SNFs Closely Monitor Delta Variant, Some Still Hesitant on Vaccine Mandates

Skilled nursing operators, much like the rest of the aging care continuum, are concerned that the COVID-19 delta variant will stall progress made on occupancy gains — but regulatory changes are due to be regional; facilities will need to look out for country or state-wide mandates based on local outbreaks.

Just last week, the Centers for Disease Control and Prevention (CDC) backtracked its mask guidance to recommend fully vaccinated individuals wear masks indoors in areas it deems “high” or “substantial” transmission rates; that includes about two-thirds of U.S. counties.

Previously the CDC said those who were vaccinated could largely leave their masks at home.


The delta variant now accounts for 83% of cases.

Fragile Occupancy Progress

Even if a skilled nursing facility hasn’t had an outbreak related to the delta variant, its occupancy could still be affected by state or county mandates, and in turn public perception of that area, according to Roger Mali, owner and CEO of Mission Point Healthcare Services.


If a family member of a prospective resident feels their loved one won’t get the proper amount of services and socialization with state or county limitations in place, they’re going to think twice about placing them in a rehab facility, even if that facility hasn’t had an outbreak.

Mission Point used Oakland and Wayne counties in Michigan as an example, explaining that if an outbreak exists in one county, mask mandates and visitation limitations will likely be implemented in both areas to protect residents across county lines.

The same could be the case in neighboring states.

“On a larger scale, if this outbreak happens in Ohio, we’re here in Michigan, you would see sort of the same thing happening. The perception of the public is going to drive a lot of this … [it’s] one of the largest deterrents and factors that I’m seeing right now on nursing home admissions,” added Mali.

Michigan has seen outbreaks of the delta variant, but none have been at Mission Point facilities, Mali said. The average number of new confirmed COVID cases in the state is 750 per day — long-term care data show 30 self-reported cases among Michigan’s facilities.

“As long as the delta variant is out there, and as long as those barriers and restrictions stay in place, we’re going to have issues; it’s going to impede the nursing home recovery,” said Mali.

For now, Mali is closely watching the situation, and monitoring hospital admissions at nearby Henry Ford Hospital in Detroit as an indicator of where the state’s cases will go. Mission Point has 28 facilities across Michigan.

Stand-alone facility Warm Hearth Village in Blacksburg, Va., is in what the CDC considers a “moderate” area in terms of variant spread, so nothing has had to change — yet — Warm Hearth CEO and President Brad Dalton told Skilled Nursing News on Friday. 

The daily average of new COVID cases as of Aug. 1 for Virginia is 869, according to the New York Times’ virus tracking data.

Warm Hearth has not experienced an outbreak from the delta variant, Dalton said.

“Masking is still required in our health care settings, but we have dropped masking requirements in our independent living spaces for vaccinated individuals. I would say as surges occur we are prepared to bring back that mask mandate in those spaces,” Dalton said.

Warm Hearth is a continuing care retirement community (CCRC) that houses residents throughout the care continuum, from active adult living spaces to skilled nursing and long-term care.

Dalton took a relatively positive outlook to the expected occupancy stall, saying he doesn’t expect growth to be slowed for very long, compared to last March.

“We are seeing a lot of people in our community move through the continuum right now, and we still feel that in our area there’s more movement to come,” added Dalton.

Regional Vaccination Rates, Mandates and Staffing

Outbreaks among staff members are a growing concern as the average vaccination rate among SNF workers is 58.6%.

Neither Mission Point or Warm Hearth are considering a vaccine mandate at this time. Staff vaccination rates at Mission Point range from 90% at some facilities to 55-60% at others.

“I think this question about the mandate is one of the most important questions we’ll face for the [rest] of this year,” Dalton told SNN. “We see what is happening around the country to those that have required the vaccine, fallout hasn’t been terrible in terms of a percentage.”

Mission Point has done a lot of work with local hospitals, especially nearby Henry Ford Hospital, to educate staff about the vaccine. The operator has offered PTO days and bonuses for staff who get vaccinated, resulting in an increase in vaccinations, but Mali says rate increases are still slow.

“I believe that a mandate would exacerbate the problem of obtaining and retaining staff, and in doing so that would then translate down to care for the residents,” explained Mali. “We’re going to certainly continue to encourage it as much as we can but I think at this time a mandate for us in the nursing home system, it’s just not really practical or something that we would be able to do.”

Operators like Mission Point have had to balance concerns from an ongoing staffing crisis with a need to get staff vaccination rates up in order to better protect its vulnerable residents. There have so far been multiple cases of fully vaccinated residents getting infected with the delta variant, what public health officials call “breakthrough cases.”

Although breakthrough cases are considered rare and result in mild or asymptomatic conditions, in frail, elderly people a breakthrough case could have more serious consequences.

A CDC investigation of skilled nursing facilities in Mesa County, Colo., linked lagging vaccination rates in the state to an increase in COVID-19 infections and deaths, AP reported.

At one facility, 16 fully vaccinated residents became infected with COVID-19 and four died, according to the AP report.

At the same time, skilled nursing staffing issues have magnified.

About 94% of 616 nursing homes surveyed by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) in June said they are experiencing a staffing shortage and three-fourths said workforce shortages worsened after last year.

“We would certainly lose a percentage of our staff if we had to mandate [COVID-19 vaccines] … we would be unable then to provide any level of care,” said Mali.

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