A big obstacle, though, continues to be resistance to vaccination among nurses and aides. Like many facility owners, Avalon Health Care Group, which owns or operates more than a dozen nursing homes in western states, is not mandating staff be vaccinated. Dr. Sabine von Preyss-Friedman, Avalon’s chief medical officer, says she tries to address the reasons with each worker and won’t abandon the push.

“We’re not going to just say, ‘OK, everyone get vaccinated,’ and then forget it about,” she said.

Avalon’s homes have used modest financial incentives to encourage staff members to get vaccinated. Some have organized contests between different units, with the winner getting prizes like a pizza party or a drawing for a gift certificate from a department store, and those efforts will resume this year.

Jim Wright, the medical director of Our Lady of Hope Health Center and two other nursing homes in Richmond, Va., said that rewards and respectful persuasion were not enough to sway his homes’ employees. They tend to be in their 20s and 30s, he said, and are not worried about catching Covid, which many have already weathered.

“They most likely will not do it to protect the residents or protect themselves,” he said. “I don’t know what the answer is.”

Sheena Bumpas, a nursing assistant in Duncan, Okla., and vice chair of the National Association of Health Care Assistants, planned to get this season’s shot, but said some of her colleagues would not.

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