COVID-19 vaccination of Pa. nursing home workers remains woefully low. Will a mandate cause too many to quit?

COVID toll

Sister Rose Nellivila checks the blood pressure of Lorraine Catney, a resident of Villa Angela at St. Anne Home nursing facility in Greensburg, Pa., Thursday, March 25, 2021. (AP Photo/Jessie Wardarski)AP

Most people believe there’s every reason for health care workers to get vaccinated against COVID-19, with protecting the people they care for as well as themselves topping the list.

That would seem especially true for nursing home workers, who care for the people most likely to die if exposed to COVID-19.

Yet those arguments have failed to sway much of Pennsylvania’s nursing home workforce, whose vaccination rate of 67.4% remains less than the overall rate of Pennsylvania adults, which is near 70%.

In early August, Gov. Tom Wolf’s administration began pushing the state’s 700 skilled nursing facilities to get their workforces vaccinated.

To add public pressure, the state launched a dashboard showing the vaccination rate at each facility. The state further said it would withhold government funding for the extra testing that will be required for unvaccinated workers.

The state set an Oct. 1 target for facilities to have at least 80% of workers vaccinated.

At the time, 60% of the state’s nursing home workforce was vaccinated. Moreover, only 13% of skilled nursing homes had vaccinated at least 80% of their workforce, which a state official called “embarrassing and, quite frankly, very frightening to residents and their loved ones.”

Yet two months later, the situation hasn’t changed much, with only 67.4% of Pennsylvania’s nursing home workforce fully vaccinated, according to the U.S. Centers for Disease Control and Prevention. Another 2.5% are partially vaccinated, meaning they have started the process and may intend to become fully vaccinated.

According to the state’s dashboard, many homes remain far short of the 80% goal, with many reporting vaccination rates of well below 40%.

Right after Pennsylvania began its push, President Joe Biden announced a national mandate for vaccination of nursing home employees and all health care facilities. Homes that fall short will lose funding from Medicaid and Medicare — losses that would put most facilities out of business.

Biden didn’t set a date, with officials saying specifics will be announced around the beginning of October.

“We’re going to get to 100% whether we like it or not,” said Zach Shamberg, the CEO of the Pennsylvania Health Care Association, which represents for-profit long-term care providers. “We fear it will be at the expense of thousands of workers when we can’t afford to lose one.”

Medicaid and Medicare account for about 82% of revenues for Pennsylvania nursing homes. No facility can stay open without those funds, according to Shamberg. Therefore, facilities will eventually be forced to fire unvaccinated employees.

But that threatens to shrink the workforces of facilities already struggling with staffing shortages, hurting the level of care for residents and putting more stress on remaining workers, he said.

Shamberg predicts homes will have to turn people away; he says the staffing shortage has already caused some Pennsylvania facilities to close wings and put people on waiting lists.

Seeing some success

Still, there are new signs vaccination mandates for health care workers are effective and won’t drive away an excessive number of workers. In New York, for example, an Oct. 4 vaccination deadline affecting most health care workers has greatly boosted rates, resulting in 92% vaccination among nursing home workers, according to Bloomberg. Moreover, the fear of being unable to sufficiently care for people as a result of workers quitting has diminished.

North Carolina-based Novant Health lost 175 workers because of the mandate. But that’s out of 35,000, giving it a 99% vaccination rate, according to Bloomberg.

According to Pennsylvania’s dashboard as of last week, vaccination rates at Harrisburg region skilled nursing facilities ranged from 89% at Bethany Village Retirement Village near Mechancisburg to about 50% at Fox Subacute near Mechanicsburg, dropping to 29.5% at Forest Park Healthcare and Rehabilitation Center in Carlisle and only 20.8% at Stoneridge Poplar Run in Myerstown.

None of the facilities with low rates responded to requests for interviews as of several days after messages were left.

Shamberg attributed the low rates to factors such as the nursing home workforce including a large number of younger women who may wrongly believe vaccination will interfere with having children, and one that includes a large proportion of racial minorities who are historically skeptical of vaccines and treatments pushed by the government.

Further, many work in rural counties where vaccine resistance is high and, as many health care executives have noted, community resistance tends to include local health care workers. He said homes are working hard at addressing misinformation and persuading workers to get vaccinated. The most successful ones, he said, are using tactics such as having their nursing directors hold one-on-one discussions with staffers.

Shamberg noted that unvaccinated nursing home workers are being tested twice a week in an effort to make sure they don’t carry the virus into the homes.

He said the low vaccination rate “doesn’t mean that any provider has necessarily let down their guard.”

Henri Lively, the administrator of health services at Bethany Village, said “momentum” helped the facility reach a 90% vaccination for a staff of 281. Early on, he said, the facility connected with a local pharmacy which came to the facility several times to give shots before they became widely available at other locations.

Moreover, Bethany leaders made a point of being present during vaccinations and when staffers were being tested for COVID-19. They provided information, addressed misinformation and sought to show employees their work and the risks they face is appreciated.

“I think we maintained a certain level of trust and honesty,” Lively said. “If people had been reluctant, you started to see a change.”

Bethany’s corporate parent also imposed a mandate, making vaccination a condition of employment. The original deadline was in November, but it was moved up after Pennsylvania announced the Oct. 1 target.

Bethany’s parent further provided funding for five weekly raffles, with the winners, who had to be vaccinated, each receiving $1,000. Bethany added to the “fun” by putting top administrators on the receiving end of pies in the face and water balloons. It showed “we appreciate our staff and we wanted to have fun with it,” Lively said.

As of the middle of last week, Lively said, 31 out of 281 staffers remained unvaccinated, including 11 who qualified for medical or religious exemptions. He noted the unvaccinated include only about seven who work in skilled nursing at Bethany, which also has residents living more independently.

He said Bethany accepts that it might lose some long-time employees who are very good at their work. “I know of at least two who continue to wrestle with this and are telling me it could mean the end of their days as a caregiver,” he said. “I tell everyone we are lovingly encouraging them to stay.”

Another factor likely helping Bethany achieve a high vaccination level is that, according to marketing and public relations director Cathy Canning, it strives to provide the best wages and benefits in each local market. Lively said the number of applications to work at Bethany has gone up recently.

‘Put the residents first’

Diane Menio, an advocate for nursing home residents, said she’s alarmed by the low vaccination levels among nursing staff and believes it’s responsible for new outbreaks.

“Residents are dying again because of this — the only people that are bringing [COVID-19] in are probably the staff,” she said.

Menio notes the many Pennsylvania facilities with high staff vaccination rates prove it’s doable. Facilities must double down on efforts to provide good information and address misinformation and offer incentives such as paid time off following vaccination, she said.

Menio, the executive director of the Center for Advocacy for the Rights and Interests of the Elderly, favors vaccination mandates at nursing homes, regardless of whether some staffers might quit.

“They should put the residents first. That’s the purpose of being in this business — to take care of the residents,” she said.

Maggi Barton, a spokeswoman for the Pennsylvania Department of Health, said the state has been reaching out to the low-performing homes as well as the ones with high rates, in order to share successful tactics.

Referring to the target set by the state in August, she said “80 percent was the minimum. The timeline is aggressive, but lives are literally depending on staff being fully protected from the COVID-19 virus.”

Barton said the state hopes people will continue to contact facilities caring for their loved ones if they feel the level of vaccination is too low.

She stressed that vaccination works, with the latest state data showing that 97% of COVID-19 deaths and 95% of hospitalizations involve unvaccinated people.

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