Since the Biden administration announced a vaccine mandate would be coming into effect, nursing home staff vaccination rates have increased from 62 to 72%. While a 10% bump is encouraging, it remains to be seen if a hard deadline of Jan. 4 will be enough to bridge the gap in vaccine rate variability currently seen across the sector.
In some states such as Rhode Island and Massachusetts — which itself issued a vaccine mandate earlier this year — vaccination rates have reached above 96%, according to CMS data last updated on Nov. 4. For others, such as Missouri and Oklahoma, rates are still below 58%.
“I know in certain areas, this mandate is not near as big of a deal as it is in others,” Traylor-Porter Healthcare President J. Mark Traylor told Skilled Nursing News. “In mine it creates a challenge for us.”
C&G Healthcare Management, a Colorado operator with seven skilled nursing facilities throughout the southern part of the state, has one nursing home with 100% of its staff vaccinated while another is in the single digits, not including religious exemptions.
“It really is dependent on the community,” C&G CEO Joyce Humiston told Skilled Nursing News. “Communities have a lot of control with [the vaccines] and the louder ones seem to rule over those who might vaccinate. It is a political issue for many.”
Guidance from CMS did include some leniency for religious and medical exemptions. It allows for exemptions based on recognized medical conditions or religious beliefs, observances or practices — with nursing homes required to develop their own process or plan to allow for those exemptions.
Harvard University professor David Grabowski expected the mandate to be difficult for certain facilities to meet, though it goes beyond just which market the operator resides.
“Within markets, certain facilities that have lower rates [include]: those that have more turnover with their staff, those that are lower rated, those that care for more Medicaid recipients, those that are for-profit,” he explained.
Still, Grabowski suggested that mandates may be necessary to help bring those facilities further along.
“I do think that the mandate will have the intended effect of increasing vaccination rates among staff and it might even bring some individuals who left the workforce back,” he said. “But I really believe that mandates are going to lead to some exit and it’s probably going to occur in the markets that can least afford it.”
Weighing Being Vaccinated Versus Being Understaffed
Minnesota-based Health Dimensions Group initially issued a vaccine mandate of Nov. 1 for its facilities in August ahead of the federal mandate announcement, but that date has since been pushed back over concerns on the impact it would have on patient care.
“We were hopeful that the staffing crisis was going to get better in September and October, given the changes to unemployment, but it’s not getting better,” HDG Principal and CEO Erin Shvetzoff Hennessey told Skilled Nursing News. “We still, of course, want 100% vaccination among our staff but because of the staffing crisis we ended up not putting people on leave or terminating them [due to being unvaccinated]. We felt that the risk to the residents was higher without safe levels of staffing.”
The impact of a Nov. 1 mandate would have varied across HDG communities.
“In some communities, it was going to be just a handful [of staffers lost],” Hennessey explained. “In other communities, we would have had significant loss of staff and we felt we couldn’t safely run the facilities without these staff members because in some of our markets, we can’t get agency right now. I really wish we could have done November 1 but sometimes you have to balance things and safe staffing outweighed vaccines.”
She said it was a very difficult decision but HDG balanced the threat of having unvaccinated employees in its facilities with the risk of being without appropriate staffing levels.
“Most of our residents are vaccinated and with 99% of breakthrough cases not resulting in hospitalization or death, we made the decision to err on the side of caution with staffing and to extend it,” Hennessey said.
Grabowski expected other operators to be faced with similar dilemmas moving forward though he will be keeping an eye on how the mandate is applied nationwide. He also admitted that for operators with low vaccination rates, hosting webinars on the effectiveness of the vaccine and other pro-vaccine messaging probably won’t move the needle much at this point.
Getting Vaccine Numbers Up
For Hennessey, messaging around the vaccine has taken a slightly different tone since the mandate was announced.
“It’s a little bit more forceful of a conversation … after this date you can’t continue to take care of our residents and what do we need to do to get you vaccinated,” she explained. “It definitely has more of a stick than a carrot approach now.”
With the Dec. 6 deadline for the first dose of a two-dose COVID-19 vaccine to be received fastly approaching, Health Dimensions Group is doing whatever it can to get its numbers up.
“Anyone who is declining the vaccine is meeting individually with the leadership of the communities. We have letters and frequently asked questions going out,” she said. “It’s everything from one-way training sessions, to open conversation, to written communication, any way that we can get in front of our staff to update them on what we are doing.”
Grabowski suggested there could be some creativity in the way the government penalizes undervaccinated facilities, creating benchmarks against community averages.
“We don’t yet know how the federal government will apply it,” he said. “Will they go in and aggressively fine places, or withhold payments … that’s a long way from shutting down nursing homes.”
Some facilities may look to bring in the national guard, agency staff or face tougher options if they can’t get their numbers up.
Hennessey expects vaccination mandate requirements will be part of surveys for nursing homes fairly quickly to begin the new year.
“I think we’re going to pretty quickly see surveys around this and penalties around it,” she said. “As much as I’d like to see benchmarks by geography or size, I think it will be 100% by the date and there won’t be any sort of flexibility.”
She said that for many communities, a jump in vaccination rates by 20 to 30% would be “great”, but she believed regulators will view it as an all or nothing approach.
“I think every single new person getting vaccinated is a win, but for us the expectation is to be in compliance 100%,” she said.
Companies featured in this article:
