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Federal Register / Vol. 86, No. 91 / Thursday, May 13, 2021 / Rules and Regulations
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TABLE 5ESTIMATES OF NUMBER AND VACCINATION STATUS OF RESIDENTS AND STAFFContinued Thousands Beginning of year 2021

New during 2021

Total for 2021

Percent vaccinated by March 31

Number vaccinated by March 31

Remaining vaccination candidates 2021

New candidates 1st quarter 2022

Total first year candidates

LTC Facility Staff
ICFIID Residents
ICFIID Staff

950
100
75

760
20
60

1,710
120
135

60
20
20

1,026
24
27

684
96
108

190
5 15

874
101
123

Total Persons

2,525

3,340

5,865

53

3,117

2,748

835

3,583

Residents Total
Staff Total

1,500
1,025

2,520
820

4,020
1,845

51
57

2,064
1,053

1,956
792

630
205

2,586
997

Total Persons

2,525

3,340

5,865

53

3,117

2,748

835

3,583

LTC Facility Total
ICFIID Total

2,350
175

3,260
80

5,610
255

55
20

3,066
51

2,544
204

815
20

3,359
224

Total Persons

2,525

3,340

5,865

53

3,117

2,748

835

3,583

Beginning of Year is roughly identical to average for year when population is stable.
Estimated number potentially needing vaccination in the first full year after March 31st.

As presented in the third numeric column of Table 5, the total number of individuals either residing or working in all of these different facilities over the course of a year is about 5.9 million persons, which is more than twice the annual average number of residents or staff shown in the first numeric column.
A new study, using data from detailed payroll records, found that median turnover rates for all nurse staff are approximately 90 percent a year.78 Due to these high turnover rates, LTC
facilities will require significantly more resident or staff vaccines compared to the total number of residents and staff in the facility at the beginning of the year. For example, when the Pharmacy Partnership completed its time commitment in LTC facilities, it probably had seen only about half of the persons who will reside or work in these facilities in 2021. Of course, most of these persons will have been vaccinated through other means when they enter the facilities during the remainder of 2021. That said, it is likely that there will be over one million residents and staff during the first year after this rule is published who will need vaccination. Much of the immediate need for LTC resident and staff education has already been accomplished through the Pharmacy Partnership for Long-Term Care Program. Even after the end of this program, remaining unvaccinated residents and staff will benefit from additional education, especially as additional information about vaccine safety and effectiveness is available.
Some resident education can take place 78 Ashvin Gandhi et al., High Nursing Staff Turnover In Nursing Homes Offers Important Quality Information, Health Affairs, March 2021, pages 384391.

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in group settings and some education will take place on a one-to-one level.
What works best will depend on the circumstance of the resident and the best method for conveying the information and answering questions.
Staff can use opportunities during normal day-to-day activities to educate the residents and their representatives if they are present on the immunization opportunities through the facility or its partners. Staff education, using CDC or FDA materials, can also take place in various formats and ways.
Individualized counseling, resident meetings, staff meetings, posters, bulletin boards, and e-newsletters are all approaches that can be used to provide education. Informal education may also occur as staff go about their daily duties, and some who have been vaccinated may promote vaccination to others.
Facilities may find that reward techniques, among other strategies, may help. In particular, the value of immunization as a crucial component of keeping residents healthy and well is already conveyed to staff in regard to influenza and pneumococcal vaccines.
The COVID19 vaccine education will build upon that knowledge.
The techniques for education and shared decision-making, where appropriate, are so numerous and varied that there is no simple way to estimate likely costs. Staff and resident hesitancy may and likely will change over time as the benefits of vaccination become clear to increasing numbers of participants in congregate settings. For purposes of estimation, we assume that, on average, 30 minutes of staff time will be devoted to education of each unvaccinated resident, resident representative, or staff person, at the same average hourly cost of $67.06 estimated for RNs in the
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Information Collection analysis. As for the recipients of such education, we assume that about three-fourths of them are residents, and one-fourth staff. We have little data on resident income but know that for most, Social Security or Supplemental Security Income are their principal sources of income.79 For estimating purposes, we assume that their time is worth about $10.02 an hour median income of older adults without earnings is $20,440 annually.80 Since residents are rarely in the labor market while in the facility, this base income has not been adjusted for fringe benefits or employer expenses. For staff, we estimate hourly costs of $27.38 based on BLS data for healthcare support occupations median of $13.69, doubled to account for fringe benefits and overhead.
We note that very little of this cost is likely to involve translation of documents, simply because very few documents are involved, and electronic and other assistance methods are so widespread. The vaccine information Fact Sheet required by FDA to be made available is already translated by FDA
into the eight most common nonEnglish languages in use in the United States and is downloadable online. For the Moderna vaccine, for example, see https www.modernatx.com/
covid19vaccine-eua/providers/
language-resources. LanguageLine or similar services are always available on call if needed for an oral explanation of 79 Only about 13% have private sources of payment. See Jose Ness et al., Demographics and Payment Characteristics of Nursing Home Residents in the United States: A 23-Year Trend, Journal of Gerontology: MEDICAL SCIENCES, 2004, Vol. 59A, No. 11, pp. 12131217.
80 Average income from Federal Reserve of St.
Louis at https fred.stlouisfed.org/series/
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