convince some to protect themselves by getting inoculated.
“I’m not gonna stop being the cheerleader for them becoming vaccinated,” she said. “I wouldn’t wish what I went through on anyone.”
Uncertain Times
Vaccine acceptance is an issue that policymakers will continue to face as the vaccine becomes more available to the wider population. A recent Atlanta Journal-Constitution poll found that roughly a third of adults across the state have doubts about the vaccine or won’t take it all.
There are lessons, however, in the early rollout with health care workers that may offer hope for those who want to see wide acceptance. Education and outreach seem to be working in some locations.
Credit: Courtesy: PruittHealth
Credit: Courtesy: PruittHealth
Dr. Kathy Hudson, chief medical officer at Phoebe Putney Memorial Hospital in Albany, said vaccine hesitancy, while certainly an issue, appears to be easing. Before the vaccine arrived, she said, the staff was close to being evenly split about taking it. But recent surveying indicates close to 70 percent of staff have either gotten the vaccine or plan to get it.
Hudson said the hospital is working on outreach in the hospital and outside of it. That effort includes offering one of Phoebe Putney’s physicians to speak to church groups and other community organizations.
“People are just afraid, afraid of the illness and afraid of anything new during uncertain times,” she said.
“There was a supposition that a lot of people would be willing to take the vaccine given what things have been like the past 11 months. I think there's a significant fear of the unknown."
Glen Nowak, a UGA professor and expert in public health communications who spent 14 years at the CDC, said he is “cautiously optimistic” that support of the vaccine will grow.
With the U.S. now seven weeks into the massive vaccination campaign, experts say the two authorized vaccines look remarkably low-risk and highly effective.
That, Nowak, says, “will make it hard to not want to be vaccinated if getting vaccinated helps people get back to life before the pandemic.”
Benefits of the vaccine, he added, “are pretty compelling.”
Credit: contributed
Credit: contributed
But expecting people to get vaccinated is far from a given, and Nowak said a highly visible public health campaign to educate people about COVID-19 vaccines combined with plenty of opportunities for people wary of vaccines to talk about their concerns is vitally important.
“You have to build trust, and building trust requires listening to people who have concerns,” he said.
Jessica Lanzo, a nurse at Emory Saint Joseph’s Hospital, is doing her part. She was a curiosity after she was one of the first on her COVID-19 unit to get the shot. She wears a “Vaccine Champion” pin, which prompts questions several times a day.
“Word spread like wildfire that I got the vaccine, and everyone was eager to ask me about it,” she said.
Reggie Pitts, a lead transportation attendant at Emory Saint Joseph’s, had what he calls serious doubts about the vaccine. But those doubts lifted, he said, after he attended a Q&A session held by one of the hospital’s doctors and got answers.
He recently got his second dose of the Pfizer-BioNTech vaccine.
“Now that I’ve done it, I’m really glad I’ve done it,” he said. “I think I’ve influenced some people in my department to get it done, too.”
