A nursing home in a large metropolitan area received technical assistance from Health Services Advisory Group (HSAG), a Centers for Medicare & Medicaid Services (CMS) Quality Innovation Network-Quality Improvement Organization (QIN-QIO), to improve its resident COVID-19 booster rate.

During initial contact with nursing home leadership, HSAG identified opportunities to build on the facility’s strong leadership and motivation to improve resident booster rates. The primary areas of focus were (1) addressing vaccine hesitancy with motivational interviewing (MI), town halls, educational materials, and peer ambassadors; (2) encouraging vaccine clinics and making them available to both nursing home residents and family members; and (3) providing technical assistance to update data on resident booster rates. HSAG created an action plan for the facility to reinforce best practices already implemented and provide evidence-based resources to address these areas of focus.

According to data from the National Healthcare Safety Network (NHSN), the facility’s nursing home resident COVID-19 booster rate was 13.3 percent at the time of initial referral in January 2022. After HSAG’s assistance they reached and maintained a 100 percent nursing home resident booster rate as of July 2022, for a total 86.7 percent increase.

Addressing Vaccine Hesitancy with Motivational Interviewing, Town Halls, Educational Materials 

The nursing home reported that most of the residents identified as culturally Armenian. The infection preventionist noted that vaccine hesitancy was a significant challenge among these residents. This is in alignment with previously reported vaccine hesitancy among Armenian Americans in the area due to historical distrust of the government stemming from genocide and upheaval. With the support of HSAG, the nursing home implemented a multipronged plan, including MI; medical director town halls with nursing home staff, residents, and their families; educational materials about vaccines; and an informal peer ambassador program.

The nursing home was committed to improving resident booster rates and had already initiated one-on-one conversations to meet residents where they were, learn more about their hesitancy, and provide information. The HSAG Full Speed Ahead! COVID-19 Vaccine Booster Quickinar Series and Office Hours included an MI webinar to reinforce these practices and support these efforts.

Additionally, the nursing home medical director hosted several town halls with staff, residents, and their families to answer questions about COVID-19 vaccines and boosters and to provide a forum to address any concerns. These efforts increased vaccine confidence. HSAG also encouraged the facility to display posters and educational information from the HSAG Vaccine Booster website to ensure that nursing home residents had clear, accurate information about vaccines and COVID-19.

Peer Ambassadors are Important to Adoption of Vaccines and Boosters

An important element of the plan to increase vaccine confidence was the use of peer ambassadors. The nursing home made bracelets that said “I’m vaccinated” to create peer support for adoption of vaccines and boosters. Several nursing home residents were seen as peer leaders in the facility, and once they got vaccinated, it encouraged other residents to get vaccinated.

Vaccine Clinic Partnership Facilitates Vaccination of Residents and Their Families

The facility established a relationship with a pharmacy to provide vaccines and boosters and was able to arrange vaccine clinics, as needed, in as short as a two-day turnaround time. When the facility hosted a clinic, it included both nursing home residents and family members, to promote adoption of the vaccine in the community of individuals who might encounter the residents. After nursing home resident vaccination and booster rates reached 100 percent, the facility continued to track all new resident admissions to ensure that each individual is up to date on COVID-19 vaccinations and boosters.

Technical Assistance to Update Data

HSAG provided technical assistance to facilitate current and accurate reporting of nursing home resident vaccinations and boosters. The facility is in a state which uses the state’s department of public health as a data intermediary reporting into NHSN. Nursing homes report data to the state, and the state reports that data to NHSN on behalf of the providers. The facility attended HSAG office hours on NHSN, as well as HSAG webinars addressing frequently asked questions, challenges, and barriers with accurately reporting data into the state reporting system. At the time of referral, the facility’s resident COVID-19 booster rate was reported as 13.3 percent. It was identified that a data entry error was the cause of the low rate. After the data were corrected, the reported nursing home booster rate increased to 70 percent. After implementing targeted strategies, such as vaccine clinics, town halls, MI, peer ambassadors, and educational resources, the facility’s reported resident COVID-19 booster rate rose to 100 percent. The nursing home has maintained this rate and continues to use these successful strategies.

All nursing homes in the two-state region served by HSAG and referred to the QIN-QIO for assistance between January 2022 and July 2022 saw a 21.3 percent net increase in resident vaccination/booster rates compared to nursing homes in the same region that were not referred to HSAG. In addition, the percentage of fully vaccinated and boosted residents at nursing homes referred to HSAG for assistance during that time increased by 37 percent, compared to the percentage of fully vaccinated and boosted residents at nursing homes that were not referred to the QIN-QIO, which increased by only 7 percent.

HSAG’s Regional Nursing Home Resident COVID-19 Vaccination/Booster Rates, Including Referrals from January 2022 through July 2022.

The graph compares vaccination rates of CMS-referred facilities (orange) with never-referred facilities (blue) and only includes referrals made between January 9 and July 2022. Never-referred facilities did not meet initial criteria for booster referral because CMS focused on facilities with significantly lower rates.

This material was prepared by The Bizzell Group (Bizzell), the Data Validation and Administrative (DVA) contractor, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. 12SOW/Bizzell/DVA-1117-07/18/2023