Monday, March 4, 2024

Opinion | The Checkup With Dr. Wen: How a South Dakota nursing home vaccinated almost all of its residents

Opinion | The Checkup With Dr. Wen: How a South Dakota nursing home vaccinated almost all of its residents

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In Canton, a rural town of about 3,000 people in southeastern South Dakota, religion is a big part of daily life. Many residents identify as being very conservative. The county Canton is in voted overwhelmingly for Donald Trump in 2020.

So it might come as a surprise that the town’s nursing home, Good Samaritan Society — Canton, is a standout in coronavirus vaccinations. The numbers are astonishing: 94 percent of residents have already received the updated coronavirus shot, far above the national average of 27 percent.

My column this week looked at the abysmally low rate of coronavirus booster uptake among nursing home residents, who are extremely vulnerable to covid-19. But North and South Dakota are two bright spots, having vaccinated 55 and nearly 57 percent of their nursing home populations, respectively. As I wrote, these two states prioritized the partnership between pharmacies and long-term care facilities, seeking to problem-solve one facility at a time.

Even within those efforts, there are positive outliers that have exceeded the states’ already impressive averages. The facility in Canton is one of them.

To understand how it reached this unusually high vaccination coverage, I interviewed the facility’s medical director, Daniel Heinemann. Heinemann is a family physician who grew up in South Dakota and completed medical school and residency there. He had an active medical practice and also served in a number of leadership roles, including representing family physicians and rural health providers with the American Medical Association. Now retired from clinical practice, he lives in Canton and oversees medical affairs for his community’s nursing home.

Based on our conversation, here are five factors for this facility’s success:

1. Trust. Heinemann has been involved with the nursing home for about 40 years and has served as medical director for about 30. The residents he and his staff take care of are their friends and neighbors. Some have been his longtime patients.

“We are small, we are local and we have really dedicated staff,” Heinemann says. Everyone is devoted to “take care of the elders, many of whom have been the bedrock people of our community.” Residents understand this commitment and they and their families trust that staff recommendations are based on the patients’ best interests.

2. One-on-one outreach. Family members must provide consent before vaccination, so “we make sure we contacted every family personally, by phone or in person, to talk to them about the importance of the vaccines,” Heinemann said.

He emphasized the need to listen carefully and answer questions patiently. If a staff member received a question they couldn’t answer, they’d contact him. “I’ll either make the phone call or give the staff the information they need to go back to that individual again.”

3. Connection with the medical system. “If the family says, ‘we want to think about it,’ or ‘we’re not sure,’ we will call them back,” Heinemann told me. “We’ll also let the resident’s physicians know that the family’s got some questions.” That way, the resident’s primary-care provider can also address their concerns and multiple trusted voices will be conveying a similar message.

“Sometimes, I will also call the physicians and say, ‘Next time you see the resident and if their family member is with them, would you be so kind as to say how important the vaccinations are and the reasons?’” he added.

4. Clear messaging. Heinemann has frequent conversations with the staff to make sure they are all on the same page about the science behind coronavirus vaccines and why they are safe and effective. “It’s not going to keep you from getting infected,” he said, but it will help prevent you from becoming seriously ill and dying.

That messaging extends to family members, many of whom are elderly themselves. Heinemann believes in the adage that “you catch more bears with honey than you do with anything else.” His philosophy is to “be honest and open and give them the information to help make them make the right decision.”

5. Strong leadership. It’s impossible to come away from a discussion with Heinemann with any sentiment other than awe for his personal commitment to the residents and his community. His strong advocacy of vaccines is also clear and no doubt translates to how he speaks with the staff and, in turn, how they convey their recommendations.

For his part, Heinemann credits the facility’s progress in safeguarding residents to its staff and “their caring nature and their connectivity with residents.” At the peak of the covid pandemic, as many as 25 residents died in one month because of the virus. But in the past year, not one resident has died from covid, even though they have weathered several outbreaks.

Not every nursing home is fortunate to have a Heinemann as their medical director. But his experience shows that passionate advocacy makes a difference, as does persistence and respectful dialogue. These are attributes all health-care providers and family members can adopt when trying to convince those we care for to follow vaccine recommendations.

Do you know a nursing home that has done particularly well to facilitate vaccine access? Have you or your loved ones residing in long-term care facilities encountered challenges obtaining vaccines? I’d love to hear from you.

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