By Abby Goodnough, photographs by Kenny Holston, New York Times, March 29 2021
WASHINGTON — The Covid-19 vaccine had finally come to Forest Hills of D.C., a nursing home in a prosperous neighborhood of the nation’s capital, but there was a problem. Though nearly all of the home’s residents agreed to get the shots, nearly half its 200 staff members declined.
Tina Sandri, the chief executive, vowed not to let those numbers stand.
Over the next two months, rounding out the most bruising year of her long career in elder care, Ms. Sandri tried everything. She bombarded employees with text messages containing facts about the science behind the vaccines. She assigned a popular young worker to try to sway reluctant colleagues as an “influencer.” She set up a giant screen to show a television special that the Black actor and director Tyler Perry made to fight vaccine hesitancy — on a continuous loop, no less. Most of all, she worked to understand their concerns.
“You really have to listen to each person’s story and address it from that standpoint, so they feel, ‘This is a workplace that cares about me,’” she said.
Three months after the nation’s health care workers were among the first Americans to be eligible for the lifesaving new vaccines, long-term care facilities across the country continue to face a similar daunting challenge. The federal program that sent vaccinators from Walgreens and CVS into tens of thousands of nursing homes and assisted living residences has by one measure been strikingly successful, inoculating nearly all of the vulnerable residents of the facilities. Deaths in nursing homes have plummeted since the program began in late December.
But reaching the mostly low-wage employees of the facilities has proved far more difficult. A poll by The Washington Post and Kaiser Family Foundation conducted from Feb. 11 to March 7 found that half of the workers at nursing homes had yet to get even a first shot, and only 15 percent of that group said they definitely planned to.
At Forest Hills, the workers who turned down the vaccine during the center’s first vaccination event in early January included nurses, certified nursing assistants, members of the kitchen and activities staffs, and a security officer. Most were Black, reflecting the overall makeup of the home’s work force; many were immigrants from African countries, such as Nigeria, Liberia and Cameroon.
Ms. Sandri’s goal was to persuade — not pressure — them. But she found there was not one unifying story behind their refusal, and no straightforward message that helped to convince them.
She ruled out some tactics deployed by other nursing homes, including requiring the vaccine — she feared alienating and losing employees in the midst of a labor shortage — and offering gift cards, bonuses or extra vacation days to employees who agreed to get it. Ms. Sandri considered those incentives inappropriate and called them “bribes.”
“We’re doing this because we care,” she said. “To dilute that message with other things is almost patronizing to people’s intellect.”
The vaccinators from Walgreens would come back twice more — in early February and early March — and Ms. Sandri had dozens of minds to change. By her count, there were still 92 employees who needed the shot.
Ms. Sandri, 57, a yoga and outdoors enthusiast whose manner is at once bustling and soothing, had arrived at Forest Hills only in May, replacing a predecessor who left after the coronavirus had taken hold.
Three residents at Forest Hills had died from the virus and 17 others had become ill, along with 45 members of the staff — a less devastating toll than at many other nursing homes, but still an ordeal. Another resident would die in February, after a flurry of cases over the holiday period.
For the first vaccination event, on Jan. 4, Ms. Sandri laid out snacks, took lots of pictures and played upbeat music — “the cookout kind!” — aiming to create a partylike atmosphere that could help people feel the hope and promise of getting immunized.
When Mariah Proctor, a security guard, arrived for her shift that day, she encountered the festive buzz — and the persistent question between colleagues: “Are you getting it?”
Her answer was no. A conversation with her mother, who she said had never taken her for vaccinations for fear of putting anything besides healthy food in her children’s bodies, had cemented her decision.
Ms. Proctor, 24, said her mother had told her: “You don’t even know what that is. You don’t know the ingredients. You know nothing.”
After the disappointing vaccination turnout that first day, and with morale dipping and emotions fragile as the pandemic wore on, Ms. Sandri changed her approach. She had been holding “huddles” with different departments to explain the science of the vaccines, but now, instead of continuing to load people with facts, she focused on asking them: What information do you need? What is your concern?
Ms. Proctor was taking a break from her shift with Deborah Childs, a colleague from the payroll department who had also refused the vaccine, when the vaccinators from Walgreens came back on a snowy day in early February.
This time, Ms. Childs agreed to get the vaccine.
“I looked up the company and, you know, I found out that they’ve been doing research on mRNA for over 10 years, so that made me feel a little bit better,” she said, referring to the molecule that is the active ingredient in the Moderna vaccine that Walgreens is offering.
She was still a little scared, especially after reading about a doctor in Miami who had developed a rare blood disorder days after getting the Pfizer shot and died two weeks later. Still, she said: “I’m ready to get back to my life. And I know that this is probably one of the ways that we’re going to get back to being normal.”
