Awaiting CMS Guidance, Operators Continue COVID-19 Vaccine Education Efforts

Although nursing home operators have gotten a bit of a respite with the federal vaccine mandate expansion announced on Thursday, some say that doesn’t deter their efforts to educate staff and get as many vaccinated as possible prior to the federal government releasing further guidance in October.

The Biden administration mandated the COVID-19 vaccine for nursing home staff on Aug. 18. As of late last week, President Joe Biden expanded staff vaccination requirements to include any health care provider that receives Medicare or Medicaid funding.

Biden’s executive order includes hospitals, home-health agencies, ambulatory surgical settings and dialysis centers, among others. The Centers for Medicare and Medicaid Services (CMS) is developing an Interim Final Rule with Comment Period to be issued next month regarding the mandate decision.

The move is part of sweeping efforts affecting upwards of 100 million Americans — employers with more than 100 workers will be required to mandate the vaccine or test employees for the virus weekly.

Operators with facilities in multiple states continue to track and document vaccination status for staff, visitors and residents in response to the government mandate.

“If you are coming in as a visitor or a vendor in California right now you have to prove that you’ve been vaccinated or that you’ve been tested within 72 hours,” said TK King, vice president of operational development for EmpRes Healthcare Management. “If you can’t prove that, then we’ll just do PCR tests, right on the spot. And we’ve rolled that mandate out across the entire company, just to ensure everyone’s consistent. We’re using those real-time Abbott devices to help ensure that we know who’s been tested and who hasn’t.”

Vancouver, Wash.-based EmpRes mandated the vaccine for its employees prior to the federal mandate for nursing homes, rolling out the requirement with letters to staff member’s homes and a vaccine page on its websites.

“We’ll just continue that emphasis. I don’t think [the expanded federal vaccine mandate] would change necessarily, our approach to [vaccine education]. But there’s certainly a … heightened focus, especially being in the most high-risk industry of all of us with the pandemic,” said Misty Reid, chief nursing officer for EmpRes.

King said the operator facilitated automated calls to staff in the field and held weekly calls with the entire company to answer questions about the vaccine — a habit that started at the beginning of the pandemic.

“That call is designed to go over COVID policies, vaccination education. We brought in a specialist from the [Centers for Disease Control and Prevention (CDC)] to help host calls with us as well,” said King. “We’ve brought in pharmacists to help discuss any true side effects, what those side effects mean, we’ve talked about the booster most recently … really flooded, everyone with education.”

Similarly, Minnesota-based Health Dimensions Group mandated the vaccine for its staff in August, prior to Biden’s first announcement.

“We’ve always been in support of vaccination mandates, and we actually did it in our own communities before the original mandate just for skilled nursing,” Erin Shvetzoff Hennessey, CEO of Health Dimensions Group, said. “What made us nervous about that was the perception issues that we needed to be told to do it or that we were somehow different than other health care settings.”

She worried about what impact a vaccine mandate that only included nursing homes would have had on the staffing crisis in already difficult markets where staff could leave for other health care settings.

“This will make a huge difference in our ability to retain our staff that now hopefully won’t leave to work in another health care setting where vaccinations weren’t required,” she said.

As Health Dimensions Group works to get its staff vaccinated by its self-imposed deadline of Nov. 1, some markets continue to prove to be more difficult than others.

“In some markets, specifically in rural areas or certain states, there’s been significant pushback,” Hennessy said.

EmpRes used incentives to get its staff vaccine compliance numbers up like trips to Hawaii and new cars offered in “vaccination sweepstakes,” King said; the move boosted company vaccination rates by 14%.

Still, the operator lost 2% of staff in its most heavily staffed Washington region and 3% on a national level as a result of its self-imposed mandate. Currently, the operator employs just under 4,800 workers.

“It’s not as huge of a number. What we’re finding is that a lot of folks are leaving our industry and going to home health,” said King, adding that EmpRes has a home health division and prior to the mandate expansion, the company was transitioning staff over to that leg of the business.

Barmi Akbar, CEO of Guardian Healthcare, called the mandate a step in the “right direction,” but with only 53.4% of the overall U.S. population now fully vaccinated, according to Bloomberg’s COVID-19 vaccine tacker, he fears it may not solve the larger issue of this becoming a pandemic of the unvaccinated.

“How we go about convincing a large portion of our society that the vaccine is a necessity for us to overcome COVID, I think [that is] a bigger issue we have,” he said. “I think it’s a good decision to have it encompass other health care providers and businesses.”

Getting everyone on board with the vaccine is a problem that still needs to be solved.

“If you operate a health care setting within those communities, it’s a lot more of an uphill climb, versus communities that already have a higher vaccination rate,” Akbar said.

While it remains to be seen what impact the mandate will have on operators, Akbar is interested to see how communities will be penalized under the mandate.

Skilled Nursing News Reporter Alex Zorn contributed to this article.