When the federal vaccine mandate for health care workers went into effect before the latest court injunctions stopped it in its path, there was a time when Accura HealthCare CEO Ted LeNeave was going to have to lay off 1,000 unvaccinated workers companywide.
Balancing what was initially issued by the Centers for Medicare & Medicaid Services – a mandate that does not currently include a test-out option – with the ongoing industry wide staffing crisis has left many providers making tough decisions for the employees who work for them and the residents in their care.
Approximately 75.1% of nursing home staff as of Nov. 21 are reported to be vaccinated, according to CMS data.
“I couldn’t do it, there’s no way I could tell 1,000 people you can’t work. I think I can work them as safe as possible with the right equipment, versus no workers and then I’m going to have residents pass away and die,” LeNeave told Skilled Nursing News.
Accura HealthCare operates 34 skilled nursing, rehabilitation and assisted living centers in Iowa, South Dakota, Minnesota and Nebraska.
“So for us, it became a matter of which one do you choose: Do you follow the mandate, or do you keep taking care of the residents? So we were going to keep taking care of the residents. If you’re talking 5, 6, 7 people then that’s different, I’m talking 1,000,” he added.
LeNeave had ultimately decided before the injunctions went into effect that he would allow those who had a medical or religious exemption, or were otherwise unvaccinated, to work under the conditions of being tested three times per week and increased PPE such as wearing a KN95 mask at all times.
Two preliminary injunctions were issued earlier this month, most recently by Judge Terry Doughty of the U.S. District Court for the Western District of Louisiana on Nov. 30, and another issued on Nov. 29 by Missouri U.S. District Court Judge Matthew Schelp. The Missouri injunction involves 10 states while the Louisiana ruling applies nationally, blocking the vaccine mandate from taking effect.
CMS then shortly thereafter announced that it would suspend the mandate so long as court injunctions remain in effect. The government agency also indicated that it has appealed both court decisions and has filed motions for stays of these orders.
He sat down with SNN in Washington, D.C. during the AHCA/NCAL Population Health Management Summit earlier this week to discuss the vaccine mandate, the court’s latest injunctions and other topics. The conversation has been edited for length and clarity.
What has 2021 looked like for Accura?
It’s been a crazy couple years, hasn’t it? COVID hit us pretty hard. It didn’t hit us with that first wave of COVID, it was actually a year ago now that we really started getting hit. So we lost, out of all of our residents, we probably lost about 200 that passed away, and it wasn’t just those that have passed away. It was just also the hospitals being closed to new admissions, or buildings kind of being closed, people not wanting to go into assisted living or a nursing home at the time.
So our business took about a 20% hit in census and so revenue was down. You know, financially we would have never survived if it wasn’t for the PPP loans, if it wasn’t for the stimulus money that came out – and so that’s how we survived.
We’re not up to where we were pre-COVID but we’re about halfway there; we think we’ll get there this summer. We’re starting to see a lot more referrals – now when the delta variant came out things slowed down, everyone got nervous again – now the new variant and I just think COVID is here for good. It’s going to be like the flu, I think we’ll be getting a shot every year. With the variant I mean we had just a little bit of outbreak in the building, we had no deaths and sent no one to the hospital. I would say that’s because of the vaccine mandate.
Our company was probably about 60% vaccinated staffwise, residents 95%. The staff, it’s just amazing you see it in different parts of the country, we were offering incentives … but the staff that don’t want to get the vaccine, they just don’t want the vaccine. It has nothing to do sometimes with whether they believe it works or not. Some of them don’t want to be told what to do.
When the vaccine mandate came out, to be honest, it scared the crap out of us and it didn’t move the needle. We went to people and said, ‘look guys there’s a mandate’ and they said, ‘I’m not getting it. I’ll just go and work at Casey’s or Kum and Go.’ So as we got closer to the mandate before the injunction, we went up a little over 70%. With the religious exemptions, that was a big win for us because the religious exemptions weren’t tied to a deity … it doesn’t have to be tied to a God or gods.
When the injunction came for Iowa, South Dakota and Nebraska, we said, ‘OK well we’re going to keep pushing the vaccine, try to get them to take it or try to find one of these exemptions.’ So we still push it. Then we focused on Minnesota because at that time the injunction in Louisiana hadn’t happened. So we got it down to out of our 800 employees in Minnesota, 11 we were like you’re not going to be able to work. So we were personally making the phone calls to try to talk to them, and then the other injunction happened. So despite the injunctions, we’re still getting ready just in case. If it gets flipped we’ll be ready.
You were able to get it down to 11 staff [who were unvaccinated in Minnesota], what do you think worked? What specifically made that difference at the end of the day?
I think a lot of the staff will dig in but I think if you give them an option that is reasonable, which is an exemption with testing, they’ll do it because they love their jobs. So in the end when we same and said, ‘If you have a strongly held belief then look at these exemptions. We’re not telling you to pick an exemption but there are exemptions based on what you believe and how you feel and then we leave it up to them.’ Our role was to offer options for people and to follow a policy to do that … and I guarantee you had the mandate stayed in place I would imagine there have been more people getting the vaccine in the last hour.
