Two women with masks

Hawaii’s assisted living and other long-term care facilities are beating the odds — and national averages — by achieving an average 84% staff COVID-19 vaccination rate.

Hilton Raethel

“We have unprecedented statewide collaboration in the effort to vaccinate all healthcare employees,” said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, which counts among members assisted living communities, public and private skilled nursing facilities, Medicare-certified home health agencies, hospices, acute care hospitals, durable medical equipment suppliers and home infusion/pharmacies. “These efforts, along with extraordinary levels of employee education and communication by long-term care facilities, have laid the foundation in preventing COVID-19 in long-term care settings,” Raethel added.

The vaccination rate is up six percentage points from a February survey of assisted living communities, adult residential care homes and skilled nursing facilities, according to HAH. The state’s long-term care resident vaccination rate is 92%, which is an increase of two percentage points from February.

Patrick M. Harrison, HAH senior director for post-acute care, said that the high rates of vaccination can be attributed to one-on-one conversations with employees, vaccine choice, continuous education and information-sharing, and town hall meetings and huddles with medical directors for staff members, residents and families.

The Aloha State, he added, has the fifth-lowest rate of COVID-19 vaccine hesitancy in the nation, according to estimates from the Centers for Disease Control and Prevention. The state’s larger percentage of Asian and Pacific Islander populations — which culturally and historically show strong respect for elders — also contributed to vaccine uptake rates, he said. 

Patrick Harrison headshot
Patrick Harrison

“Hawaii tends to be a more tightly knit community because it is small and isolated,” Harrison said. “People in this environment can be more strongly influenced by what their co-workers, family members, neighbors and friends are doing.”

Nationally, a recent report from the Center for Public Integrity and National Public Radio cited an average of 50% of fully vaccinated long-term care workers as of mid-March. A National Investment Center for Seniors Housing & Care executive survey found staff vaccination rates averaging 64% in mid-April, an improvement from 55% in March. 

Vaccine mandates

Elsewhere, some providers have responded to lower-than-desired staff vaccination rates with mandates tied to employment.

woman getting vaccinated
Stephanie Adams, healthcare administrator at Presbyterian Village Hollidaysburg, a Presbyterian Senior Living continuing care retirement community in Hollidaysburg, PA, is vaccinated against COVID-19.

Dillsburg, PA-based Presbyterian Senior Living and the Jewish Home Family in Rockleigh, NJ, are the latest senior living providers to announce COVID-19 vaccine mandates for staff members.

At PSL, current staff members must be fully vaccinated by Aug. 31 to continue employment, whereas employees hired after June 8 will have 60 days from their first day of employment to comply. At Jewish Home Family, workers must receive their first dose by July 1 and ultimately become fully vaccinated.

“Although our staff vaccination rates are gratifyingly high — 85% at the Jewish Home at Rockleigh and 88% at Jewish Home Assisted Living — we believe that 100% vaccination is vital,” said President and CEO Carol Silver Elliott, who also is chair of the LeadingAge Board of Directors.

At PSL, President and CEO Jim Bernardo said, “The mutual respect we show our fellow teammates and the residents who choose to call a PSL community home must be a priority for our organization. We must listen to the voices of others who are clearly calling for our staff and resident population to be vaccinated so they may once again hold the hand of those they love.”

PSL Chief Operating Officer Dan Davis said the company struggled with opening communities for visitation, only to have to close when testing returned a positive staff case. Providers of senior living and care services, he said, have an “obligation” to residents and families.

“The emotional impact this has had on residents and their families has been devastating,” Davis said. “The only way we will be able to consistently welcome loved ones back to our communities is to ensure we have each done our part to combat this deadly virus.”

Atria Senior Living has achieved a 98% vaccination rate among staff members, and Silverado has seen a 97% rate through vaccine mandates. 

Other senior living providers that have mandated staff COVID-19 vaccinations include ALG Senior, American House Senior Living Communities, The Arbor Co., Civitas Senior Living, Continuing Healthcare Solutions, Enlivant, Five Star Senior Living, Juniper Communities, Integral Senior Living, Masonicare, Retirement Center Management and Sunrise Senior Living.


Other providers are turning to incentives to encourage vaccination.

Merrill Gardens, for instance, had prize giveaways for vaccinated workers, including a grand prize of five days of paid time off and $2,000 for a vacation. Bay Village, an IntegraCare assisted living and memory care in Annapolis, MD, received a signed certificate and visit from CEO Larry Rouvelas after all employees got the shot.

The Gardens at DePugh Nursing Center in Winter Park, FL, promised each vaccinated worker a $1,000 bonus — with a catch. Each worker received $100 after his or her first shot, with the remaining $900 coming when at least 75% of staff members were vaccinated. It worked, as the company is sporting a 92% vaccination rate.