Nursing homes face the dilemma of vaccinating staff or not getting paid.


Marita Smith runs a retirement home in Seattle, while Janet Snipes runs one in Denver. They share years of industry experience and painful memories of Covid-19, but have very different views on a new federal policy that will require all nursing home workers to be vaccinated.

In Smith’s view, unvaccinated people should not be caring for a vulnerable population already hit hard by the pandemic. The industry is once again seeing rising rates of infection and death among residents, though none are approaching last year’s record numbers, and the mandate aims to stave off another wave.

“This is great,” said Ms. Smith, administrator of the St. Anne Nursing and Rehab Center, calling the policy “pretty big” that “would crowd out health professionals who shouldn’t be in health care.”

Such departures are precisely what worries Ms Snipes, executive director of the Holly Heights Care Center in Denver. She, too, wants all nursing home workers to be vaccinated, but not at the risk of losing non-compliant employees amid a labor shortage in an industry with an already high turnover rate. raised.

Of the 1.5 million nursing home workers in the United States, some 540,000 – 40% of the workforce – are not vaccinated. Their fate could be directly affected by a policy announced by President Biden on Wednesday requiring all nursing home workers to be vaccinated, with the rules due to go into effect in September. Facilities that fail to meet this target could face fines or lose their federal rebate eligibility, a vital source of revenue for many.

The practical effect of the policy is that workers will have to be vaccinated or lose their jobs. Ms Snipes said several employees told her they could leave. One, whom she described as her best nurse, told her she was “very, very scared” of the vaccine, in part because she is black and concerned about past medical experiments.

Getting vaccinated “is the safest thing for our residents and staff, but we strongly believe he should impose it on all health care facilities,” Ms Snipes said of President Biden. “We cannot afford to lose staff to hospitals and assisted living facilities. “

Several large nursing home chains and some states have already imposed vaccination mandates. Industry officials said inoculations were strongly advised, but their stance on the new policy echoed that of Ms Snipes.

“We are going to lose tens of thousands, maybe hundreds of thousands of workers,” said Mark Parkinson, president and CEO of the American Health Care Association, a major nursing home business group. He said he hoped for policy changes and had previously spoken to Dr Lee A. Fleisher, chief medical officer of the Centers for Medicare & Medicaid Services, and was looking to meet Xavier Becerra, the secretary of health and human services. . .

The main change sought by the industry is a signal from the administration that a mandate will eventually apply to all health care facilities, so that nursing home workers recognize that there is no share where to go. “The mandate for everyone,” Mr. Parkinson said.

In fact, around 2,000 hospitals have already issued immunization warrants, reducing employment options for unvaccinated healthcare workers.

Dr Fleisher said the CMS and the Centers for Disease Control and Prevention saw in recent data a relationship between increased infections in nursing homes and unvaccinated staff.

“The higher the percentage of unvaccinated staff, the higher the percentage of cases that we have seen in these outbreaks,” said Dr Fleisher. “There was a strong relationship.

Currently, 60% of nursing home staff nationwide are vaccinated, well below the industry’s initial target of 75% by the end of June.

Mr Parkinson said the industry was also pressuring the government to launch “a much more intense media campaign to influence workers” that vaccines are safe and effective. The trade organization also wants the government to create a grace period for hesitant staff.

Dr Joshua Uy, geriatrician and medical director of a nursing home in Philadelphia, said he had seen staffing issues before and was “thrilled with the tenure.”

“I’m exhausted,” he said. “The vaccine is like a mini fortress around the most vulnerable, where even if there is a fire raging outside, those inside stay safe.”

The mandate aims to prevent an increase in Covid cases and deaths in a very vulnerable population.

Of the 625,000 Covid deaths in the United States to date, nearly a fifth – 133,700 – have been nursing home residents, according to the CDC

And a recent CDC study of 4,000 nursing homes found that the effectiveness of Pfizer and Moderna vaccines among nursing home residents fell from 75% in the spring to 53% in the middle of the summer, so as the Delta variant spread. “The results underscore the critical importance of vaccination against Covid-19 for staff, residents and visitors,” noted the study authors.

Public health experts fear that unvaccinated employees could bring Covid-19 into a nursing home and infect residents. More than 80% of nursing home residents nationwide are vaccinated, but cases are already increasing in this population. In the week ending August 15, 354 nursing home residents died with Covid-19, the highest figure since mid-March, and 3,585 have tested positive, according to the CDC

More and more staff are falling ill, the CDC has found. The week ending August 15 saw 5,810 nursing home workers sick with Covid-19, five times more than a month earlier, and 25 staff members died.

Earlier this month, the Good Samaritan Society, which operates 142 nursing homes nationwide, announced that all 15,000 staff are due to be vaccinated by November 1 – a position the company has taken after seeing an increase in infections of residents in homes where unvaccinated staff have also tested positive. So far, staffing levels have remained stable, said Randy Bury, chief executive of the company, who has argued in the past that such mandates would create safe and desirable workplaces.

But he argued that the Biden administration’s new policy was wrong unless it was applied to the entire healthcare industry. “What’s the difference in a long-term care facility or in a hospital?” Mr. Bury said. “They are susceptible to the virus if they come into contact with unvaccinated staff. “

LeadingAge, a nonprofit representing 2,000 nursing homes that had previously called for mandates in single-family homes, criticized Biden’s policy for its narrow focus.

“The administration is right,” said Katie Smith Sloan, President and CEO of LeadingAge, in a released statement. “We are on a war footing. Funding the healthcare providers who continue to struggle on the front lines would be a tragic misstep. “

Ms Snipes, director of Holly Heights in Denver, said she spent months trying to educate staff and encourage vaccination. She said most of her unvaccinated employees had agreed to obey the mandate, but mentioned three that she feared leaving. One of them told her that she didn’t want to put anything foreign in her body. A second, who was Catholic, said he didn’t want an mRNA vaccine for religious reasons and had a letter of support from his bishop.

The third was the black nurse who “of all the people I’ve spoken to seems the most frightened,” Ms. Snipes said. “I want to save her as an employee.”


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