Nursing home aides — the staff members who provide the most direct care to residents — were the least likely to be fully vaccinated against the coronavirus by mid-July, according to a new analysis of U.S. facilities.

The study underscores the influence that President Biden’s new federal mandate for all health care workers may have on populations like the elderly in nursing homes who are vulnerable to coronavirus infections, experts say.

The findings are “alarming and reason for pause,” said Brian McGarry, a health researcher at the University of Rochester and one of the authors of the analysis, which appeared in a research letter in JAMA Internal Medicine on Thursday.

Low vaccination rates among nursing home workers in some areas have fueled concern about fresh outbreaks among staff and residents in these facilities, even with high numbers of vaccinated residents. Covid deaths among nursing home staff and residents accounted for nearly one third of the nation’s pandemic fatalities as of June 1, and vaccination rates among staff average around 63 percent, according to the latest federal data.

But slightly under half of the certified nursing assistants were fully vaccinated, according to the analysis, which looked at federal vaccination data through July 18. That was before many nursing homes, states and cities began imposing mandates.

According to the study, in nursing homes overall, 61 percent of nurses, both registered nurses and licensed practical nurses, were vaccinated, compared with 71 percent of therapists and 77 percent of doctors and independent practitioners like physician assistants or nurse practitioners. Some large nursing homes were starting to mandate vaccinations as the Delta variant began tearing through their communities and coming into nursing homes.

Nationally, about two-thirds of adults are now fully vaccinated, according to federal data.

The researchers also looked at characteristics of the nation’s 15,000 nursing homes to determine which facilities had the most success in vaccinating their workers. While the vaccination rates of the county where they were located played a significant role, the researchers also found that traits like higher quality ratings from the Medicare program, the nonprofit status of the facility and a long-tenured staff also seemed to lead to higher rates.

“That gives us some suggestion that facility culture and leadership may play a role,” Dr. McGarry said, and management at these nursing homes may be better able to work with their staff to increase vaccine acceptance.

But none of those factors alone appeared to be critical in a nursing home’s success. “A lot of things seemed to matter a little bit,” he said.

Most influential may be the president’s decision earlier this month to impose a new federal mandate requiring all health care workers to be vaccinated. Nursing home workers may no longer be able to “job shop” as easily to find employment where vaccines are not mandated.

“The mandate takes all those things off the board and says everyone has to do it,” he said.

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