The number of nursing homes across the state with at least one active COVID-19 case has shot up nearly 800% in the past month — while nearly half of nursing home employees in Texas remain unvaccinated.

Nursing home residents were among the hardest hit by COVID-19 last year as the virus tore through facilities at an alarming rate. More than 400 Texas nursing home residents died during a single week in August 2020; since the pandemic began, 9,095 have died after contracting COVID-19, according to the Texas Health and Human Services Commission. As of Aug. 11, that’s 17% of the state’s COVID-19 deaths.

To slow the virus’s spread, Gov. Greg Abbott shut down nursing home visitation in March 2020, then eased those restrictions five months later for facilities that didn’t have active cases in the previous two weeks. HHSC’s current visitation guidelines for nursing homes require visitors to wear a mask at all times and limits visitation to no more than two “essential caregivers” per resident.

But after seeing infections remain relatively low in recent months, the state’s more than 1,200 nursing homes are seeing a new wave of infections as COVID-19 cases explode around the state, driven by the highly contagious delta variant:

• The number of Texas nursing homes with active COVID-19 cases has risen by 773% in the past month, from 56 in mid-July to 489 on Aug. 11. That’s still well below the peak in January, when more than 900 facilities had at least one active case.
• Deaths are increasing as well. From July 21 to Aug. 11, 84 nursing home residents died from COVID-19, compared to seven deaths during the four-week period before.
• Roughly 76% of nursing home residents in Texas have been fully vaccinated, putting the state 46th nationally. The national average is 82%.

But the current surge in nursing home cases hasn’t triggered renewed restrictions by the state.

“We continually assess what actions are necessary to keep people safe in the facilities we regulate,” HHSC spokesperson Helena Wright-Jones said in a written statement.

Meanwhile, just over half — 56% — of nursing home staff have been fully vaccinated, below the national average of 59%, which puts Texas 33rd nationally for nursing home staff vaccination rates.

The state doesn’t require nursing home residents or staff to be vaccinated. Wright-Jones said nursing homes are required to offer the vaccine to residents, and her agency “highly encourages vaccination against COVID-19 for all long-term care facility staff and residents.”

Some national nursing home chains have begun requiring their staff to be vaccinated, and all nursing home staffers in Massachusetts will be required to be vaccinated by Oct. 10 under an order by Gov. Charlie Baker, according to Boston radio station WBUR.

Kevin Warren, the president and CEO of the Texas Health Care Association, whose members include both for-profit and nonprofit long-term health care facilities, said nursing homes are hesitant to require staff to be vaccinated because they are fearful of losing employees who might look for other jobs that don’t require vaccinations.

“Right now, we have a severely stretched workforce,” Warren said. “And when we see this surge occurring again, the stress and the emotional toll it places on staff and others that are in the building, the concern is: ‘If I put this vaccine mandate on, am I potentially going to lose staff?’”

The percentage of nursing home staffers who are unvaccinated is similar to the general population, Warren added, “so let’s not set them out to the side.”

Warren said the pandemic has put big financial burdens on the industry.

“Our real focus right now is having and getting additional resource relief,” Warren said. “And getting financial support and financial assistance to pay for the testing, to pay for the [personal protective equipment for staff] and to pay for the significantly added costs in recruiting and retaining staff — especially at this critical time.”

Annaliese Impink, executive vice president and spokesperson for Retama Manor Nursing Center, which operates around 55 nursing homes in the state, said 70% of its staff have been vaccinated, well above the state rate for nursing home workers. Still, around 20 of the company’s facilities currently have one or more active COVID-19 cases among staff and residents.

“We believe that the spread is caused by the unvaccinated staff members,” Impink said. “… Our residents are in our center and don’t often go out, and our vaccination rates in our centers are pretty good. So, you just have to surmise that it’s primarily coming in from unvaccinated staff members.”

Retama Manor requires its executives, administrators and managers to be vaccinated, and is considering whether to require all staff to get the shot. Some of the staff are not getting vaccinated, she said, because of “a lot of misinformation out in the community, and there’s the anti-vaxxer movement that’s facilitating the misinformation.”

Impink said most residents who are vaccinated and test positive for the virus are not getting severe symptoms — typically it’s nothing more than a sore throat or runny nose.

“But the residents and staff that are not vaccinated are seeing more acute symptoms,” Impink said, adding that some unvaccinated residents have been hospitalized after getting the virus.

At Focused Post Acute Care Partners, which runs 31 Texas nursing homes, about 55% of its roughly 2,200 staff members are fully vaccinated, according to Becky Anderson, the company’s chief clinical officer.

Most Focused Care residents who test positive for COVID-19 are sent to the company’s 87-bed facility in Baytown, where residents from other nursing homes across the state are also sent. The facility is currently treating 45 patients with the virus, according to Anderson, up from 14 on June 30.

And like Retama Manor, the company doesn’t require staff to get vaccinated.

“Getting the vaccine for COVID-19 is a personal choice, and Focused Post Acute Care Partners, at this time, is honoring that choice,” Anderson said. “We continue to educate and re-educate infection control practices within our organization … [about] the importance of protecting the residents and our staff from the virus, and it is frustrating and kind of exhausting that we may be going through this next wave of breakthrough cases, but our health care workers will continue to fight this fight.”

Disclosure: The Texas Health Care Association has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.