When it comes to increasing vaccination rates against respiratory viruses, it’s not only important to educate senior living residents about the value of vaccines; it’s also important to educate their family members and people in the greater community.
“What goes on in the community works its way into assisted living settings,” David Gifford, MD, MPH, chief medical officer for the American Health Care Association / National Center for Assisted Living, told McKnight’s Senior Living.
During National Assisted Living Week, AHCA/NCAL is looking to get the word out about vaccinations against the big three respiratory diseases: influenza, COVID-19 and the respiratory syncytial virus, or RSV. Gifford said decisions about vaccines for senior living and other long-term care residents — particularly for residents living with dementia — often are made by family members, including their adult children.
Risk Less. Do More. is a national campaign from the US Department of Health and Human Services aimed at increasing awareness of, confidence in and uptake of vaccines that reduce severe illness from influenza, COVID-19 and RSV in at-risk populations. Gifford said he’s excited about this campaign because it addresses the value of vaccines, whereas past messaging was about who was eligible for vaccines.
The campaign is targeting older adults — especially those living in residential long-term care settings — along with family members, friends and healthcare providers, by delivering education about effective prevention measures and research-based messages through national, state and local organizations.
AHCA/NCAL is adding the Risk Less. Do More resources to its #GetVaccinated Toolkit, launched last fall, to incorporate information from HHS and the Centers for Disease Control and Prevention, which recently released its fall 2024/winter 2025 vaccination guidance.
Combatting vaccine fatigue
COVID-19 vaccine reluctance continues to be a challenge for senior living and other long-term care providers, Gifford said. The initial vaccine was “incredibly effective” at preventing infection, he said, adding that an increase in preventive measures to prevent the spread of illness — including masking and hand-washing — also “dramatically” reduced infections from influenza and RSV.
Those reductions in illness, including a drop-off in the number of deaths from COVID-19, have lulled people into a sense of security that the risk is over, Gifford said. The message now, he added, is about reducing risk for serious illness and hospitalizations among at-risk populations by getting vaccinated.
“The HHS campaign Risk Less. Do More. is nice in a sense that it captures this — don’t risk getting sick or going to the hospitals, and do something about it,” Gifford said. “Older people, and people with chronic disease and weakened immune systems, are all more susceptible to getting sick.”
Every winter, he said, older Americans living in assisted living communities, nursing homes or in homes in the greater community are hospitalized due to influenza, RSV and other respiratory viruses following family visits and holiday gatherings. Those individuals “do a lot worse, and hospitals fill up” due to viral infections and their effects on underlying health problems, including diabetes, heart failure and stroke, Gifford added.
“Our residents in assisted living, when they land in the hospital, they don’t do well,” he said. “They may be able to treat them when they’re in the hospital, but they always come back worse.”
What’s different today is the availability of three vaccines against the three most common respiratory viruses. Gifford said that, every winter, there is a 25% to 30% increase in the number of older adults who contract respiratory viruses. Getting everyone vaccinated, he added, can drive those numbers down.
Other strategies to reduce infection risk
The other message he has for providers is to tap into local public health resources. Public health organizations monitor the spread of respiratory viruses in the greater community. When those numbers start to increase, Gifford said, it’s time to start thinking about taking additional precautions, including suggesting that ill family members postpone their visits, encouraging masking and recommending frequent hand-washing and the use of alcohol wipes. Those strategies helped reduce the rates of influenza and other viral respiratory viruses, he said.
Although Gifford doesn’t promote a return to the hypervigilance of the pandemic, he said that “really good diligence” in preventing the spread of viruses can go a long way in reducing the risk for serious illness and hospitalization in at-risk populations. “Couple that with vaccines when there is a breakthrough, and you’re not going to get really sick, and you’re not going to go to the hospital,” he said. “Now your odds are better, and you might beat the house.”
Boosting staff vaccination rates
Vaccination rates in senior living communities and nursing homes, he said, often reflect what’s going on in the general community. It’s important to educate staff members and offer vaccines, Gifford said, but it’s just as important to listen to those who refuse vaccinations and empathize with their reasons.
“They have a reason, and if we don’t acknowledge and empathize with that reason, if we’re dismissive, we may not address what their concerns are,” he said. “A rising tide raises all boats — that’s what we need with this. We can’t do it alone.”
Another challenge for assisted living, Gifford said, is that in most states, providers are not allowed to administer vaccines to staff members, so operators need to schedule vaccination clinics. Getting those clinics scheduled in a short period of time, he added, also can be affected by staff members not wanting to receive multiple vaccines at once. New residents moving in and new hires joining a community also complicate scheduling of vaccine clinics. Smaller communities find it’s not economical to host vaccine clinics, Gifford said, so they face the additional challenges of sending people to a local doctor, pharmacy or vaccine clinic.
“It is a challenge, and I think if the country is committed to making sure older adults have easy access to vaccines, they need to figure out how to solve the problem and not let the free market handle it,” Gifford said, adding that the government should subsidize vaccine clinics.
