Throughout the pandemic, nursing homes have struggled to get staff to fully accept vaccinations. That's especially troubling given residents' extreme vulnerability to coronavirus infection.

But are some facilities worse than others and, if so, why?

A cross-sectional analysis of federal National Healthcare Safety Network facility-level data through the week ending July 18, 2021, reports that vaccination rates among nursing home staff fall about 20% behind residential rates. 

Certified nursing assistants fell 30% behind, while therapists, physicians and independent practitioners trailed by 4%-10%.

Staff rates were highest in nonprofit and nonchain homes, and in facilities with higher Medicare ratings and longer-tenured staff.

Homes tended to conform to regional patterns, and those located in counties with higher Republican margins in the 2020 presidential election had significantly lower staff vaccination rates. 

The authors also analyzed demographic characteristics of residents and staff, as well as COVID-19 death rates among the more than 14,900 nursing homes studied.

The research was published in JAMA Internal Medicine.