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COVID-19 Vaccination Coverage Among Nursing Home Staff

Updated: Sep 16, 2021

JAMA Intern Med. Published online September 16, 2021. doi:10.1001/jamainternmed.2021.5897


In this issue of JAMA Internal Medicine, McGarry et al1 show that COVID-19 vaccination rates among nursing home staff are unacceptably low, falling considerably behind that of nursing home residents. At less than 50%, the rates are lowest among certified nursing assistants (CNAs), who provide the most direct care. Certified nursing assistants bathe, dress, and groom residents. They help them eat. Physical distancing is impossible. A CNA with a positive SARS-CoV-2 test result is highly likely to transmit COVID-19 to a resident. For this reason, nursing homes would be the most sensible place to introduce a vaccine mandate, because unvaccinated nursing home staff present an imminent risk to the vulnerable residents in their care. A recent Biden administration initiative that would make federal funding for nursing homes contingent on the vaccination of their employees is an important step.2

Certified nursing assistants work extremely hard and have an immense positive influence on the care of nursing home residents. In general, CNAs are sorely underpaid and receive inadequate benefits, including sick leave.3 We believe low voluntary vaccination rates among CNAs suggests a failure of nursing home owners to effectively partner with their most essential workers and provides one more indication of the need to improve the pay and working conditions of this group.



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