New York’s nursing home staff worked against the clock as the state’s health care worker COVID-19 vaccine mandate took effect Monday, and those who did not comply could risk losing their jobs.

About 92% of skilled nursing facility staff were vaccinated as of Sept. 28. That’s according to the most recent self-reported data provided by SNFs via the New York State Department of Health’s HERDS survey. The percentage is calculated from the number of eligible staff and the number receiving at least one dose of the vaccine to date.

New York’s staff vaccination rate is considerably higher than the nationwide average. According to data from the Centers for Medicare & Medicaid Services (CMS), the national percentage of vaccinated staff per facility as of Sept. 12 sat at 64.4%.

Back in August, then-Gov. Andrew Cuomo called on the state’s department of health to issue orders requiring hospitals and long-term care facilities to develop a policy mandating all employees be vaccinated.

Staff at home care, hospice and adult care facilities must be vaccinated by Oct. 7.

At that time, 68% of the state’s roughly 145,500 nursing home workers were fully vaccinated, according to a press release from the governor’s office.

Stephen Hanse, president and CEO of the New York State Health Facilities Association, told Skilled Nursing News that achieving a 100% vaccination rate in nursing homes, hospitals, or the community for that matter, is a “very difficult task.” He noted, though, that “the best way to get to that [level] is a mandate.”

Hanse also recognized the reality that there will be health care workers who ultimately choose not to be vaccinated. Due to rising demand, the system can’t afford to lose those individuals from the workforce, he said.

“If we don’t see the vaccination rates continue to increase, we would advocate implementing a test-out provision to ensure we have sufficient staff to care for the residents that we provide care for regularly, and not to cause any negative implications in the health care continuum where individuals are not able to get to a nursing home from a hospital or a community to receive the care they need because there’s insufficient staff,” Hanse said.

There is not currently a testing opt-out provision in the state’s health care mandate guidelines.

Over the weekend, current Gov. Kathy Hochul released a plan — that included declaring a state of emergency or deploying the National Guard — to address potential staffing shortages at nursing homes and other health care facilities following the deadline.

Other options included partnering with the federal government to deploy Disaster Medical Assistance Teams to assist local facilities and health systems, as well as working with the Biden administration and other state leaders to find ways to expedite visa requests for medical professionals.

It remains to be seen what measures the Hochul administration may need to take following the deadline.

Hanse said while he is encouraged by the continued growth in staff vaccination rates, possibly losing any portion of the workforce is problematic.

Instead of immediately terminating employees, some facilities have given workers a 30-day unpaid leave of absence to give them more time to think about the decision and perhaps change their minds.

“Working in long-term care is a difficult job but it’s incredibly fulfilling and what we’re seeing is many folks don’t want to leave the industry,” Hanse said. “So we’re trying to really work with them and educate them [on the vaccine].”

Every nursing home in the state has an emergency staffing plan — typically used for short-term situations like hurricanes or snow storms — that has been implemented in facilities experiencing staffing shortages. But they are not long-term, or even midterm solutions, Hanse said.

Like many other states, New York’s staffing issues were ongoing prior to the coronavirus pandemic. Of the New York State Health Facilities Association’s members, almost all have vacancies among CNA, LPN and RN positions, Hanse explained.

“Of our members, 60% of them have stated that their staffing shortages are negatively impacting their ability to accept new residents from hospitals and the community,” he noted. “So our concern is backups in the hospitals, the hospitals are voicing those concerns, and the fact that individuals won’t get the necessary care they need.”

One of the ways Hanse is hoping to close that gap is by asking the state to increase its Medicaid rate for nursing homes, with 100% of that increase going to staff salaries so providers’ salaries can be more competitive.

New York currently has a $56 per resident per day shortfall, Hanse said.

“If we can compete with other sectors of the workforce through a Medicaid rate increase, I think that’ll go a long way into recruiting new workers and retaining the workers we have and paying them for the hard work that they do,” he added.