Hillcrest Commons Building 2 (copy)

A COVID-19 surge devastated Hillcrest Commons Nursing & Rehabilitation Center last winter, in the deadliest long-term care outbreak in Berkshire County. Now, the facility holds another distinction — one of the highest rates of vaccinated staff in the county. 

As last winter’s coronavirus surge slowed, and the vaccine rollout sped up, long-term care industry leaders set an ambitious goal: 75 percent of all long-term care staff vaccinated by the end of June.

The country missed the mark, but Berkshire County nearly hit the target.

According to an Eagle analysis of data from the Centers for Medicare & Medicaid Services, 74 percent of staff at long-term care facilities across the county have been vaccinated fully against COVID-19, a rate higher than Massachusetts, at 70 percent, and the nation, at 58 percent.

“We’re very pleased [with the vaccine rollout],” said Lisa Gaudet, vice president of communications at Berkshire Healthcare Systems, which operates facilities across the county. “It was kind of that light at the end of the tunnel we were hoping for. You never know until you get there: Will it be as effective as everyone was hoping it would be? And it has proved to be that way for us. That’s a tremendous relief.”

Since the rollout began, COVID-19 risk to local long-term care residents has plummeted.

Resident vaccination rates surpass 90 percent in almost every county facility, and overall virus spread has slowed to a crawl. Statewide, long-term care cases have plateaued, according to Department of Public Health data.

But, staff vaccination rates in the county are not uniformly high. Instead, they vary widely by facility, from below 50 percent to nearly 90 percent. Large portions of the staff remain unvaccinated at some nursing homes, at a time when health experts have begun to urge caution about the spread of the delta variant in the United States.

Even when COVID-19 cases among staff do not pose a direct threat to the health of most residents, infections can disrupt life at facilities, shutting down visitations and activities. In April, Williamstown Commons had to suspend visits to one unit after two staff members tested positive.

Above state, national averages

Of the 13 Berkshire County long-term care facilities tracked by the CMS, nine fall above the Massachusetts average staff vaccination rate. All but one beat the national average. Almost half have met the industry’s 75 percent target, and several more are close behind.

All rates are reported by the facilities to the CMS. Most of the staff vaccination rates analyzed by The Eagle come from the CMS report for the week ending June 20. Williamstown Commons Nursing & Rehabilitation Center and North Adams Commons Nursing & Rehabilitation Center did not include vaccination data in that report, but they reported vaccination rates for the weeks ending June 6 and May 30, respectively.

In many facilities, the numbers are promising. At Hillcrest Commons Nursing & Rehabilitation Center in Pittsfield, the site of the county’s deadliest long-term care outbreak, close to 80 percent of the staff are fully vaccinated. Mount Carmel Care Center in Lenox and Berkshire Place in Pittsfield have the county’s highest rates, at 85 and 89 percent of staff, respectively.

But, vaccination rates have lagged at other facilities, even several that experienced virus outbreaks: Williamstown Commons, Kimball Farms Nursing Care Center in Lenox and Lee Healthcare. At Williamstown Commons, where the virus struck hard during the early weeks of the pandemic, more than one-third of staff remain unvaccinated, according to the CMS data.

Lee Healthcare had the lowest staff vaccination rate in the county, with 54 percent of staff still unvaccinated, according to the CMS. The facility also reported, as recently as June 20, that 25 percent of residents in the facility are unvaccinated, an outlier among local facilities. Next Step Healthcare, which owns Lee Healthcare, did not respond to The Eagle’s request for an interview.

‘A lot of questions’

Vaccine hesitancy has taken many forms across the country, and fears and concerns that played out in the general public also have taken hold in long-term care facilities.

Gaudet attributes some of the hesitancy at Berkshire Healthcare facilities to misinformation and distrust of the medical system.

“Certain ethnic groups, understandably due to historical or personal experiences, have a bit of skepticism when it comes to this,” she said. “Some people, it’s very much about their religious beliefs.”

Across Berkshire County, people in their 20s remain among the least vaccinated of all eligible age groups. Gaudet says she has seen hesitation among younger staff in the company’s facilities, though age has only been one factor.

She also has heard of some young women not taking the vaccine because of fertility concerns. The Centers for Disease Control and Prevention says there is no evidence that vaccines impact fertility.

At Mount Carmel, vaccine uptake started slow and ramped up. When CVS first showed up to administer vaccines in early January, only about two out of every three staff members wanted it, said George Mercier, the facility’s administrator.

“There were a lot of questions,” he said. “[The staff members] were just being careful with what they put into their bodies.”

Many hesitant staff saw that those who got vaccinated had few negative side effects, Mercier said, and changed their minds. When vaccinators came back to administer second doses, some employees opted to get their first shot, and the rates continued to rise over the next weeks and months.

Like Berkshire Healthcare facilities, Mount Carmel continues to test unvaccinated staff each week. Vaccinated staff no longer are tested regularly.

Encouragement, education and mandates

Mercier understands the uncertainty and hesitancy that have plagued nursing home workers. He suspects that being among the first people to get vaccinated, outside large-scale clinical trials, made it a more stressful decision for some health care workers.

“We were put in a situation where we had to make a decision based on what we knew at the time,” he said. “[At] nursing homes, we were among the first to get vaccinated because we got hit the hardest. So, I think, because of the severe consequences of not having the vaccine, people were persuaded to err on the side of caution” and get the shot, he says.

For the holdouts, Mercier said, conversations proved an effective tool.

“It’s a small facility, and we operate more like a family than an institution,” he said. “The communications are personal, direct and based on trust.”

Berkshire Healthcare has made similar efforts to increase rates, including pairing staff members with similar backgrounds for peer-to-peer education and tapping younger leaders in the company to encourage others.

“We find that personal relationship with a leader,” Gaudet said. “It could be a unit manager, administrator, medical director. We try to leverage who already has relationships with them and who can go have a conversation with them, to see what might be the barrier they’re up against.”

Across the state, nursing homes have deployed education, peer outreach and incentives, such as gift cards and giveaways, to increase staff vaccination rates, says Tara Gregorio, president of the Massachusetts Senior Care Association.

“While vaccine hesitancy among frontline health care workers in general persists, we continue to work with medical professionals and state public health authorities to increase the percentage of vaccinated nursing home staff,” she wrote in a statement to The Eagle.

Spurred on by hospitals requiring vaccinations, one major long-term care company recently announced a vaccine mandate. Legacy Lifecare, which has nearly 1,800 employees, said Wednesday that its mandate will go into effect once the Food and Drug Administration grants full approval to at least one of the three COVID-19 vaccines now authorized for emergency use in the United States.

Berkshire Healthcare already has started requiring new staff members to be vaccinated as part of the hiring process, Gaudet said, and a mandate for current staff has begun to look like a possibility.

“We’re actively talking about that,” Gaudet said. “It’s something that, as a responsible health care organization, we should be talking about.”

She said the discussion will involve significant input from across the organization, as well as all the evidence available on vaccines. The company likely will make a decision “in the not too distant future.”

Mandates could make it harder for facilities to retain staff, Gaudet acknowledged, in an industry that has struggled with labor shortages. But, as she sees other facilities begin to implement mandates, she wonders if a consensus across the state to require vaccinations might ease the burden on individual facilities.

“I’ll be interested to see how it plays out,” she said. “It would be more pressure on [the] staffing side of things initially, but, hopefully, in the long run, it’d create safer environments for everyone.”

Francesca Paris can be reached at fparis@berkshireeagle.com and 510-207-2535.