Ms. Proctor was wavering. “My emotions are everywhere,” she said. She had been watching co-workers who had received their shots and asking them how they felt. “I would say that I am educating myself a little more now, versus just saying, ‘I don’t want to do it,’” she said.
Yet, she ended up refusing the shot again that day.
She wasn’t afraid of needles — she had multiple tattoos, she said, laughing. So what was holding her back?
“Having a bad reaction, or not being able to adjust to it at all,” she said.
She had also heard some frightening things — even though she suspected they weren’t true. “I heard someone say the first couple of people who took it for the trial died,” she said. “I’m not going to believe those things, but you do keep them in the back of your head and it makes you scared.”
Still, Ms. Sandri’s efforts seemed to be paying off. Forty-eight more workers decided to get their first shot that day.
For those who remained unvaccinated, Ms. Sandri had four weeks to change their minds.
Across the country, vaccine hesitancy was receding — a Pew poll conducted in late February found that 30 percent of Americans said they would probably or definitely not get vaccinated, down from the 39 percent who said the same in November. The poll also found that far more Black Americans were willing to get the vaccine than they were before, but Ms. Sandri did not find that to be true among the African immigrants on her staff.
For them, the half-hour Tyler Perry video that had been playing on repeat on a giant screen in the multipurpose room did not seem to resonate.
Ms. Sandri, who is of Chinese descent, began to understand. “I’m Asian, but I’m not Japanese or Thai or Indian, and they are very different people,” she said. “Until we understand cultural sensitivities beyond the major skin color groups, we’re not going to be successful at reaching herd immunity levels with some of those subsets.”
She started planning to have her director of maintenance, an African immigrant who has been vaccinated, to talk to reluctant peers about his experience and their concerns, and to find leaders of local African churches who might be willing to do the same.
She also doubled down on what she believed was working best: listening to and addressing the concerns of her employees one by one — what she called a “time-intensive, conversation-intensive, case-by-case uphill climb.”
The key, she said, was to tailor her message to what would resonate most with each person.
“For analytical people, we provided data on number of cases, number of people in trials, percent of people who experience an immune response,” she said. “For relationship-based thinkers, we asked if they had any vulnerable friends or family members, and how having or not having the vaccine might impact the relationship.”
Still, as the date of the third vaccination event approached in early March, Ms. Proctor was tired — of the pandemic and the long loss of freedoms, but also of hearing every day at work about the importance of getting the shot. Ms. Sandri, whose office was just around the corner, stopped by frequently to chat and gently raise the benefits of being vaccinated.
“It feels a little — almost like peer pressure,” Ms. Proctor said.
At times, she envied people who worked outside health care, suspecting they were not being barraged with information about the vaccine in quite the same way. Yet, she had come to appreciate that the vaccine was a commodity that most people her age — and most people in general — did not have access to yet. Getting vaccinated, she told herself, could help protect her sister who lived with her. It would also protect her when she returned to her second job — bartending — and made long-delayed trips to Puerto Rico and Jamaica later in the year.
By March 8, the day of the final event at Forest Hills, she was close to talking herself into rolling up her sleeve. At Ms. Sandri’s urging, she had watched the Tyler Perry special and an online town-hall-style forum for workers at nursing homes about the vaccine, organized by the Black Coalition Against Covid-19.
“It gave me a little more confidence,” she said. “I don’t know anyone in my immediate circle that took the vaccine yet, and it just makes me feel like if no one else has done it, then maybe I should.”
The final tally
Fifteen minutes before her shift ended, Ms. Proctor made her way to the home’s all-purpose room — normally the sight of bingo games and movie nights — and took off her jacket. Scanning the consent form with its daunting questions — Have you ever had a severe allergic reaction to something? Do you have a bleeding disorder or weakened immune system? — made her feel “leery,” she said.
Still, she got the shot. As she lingered in an easy chair afterward, Ms. Sandri fluttered in to check on her, gently touching her bare arm.
“I don’t have any thoughts, really, besides wondering how I’m going to feel — that’s my main concern,” Ms. Proctor said. By the end of the day, 18 more co-workers, along with Ms. Proctor, had joined the ranks of the partly or fully vaccinated. They now make up 79 percent of the staff at Forest Hills.
“I’m ready to do cartwheels down the hallway,” Ms. Sandri said, noting that Forest Hills had surpassed the goal set by the American Health Care Association, a trade group, to vaccinate 75 percent of the nation’s nursing home work force by the end of June.
With the federal program ending soon, the city’s health department had agreed to provide doses for anyone in nursing homes who still needed them.
“Everyone’s fears are real, whether or not they are grounded in science or in something they believe right now,” Ms. Sandri said, recounting what she had learned from her staff over the past few months. “Beliefs change with time or new knowledge, so we have to ride it out. Listen hard, don’t judge and let them move at their own pace.”
Kenny Holston contributed reporting.