What are some other goals you guys have for 2022?
Yeah, so 2022 is trying to learn what the new normal looks like. I think the COVID virus and variants are here to stay for a while. It’s how do we get our residents feeling comfortable, that we’re going to continue to protect them and how do we get people back interested in coming into our homes? I think there are certain people that are ready to come back to nursing homes but they’re worried that in any institutional setting and indoor setting that stuff begins to spread.
We’ve got a big staffing crisis right now across the country, trying to figure out how to get people reengaged and coming back. Our culture is pretty unique … our culture is an upside down organization. You’ve seen a traditional org chart where the CEOs up here and the chart gets wider. So what we did is we flipped the organization upside down, because when I was a nursing home administrator I would hate it when people would say the corporate office says you have to do this and the corporate office says you have to do that … So when I bought my own company we flipped the organizational chart upside down, and so I’m at the very bottom of the chart and and wherever you are on the chart you are a resource to the people above you and then the residents and the direct care specialists are at the very top of the organization. So we’re all about culture, our mission statement is partners in care and family for life. We believe we’re all partners in the delivery of this care [where it’s the] residents, staff members, staff family, resident family members, doctors, legislators, we all have our impact on what goes on in the building. So we believe that we’ll focus a lot on our culture this [upcoming] year. One of the things we’ve done is the health care insurance increases came out this year, 13% increase as a company, and we picked it up. Now we’ll figure out how to pay for it but I just couldn’t pass that on to my staff, they’ve been through so much. So the majority of this year is getting kind of some very simple things: Loving the staff, building them up, getting back into the buildings because we couldn’t go to them a lot, doing cookouts for them, making visits, doing special things to just help them feel supported and loved. When they feel that way then it becomes infectious and then they can take better care of the patients.
Then strategically we’ve joined this provider network that has been great for us. We picked up some new contracts that we couldn’t get before … We are starting our own I-SNP so that’ll start January 2023 so continuing to get ready for our I-SNP will be another big project and then getting back into the buildings to repair what I call the COVID hangover. The way that we had to drastically clean the buildings in the beginning of COVID with chemicals that you just didn’t know the wear and tear it would take on the buildings and they would they would mess up the paint, they would peel the wallpaper, it would bleed down onto the carpets and so we’re going through a massive kind of refurbish of the carpets and floorings and walls and paint, just to get through that COVID hangover.
Going back to staff a little bit, I know everybody is dealing with the staffing shortage. What are you guys seeing specifically and where do you think this needs to go to help facilities that are all dealing with the same issue?
You know it’s been tough because you can go to a conference and a lot of conferences and a lot of staff experts will say let me show you how to do a good open house, let me show you how to put a good ad together. It doesn’t necessarily work, I mean yes, but everyone has a problem. The problem is getting more people into our industry. When you do the best open house, you’re moving the problem. So there’s only so much of that you can do because what that does is you can have a great culture, a great place, great word of mouth or retention bonuses or recruitment bonuses, and people come over and they work for you and they say, ‘well I love the culture.’ In our company you get to know the CEO and the owner. I mean you get to know me and text me and we get to visit. So culture can take you a ways but I’m concerned about the whole industry. So when that happens we’re just taking staff from someone else and now we’ve got a problem over there that could with our competition that could lead to poor care and I don’t want that to happen. So we have to figure out a way as a profession to get more people into our business because the only other thing that does is they’ll offer to pay more money and then I have to offer to pay more money and you’re just sharing it back and forth. I will say attracting people into the profession, sometimes just from a cost perspective, we’re not reimbursed enough from a Medicaid perspective to be able to pay the wages that would attract someone from going to a different profession. I actually think we’ve got to get people from overseas or people at the border. I think about all the people that come across the border that we hear about on the news all the time. If we could ever get the powers in Washington to figure out some sort of kind of work program that allows if you’re in the country and you’re not legal, let’s give them a pathway to citizenship. If they come into the nursing profession we’ll train them, we’ll give them the education and we’ll train them as CNAs we’re trying to get them into nursing and we’ll pay for it. Then they’re working towards a goal and they’re able to help us with our problem. And then they’re able to get a pathway to citizenship and pay taxes. I know how controversial that is in the country … but I think the two parties just gotta figure it out because in the end it’s the residents that are going to pay the price, they’re the ones that need the workers. So, we’re doing a lot to talk with our legislators as much as we can about those types of things.
I don’t know how you create the priorities but something’s gotta give; I mean this staffing crisis is just ridiculous and the inflation that’s gone along with it. Our reimbursement doesn’t keep up with it. Currently we’re running at a loss and we have reserves and credit to sustain that for a period of time, but there’s gotta be something that breaks and everyone is in the same boat. We’re all feeling that.
Companies featured in this article:
Accura HealthCare, Centers for Medicare & Medicaid Services, CMS
