Fewer vaccine programs part of ‘critical vulnerability’ in assisted living
LOS ANGELES: A newly published study finds that assisted living communities consistently had fewer vaccination programs than nursing homes across all vaccine types. That lower coverage, combined with higher perceived risks in the setting, the authors write, “underscores a critical vulnerability in ALs.”
Researchers from the Scripps Gerontology Center at Miami University in Oxford, OH, compared the prevalence of vaccination programs between assisted living and nursing homes in the Buckeye State. They shared their results in an article in press in JAMDA – The Journal of the Post-Acute and Long-Term Care Medical Association.
Using data from the 2023 Ohio Biennial Survey of Long-Term Care Facilities of all licensed assisted living communities and nursing homes in the state, the researchers analyzed the presence of programs for seven vaccination types: influenza; COVID-19; respiratory syncytial virus, or RSV; pneumococcal; hepatitis B; shingles; and tetanus, diphtheria and pertussis, or Tdap. The survey garnered responses from 623 assisted living communities and 736 nursing homes on questions related to vaccinations.
The investigators looked at the prevalence of adult vaccination programs across both settings as well as whether having vaccination programs was associated with fewer hospital transfers and fewer instances of temporary admission suspensions due to vaccine-preventable disease outbreaks.
They said that their findings suggest a potential opportunity for providers and policymakers to expand the scope of immunization efforts in long-term care, particularly in assisted living communities, where medical oversight is less regulated than in nursing homes.
Assisted living communities consistently had fewer vaccination programs than nursing homes across all vaccine types, the researchers found. Eighty-five percent of assisted living communities, for instance, had pneumococcal programs, compared with almost 100% of nursing homes.
Assisted living communities also were less likely to report having programs for RSV (50% compared to 76% in nursing homes), hepatitis B (56% versus 80%), shingles (47% versus 72%) and Tdap (38% versus 58%). Coverage was closer for influenza, however, with 99% of assisted living communities having programs versus 100% of nursing homes.
Studied assisted living communities also consistently reported higher transfer rates to hospitals than did nursing homes, across all of the conditions examined, with 90% of assisted living respondents reporting some or frequent transfers of residents for influenza and COVID-19. By comparison, nursing homes reported transfer rates of 28% for influenza and 39% for COVID-19.
Similar patterns emerged for pneumococcal disease, with 85% of assisted living communities versus 47% of nursing homes reporting hospital transfers, and RSV, with 50% of assisted living communities and 24% of nursing homes reporting transfers. The perceived risk for transfer for hepatitis B, shingles and Tdap also notably was higher in assisted living communities.
Previous research showed that assisted living communities often have fewer resources for infection prevention, fewer medical and clinical staff members, and greater variability in care provided compared with nursing homes, the authors noted.
“The combination of lower vaccination program coverage and higher perceived risk underscores a critical vulnerability in ALs,” they wrote. Having a vaccination program doesn’t eliminate the possibility of an outbreak, but it may reduce the likelihood and severity of one, they added.
Despite government-funded vaccination programs that result in increased vaccination uptake in older adults, vaccination goals remain unmet in senior living and care, the researchers said.
Limited education on vaccine benefits, cost or insurance gaps, staffing shortages and billing challenges are known common obstacles to vaccination, they added. Those barriers often are more pronounced in assisted living because such communities operate with fewer clinical resources and less regulatory oversight than nursing homes and primarily rely on residents’ personal funds rather than government reimbursement, the authors said.
“The absence of structured vaccination programs in ALs may intensify outbreak risk, lead to higher hospitalization rates, and strain acute care systems,” according to the study. “Addressing these gaps will require targeted policy interventions, resource allocation, and stronger educational initiatives aimed at both staff and residents.”
Increasing awareness of vaccine benefits, they wrote, can help counter complacency and build trust in immunization efforts.