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Every day Tamara Blue was out of work and battling her own case of COVID-19, she would get a call: Another person she loved had died. Someone else was being rushed to the hospital.
While Blue, a certified nursing assistant at a nursing home in Detroit, was spending her days at home struggling to breathe and praying to live in April 2020, the people she considered to be like her family — her patients — were spending their last moments alive in a hospital.
“I lost over half of my patients at the nursing home,” said Blue. “While I was out, all of my favorite patients passed away. It’s very traumatic. We lost so many residents, and they’re like your extended family because you spend so much time with them.”
Like health care workers across the country, the pandemic has left deep scars on Blue. Her life, she said, has never been the same since it began.
“It took me a year to go back to the nursing home because COVID has left a fear in me to this day,” she said. “My breathing has never been back to normal. I still take COVID tests every day. I can’t get past my fear of COVID. I’m working now, and I’m praying every day. For the love of our job and our patients, [nursing home workers] push by this every day. We live this every day; we live in constant fear.”
To alleviate some of that fear, Blue received her COVID-19 vaccine in January.
“It gave me a sense of relief, like, ‘OK, I can almost live again,’” she said. “When I was able to get the vaccine, it was like a calmness, like, OK I cannot be contaminated or contaminate others.”
It certainly hasn’t been a cure-all. There’s a deeply rooted anxiety surrounding both the disease — having COVID-19 was “the scariest time in my life,” Blue explained — and, now, the fast-spreading Delta variant that currently makes up about 83% of all COVID-19 cases in the United States. But, it has left her feeling as though she could return to her job, and to some social functions — including when she introduced Vice President Kamala Harris at an event urging Detroiters to get vaccinated earlier this month.
And, she said, the way out of this pandemic, the way out of at least some of this trauma and pain, is people getting vaccinated. That’s why Blue has become an advocate. She has convinced family members to get immunized; she has partnered with her union, SEIU Healthcare Michigan, to reach people about the vaccine; and she routinely speaks with colleagues and others in her community who so far have not been vaccinated.
‘People don’t want to be a guinea pig’
Blue said she understands why some of her health care colleagues haven’t gotten the vaccine.
“People don’t want to be a guinea pig,” she said. “A lot of people are worried this is the way for the government to take them out. We don’t know everything about the [vaccine] yet, but when you look at COVID and the damage it does on our bodies, I’d rather deal with the unknowns of the medicine. COVID has torn up my lungs, and that’s with a mild case of COVID. We’ve seen what COVID does to people. You will fare better with the medicine than you will with COVID.”
That message is one that health experts hope will reach and resonate with more nursing home workers, about half of whom have received a COVID-19 vaccine in Michigan. While the pandemic wreaked havoc on nursing homes, leaving a trail of deep trauma and death in an industry that became one of the most dangerous workplaces in the country because of COVID-19, employees in those facilities have been slow to seek vaccinations.
About 50.9% of nursing home staff have been fully vaccinated in Michigan, according to the Centers for Medicare and Medicaid Services. Comparatively, 53.6% of eligible Michigan residents have been fully vaccinated, the state Department of Health and Human Services reports.
Just 7% of Michigan’s nursing homes — 32 facilities — have reached the 75% of vaccinated staff that health experts recommend. A far greater percentage of nursing home residents — which witnessed a tremendous amount of death during the pandemic, in the state and nationwide—have been vaccinated. About 79% of individuals living in Michigan nursing homes have been fully vaccinated, according to the Centers for Medicare and Medicaid Services.
According to the most recent state data, 5,677 long-term care facility residents and 77 staff have died from COVID-19, accounting for about 30% of the state’s total COVID-19 deaths.
Nationally, 58.% of health care workers and 81.3% of residents in nursing homes have been fully vaccinated — greater than the 57.2% of eligible U.S. residents who have been fully vaccinated, according to federal statistics.
Misinformation, structural racism are factors
The reasons behind the lagging vaccination numbers in Michigan’s nursing homes are complex and are often rooted in misinformation about the vaccine and mistrust of the medical field, particularly among Black and Brown workers facing structural racism in the health care industry, said Dr. Sheria Robinson-Lane, an assistant professor, gerontologist and expert in palliative care, long-term care and nursing administration at the University of Michigan’s School of Nursing.
Robinson-Lane also explained some of the vaccine hesitancy comes from the fact that employees do not trust their employers after working through a pandemic in which they were not provided adequate personal protective equipment (PPE) while working low-wage jobs that put them at a high risk of contracting COVID-19.
“It’s a deeply layered issue,” Robinson-Lane said. “There’s quite a bit of misinformation that’s taken place. There’s still the belief that vaccines are putting microchips inside of individuals; there’s still information circulating that the vaccines aren’t approved by the FDA [Food and Drug Administration], that the emergency process of approvals aren’t really safe.”
These conspiracy theories around microchips and FDA approvals are false, but they have persisted, and Robinson-Lane emphasized that it’s important for health professionals, educators and community leaders to address those falsehoods with both empathy and correct information.
“For a while, there was a dismissiveness around the implanting of the microchips or that vaccines were adjusting DNA,” Robinson-Lane said of the response to vaccine misinformation. “Not understanding these were deep beliefs that people held, people didn’t address that. We need to validate this is a legitimate concern individuals have and walk them logically through the science of why these concerns can’t be the case.”
