Op-Ed: How to protect family members in nursing homes from COVID

Dr. Neil Skolnik

The COVID-19 pandemic has caused more than 130,000 deaths among nursing home residents. And while vaccines have done some good to decrease the rate of infections, hospitalizations and deaths, we're at the beginning of an unfortunate trend — cases in nursing homes are on the rise again.

Over the past two months, the rate of COVID-19 cases in nursing homes has increased by more than 10 times, and the rate of nursing home deaths from the disease has increased more than five times.

Neil Skolnik in protective gear

There are multiple reasons for this increase. The delta variant is highly contagious. When it gets into a nursing home, it can sweep through the building like a spark lighting on dry tinder. And while vaccination is effective, its efficacy diminishes over time. The combination of the delta variant and waning immunity has led to a decrease in effectiveness against infection. In nursing homes, early on it was about 75% effective. Now that rate has dropped to 53%. And finally, delta often gets into a nursing home because someone, often an unvaccinated staff or family member, brings it in.  

Many nursing homes do all they can to protect their residents. Some don't. And vaccination rates for patients vary by state: They tend to be on the higher end in Vermont and Maine, where the lowest rate was 72%. But in Florida, for example, the percentage of vaccination overall is lower, with one home having only vaccinated 10% of residents. Even within a state, rates of vaccination fluctuate. In Pennsylvania, where I practice, some homes have a patient vaccination rate of around 70%, others 95%. 

The Biden administration announced that it would be making vaccination of staff mandatory for all nursing homes, and the mandate could begin at some point this month. When it is implemented, it will be an important step in protecting one of our most vulnerable population groups.

But we don’t need to wait until then to do something. Here are four things you can do now when choosing a nursing home or caring for a loved one who already is in nursing home in order to keep them safe: 

► Ask when the most recent case of COVID-19 was in the facility. Nursing homes are not obligated to proactively let you know. But if you ask, they can and should tell you. If facility officials attempt to use privacy laws (or HIPAA) as an excuse not to divulge information, call them on it. Individual patient information is protected under that law. Facility data can be shared. That also goes for officials divulging whether there has been a recent outbreak under their watch. 

► Ask about resident and employee vaccination rates. See how the facility responds to your question. Are they transparent? You can also get that information from the Centers for Disease Control and Prevention's website, where nursing homes are required to submit weekly data.

► Ask about the visitation policy for unvaccinated family members. Because one case of COVID-19 brought into a facility can infect many patients, strict policies are safer policies. All visitors should be required to demonstrate proof of vaccination. Demand that visitation requires vaccination.

►Ask whether participation in group activities for residents of the nursing home requires vaccination. You do not want your loved one playing Bingo next to an unvaccinated resident. At a minimum, if a patient is unvaccinated, they should have to wear a mask and be at least 6 feet away from others in the group. 

Family members often feel helpless, but in fact they have a lot of power. Nursing homes care what they think. By taking an active role, asking the right questions and choosing facilities that demonstrate best practices, we all help nursing homes (many of which are overworked and understaffed) stay focused on their core mission — excellent and safe care for some of the most vulnerable among us.

Dr. Neil Skolnik is a professor of family and community medicine at the Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia and associate director of the Family Medicine Residency Program at Abington Jefferson Health in Montgomery County.