With one of the lowest staff vaccination rates in the country — 45.8% compared to the national average of 59.3% —Florida operators may have a tough road ahead of them as the emergence of the delta variant and an easing of state and federal mandates has created a flood of new cases at local hospitals.

Florida currently has 86.19% of its inpatient beds and 90.08% of its ICU beds in use with 238 hospitals reporting in, U.S. Department of Health and Human Services data shows.

Due to the spike, many of which seem to be COVID cases, hospitals have had to return to early pandemic policies of postponing elective surgeries as the need for beds for COVID patients increases.

“I started to see it announced last week and started hearing from our hospital partners that they were postponing elective surgeries due to increased demand,” Luke Neumann, vice president of service and relationship development at Palm Garden Healthcare, told Skilled Nursing News. “It is a concern because it causes a significant decline in the number of referrals we receive.”

One way the state could look to lessen the impact on its hospitals is through vaccinations, but with one of the country’s lowest nursing home staff vaccination rates and resident vaccination rates, according to the U.S. Centers for Medicare & Medicaid Services, that has proven to be a different conversation compared to other areas of the country.

Joe Steier III, president and CEO of Louisville, Ky.-based Signature HealthCARE, with 20 skilled nursing assets across Florida, referenced the state’s low vaccination numbers and admitted it may be time for operators to come out and make a decision on imposing vaccine mandates at the Midwest post-acute executive leadership summit this week.

He said that the numbers are particularly problematic in the Florida Panhandle, where the vaccination rate is much lower.

“They don’t think COVID exists,” he admitted of the patient population in the Sunshine State.

While Avante Group hasn’t moved to mandate vaccines, the company’s Chief Nursing Officer Kimberly Biegasiewicz said the organization is continuously “checking the pulse” of the American Healthcare Association and Florida Health Care Association on the topic.

The AHCA/NCAL strongly encourages vaccinations for all health personnel.

Vaccine mandates

Rather than jumping to mandate vaccines, Avante Group is focused on education to up its rates.

“We just recently did a 30-day vaccination push where we implemented all of the stops to get our staff and residents comfortable with the vaccine,” Biegasiewicz explained. “There are all types of opinions: cultural, religious, so it’s been challenging.”

Physicians and advanced practice nurses and physician assistants have been shown to have the highest vaccination rate among health care professionals at more than 75%. Aides, including certified nursing assistants, nurse aides, medication aides and medication assistants, have much lower rates, at 45.6%, according to a recent CDC study.

Biegasiewcz said physicians at Avante Group have been more compliant in getting vaccinated than floor staff.

“I think it’s based on knowledge,” she said.

Avante Group takes a multifactorial approach to upping its vaccine rates.

“The biggest thing I see is that it’s multifactorial in terms of reasons why,” Biegasiewcz said. “We have different types of cultural populations in our centers. We have rural centers; we have centers that are down south and a large Hispanic population in our central Florida facilities.”

She said that family culture and perception can often be factors for whether individuals choose to get vaccinated or not.

Roundtables with Avante Group staff members have proven to be a valuable tool in raising vaccination numbers. Using real-time data from its hospital partners, such as that 80-90% of hospitalized patients are unvaccinated, have been helpful in convincing individuals who were on the fence, Biegasiewcz said.

Every Friday for four weeks Avante Group invited its floor staff in to meet with vaccine experts to answer questions, debunk myths, and give them evidence-based information on why to get vaccinated.

“We have been bringing in different disciplines as far as epidemiologists, pharmacists and physicians who can give medical facts on what the actual vaccination is and what the truth is in terms of what can happen if you aren’t vaccinated,” Biegasiewcz added.

In one of The Avante Group’s centers staff vaccination went up nearly 13% and resident vaccination rates went up about 15% just in that 30-day vaccination push.

Similarly, Palm Garden Healthcare is looking to educate rather than mandate.

“Our policy is to educate and we’re hopeful that every day that goes by, we are able to vaccinate more and more caregivers,” Neumann added.

Florida’s PCA program

One way the state is helping out skilled nursing operators is with the personal care attendants bill, which became permanent earlier this year. The bill allows PCAs to work in long-term care to help with basic duties as they work to pass exams to become certified nursing assistants (CNAs).

“One of the powerful things that was done here in the state of Florida was the creation of the PCA program,” Neumann said. 

With 14 post-acute care centers across the state, Palm Garden has not had to limit census in any way due to the staffing crunch unlike many of its peers.

A recent survey revealed that 52% of Florida operators are reducing admissions due to workforce challenges as the state’s occupancy levels still sit 10% below what they were pre-COVID, a spokesperson with the Florida Health Care Association told Skilled Nursing News.

Palm Garden currently sits at 86% occupancy.

Florida’s PCA bill, House Bill 485, authorizes nursing homes to hire PCAs who are participating in the training program developed by the Agency for Health Care Administration in accordance with federal requirements for nurse aide training, the bill said. Each PCA may only work for a single nursing home for a period of four consecutive months before becoming a CNA.

Neumann said he uses the program as a selling point for workers looking to start a new career.

“For folks who are working an hourly job where they earn an income but may not see a career, we’re able to offer them an entry level position in post-acute care,” Neumann said.

Palm Garden pays PCAs while they are training, helps cover their CNA certification costs and puts them on a path to a career in health care.

After one year of full-time work with Palm Garden Healthcare, participants are eligible to enter its tuition reimbursement program which helps reimburse a portion of tuition costs.

“What we found is we’ve been able to add a sorely needed new crop of inspired caregivers,” Neumann said. “It’s really helped to add new passionate caregivers that look at health care and post-acute care as a career.”

The Florida Health Care Association was recently awarded a $1.8 million grant from CMS to strengthen the long-term care workforce and attract more CNAs through a new program.

The CaregiverFL Career Program, a two-year project focused on raising awareness and enhancing recruitment and retention for long-term care careers, will launch in October and includes an interactive website.

Neumann said he’s looking to leverage the grant to attract anyone drawn to the profession.

For Orlando-based Avante Group, with 11 skilled nursing facilities across the state, occupancy is currently running at 85% company-wide and utilization of the PCA program has been key in avoiding a census ceiling due to staffing shortages.

“That has helped dramatically. We’ve converted a lot of our PCAs into CNAs by helping them test out,” Biegasiewicz told SNN. “We’ve had to increase wages and have had to be very competitive.”

Through the program Avante Group brought in a new crop of young uncertified professionals and while there are certain tasks that they can’t do that CNAs can, Biegasiewicz said counting them among staff has helped cut into their facilities’ daily per patient day ratios.

Moving forward Biegasiewicz said she would like to see change in the way the long-term care industry structures its staffing requirements in terms of who is included in direct care contact hours. 

“Even prior to COVID, we are seeing a different type of patient being admitted into our nursing homes. They are more clinically complex, sometimes needing more psychiatric services, and require different kinds of staffing models,” she explained.

For FHCA members, each nursing home facility must provide each resident with a minimum of 2.3 hours of certified nursing assistant staffing per resident per day and one hour of direct care from at minimum a licensed nurse per resident per day.

Facilities must be above one certified nursing assistant per 20 residents and one licensed nurse per 40 residents.