Additionally, to correct this misinformation, as well as address structural racism in the medical field, Robinson-Lane said it’s crucial for trusted community leaders who live in, or have long been engaged with, marginalized communities to work with individuals who are hesitant or opposed to the COVID-19 vaccines.
“We can address a lot of these concerns through forums where people are able to talk about these concerns in a way that feels open and with trusted individuals from the community, whether they be nurses or doctors or scientists who are part of those communities,” she said.
Those trusted individuals are especially important for Black and Brown individuals whose past health concerns have been dismissed by medical professionals.
“When it comes to medical mistrust, and particularly individuals who are Black or Latino, these are individuals who have deep histories of racism and mistreatment within the medical system,” Robinson-Lane said. “There are many instances when they’ve brought forth medical concerns and have been dismissed or have been treated differently regarding important health concerns.”
SEIU Healthcare Michigan President Andrea Acevedo, whose union represents more than 6,000 nursing home employees in the state, has worked to increase nursing home staff vaccination rates by connecting workers with both experts and peers who can share their experiences with getting the COVID-19 vaccines.
“We’ve had experts come in to talk to workers, we’ve had webinars, we’ve emailed; we’ve treated this vaccination education effort as we do a political campaign because we feel it’s so important,” Acevedo said. “We feel this could be a life or death choice, and we want people to be able to make the right choice.”
Acevedo, who was vaccinated in early January, said she and other union members, including Blue, have shared their stories with nursing home employees, among others, with the hope that those who are on the fence about the vaccine will feel increasingly comfortable getting it.
“I was very open and honest about it and answered any questions members had,” she said. “I let them know that getting the vaccine was about protecting me, about protecting my family and protecting my community.”
Mistrust of employers
The lack of protective equipment at work during the pandemic has also left employees hesitant, or outright opposed, to accepting their employers’ recommendations to get the vaccine because they don’t trust them, Robinson-Lane explained. Blue said that her employer, a Detroit nursing home, did not provide necessary protective equipment throughout the pandemic — particularly in the beginning last year, when workers were not only told they could not wear masks but had masks removed from them if they wore them.
“The [SEIU Healthcare Michigan] union had to bring equipment in for us because they did not give us the proper equipment we needed,” Blue said. “Then when city officials or the state came in, the equipment magically appeared. They gave us one mask and said, ‘This is all you’re going to get.’ If that mask broke, you had to find a way to fix it because that’s all you had.”
This situation was widespread across the state and country, Robinson-Lane said.
“There’s overall medical mistrust that started from the beginning in the way that the pandemic was handled and the way information was delivered,” Robinson-Lane said. “A lot of facilities didn’t have [personal protective equipment] available; facility staff weren’t able to bring in their own equipment. During this whole process, people were dying. No more did we see the extent of this happening than in long-term care facilities.”
And, while workers were being paid low wages and receiving the necessary protective equipment to work in high-risk jobs, they were also seeing their workload skyrocket as the staffing shortage worsened significantly. Blue, for example, would take care of around 10 to 12 patients per shift prior to COVID-19; now, that has increased to 32 patients.
According to the American Association of Retired Persons [AARP], 33.9% of Michigan nursing homes are facing staffing shortages.
“We’re the least paid and the least appreciated in the field,” Blue said of certified nursing assistants at nursing homes. “You’re paying us minimum wage, and we’re giving our all. Our pay does not reflect what we show up to do. Most of us are struggling; most of us cannot afford a car or rent or health insurance or groceries for our kids.”
There’s a strong connection between feeling valued and getting vaccinated, Robinson-Lane, Blue and Acevedo said. If someone feels as though their employer values their work, they may be more willing to respect their opinion on something like a vaccine, Robinson-Lane explained.
Mark Hornbeck of AARP Michigan said his organization is pushing for nursing home staff to earn higher salaries, particularly because of the issues that have come to light during the pandemic — such as nursing home employees working long hours under severe staff shortages for little pay.
“Michigan’s getting a lot of federal stimulus dollars, and we are advocating that a chunk of that money goes to improve the situation in nursing homes,” Hornbeck said.
Acevedo also called on the state to invest federal stimulus dollars “into long-term care.”
“We need to invest in this industry so folks want to work in it,” she said.
Part of that investment, Acevedo said, should include allocating stimulus dollars for what’s known as “hero pay.” Under the American Rescue Plan, state legislatures can give up to $25,000 per essential worker—including those in nursing homes — in what is essentially meant to be back hazard pay.
More directly, nursing home workers should be “incentivized for taking the vaccine,” Acevedo said.
“Detroit teachers are getting $500 to get the vaccine,” Acevedo said. “We need to incentivize nursing home workers to get the vaccine. They also need to be supported and given paid time off and recovery for being ill. At the beginning of the pandemic, if they had [COVID-19] symptoms, they had to choose between paying their bills and supporting their children or going to work and hoping they don’t have COVID.”
Of course, the better working conditions are ultimately about far more than workers getting the vaccine. It’s about valuing people caring for an aging population, Blue emphasized.
“I speak for a community of people working in grocery stores and fast food restaurants and nursing homes who sacrifice every day,” Blue said. “We deserve to be treated with respect and dignity.”
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