Idaho was hard hit by the Delta surge this summer and early fall, and nursing homes were not impervious to the highly contagious variant that swept through many states with lower vaccination rates.

Ten states, including Florida, Michigan and Ohio, still report vaccination rates for nursing home staff under 60 percent.

But many nursing home administrators are waiting for the federal government to issue new rules that will govern a mandatory vaccination program for all their staff members that President Biden first announced two months ago.

After steep declines earlier this year, Covid cases and deaths in nursing homes climbed in August and September, resulting in about 4,000 deaths — even though nearly 90 percent of the nation’s nursing home residents were fully vaccinated.

“It is medically wrong and borders on unethical to have unvaccinated nursing home staff caring for residents,” said Dr.

Elizabeth, a nursing home resident in Minnesota, said she caught Covid earlier this year from an unvaccinated worker before she got her second dose of the Moderna vaccine.

When she asked when the staff might be vaccinated under the president’s order, she was told the nursing home may focus on testing workers rather than requiring them to be vaccinated.

“Nothing has happened,” said the resident, who asked that only her middle name be used and that her nursing home not be identified in fear of retaliation, a concern shared by others interviewed for this article.

“People are dying, residents are dying,” said Susan Reinhard, the director of the AARP Public Policy Institute, which has pushed for more transparency about vaccination rates in nursing homes.

Vaccination rates among nursing home staff increased to 69 percent by early October from 62 percent in early August, when Mr.

While some nursing homes have moved ahead with their own mandates, many are taking a wait-and-see approach, said Mark Neuberger, a lawyer with Foley & Lardner who advises health care organizations on employment issues.

Many nursing homes “remain very concerned that we are not going to see vaccination acceptance rates increase,” he said.

At Chaparral House in Berkeley, Calif., where vaccination rates are high, the vast majority of employees presented with paperwork to get immunized were willing, said the nursing home’s chief financial officer, Chuck Cole.

By talking one-on-one with the small number of workers who were concerned about the vaccine, the nursing director and administrator were able to persuade the holdouts, he said.

The state mandates are helping to increase levels of protection for all age groups, and about 14 percent of the nation’s nursing home residents have already received a booster dose