While waiting for the US mandate, some retirement homes are slow to vaccinate staff

When Jim Lewis learned earlier this month that his 90-year-old mother, who lives in a nursing home outside of Boise, Idaho, had tested positive for Covid-19, he wondered if she had contracted the virus from an unvaccinated employee.

And he had reason to be concerned. Just over half of the workers at the home, Creekside Transitional Care and Rehabilitation, were unvaccinated at the time, according to federal data.

“It was evident that the facility had staff members who were reluctant to get vaccinated,” said Lewis, whose mother and immediate family are all immune.

Idaho was hit hard by the delta wave this summer and early fall, and nursing homes were not immune to the highly contagious variant that has swept through many states with higher vaccination rates. weak. Ten states, including Florida, Michigan and Ohio, still report vaccination rates for nursing home staff below 60%.

Others, like New York and California, and some large nursing home chains have imposed their own mandates. But many nursing home administrators are waiting for the federal government to enact new rules that will govern a mandatory vaccination schedule for all their staff that President Biden first announced two months ago. And some facilities and workgroups are still pushing for a testing option instead of a gunshot.

But months of delays and vaccine resistance have had heartbreaking consequences for families like Mr Lewis’, who, once again, are barred from visitation due to epidemics. Creekside did not respond to repeated calls and emails seeking comment.

After sharp declines earlier this year, Covid cases and nursing home deaths increased in August and September, resulting in around 4,000 deaths – though nearly 90% of nursing home residents nationwide were fully vaccinated. Residents are particularly vulnerable to breakthrough infections as many are older and suffer from serious medical conditions, such as multiple myeloma for which former Secretary of State Colin Powell was being treated when he died of complications from Covid on Monday.

“It is medically wrong and bordering on ethics to have unvaccinated nursing home staff caring for residents,” said Dr Michael Wasserman, geriatrician and former nursing home executive who has become an industry critic. “The vaccine works. It made a big difference.

The Biden administration said nursing homes could face a loss of government funding – the sector relies heavily on Medicaid and Medicare funds – if they don’t comply, but the regulations for enforcing a warrant have not yet been disclosed.

Federal officials say they expect to release the regulations later this month. Rules were delayed from last month after the mandate was expanded to include all healthcare workers.

Officials from the Centers for Medicare and Medicaid Services, which will publish the rules, declined to comment on upcoming regulations and did not make anyone available for an interview. It is not known whether they are considering a nursing home testing option, according to people who have worked closely with the administration.

Residents and their families say they are frustrated with the delays of several months in getting that extra layer of protection, given that so many unvaccinated people are helpers and nurses providing the most direct day-to-day care.

Elizabeth, a resident of a nursing home in Minnesota, said she caught Covid earlier this year from an unvaccinated worker before receiving her second dose of the Moderna vaccine. When asked when staff could be vaccinated on the president’s orders, she was told the nursing home could focus on testing workers rather than requiring them to be vaccinated.

“Nothing happened,” said the resident, who asked that only her middle name be used and that her nursing home not be identified for fear of reprisal, a concern shared by other people interviewed for this. article.

The surge of Covid in his state prompted the governor to call in the National Guard last week to help ease his severe shortage of healthcare workers.

“I feel like a sitting duck,” she said. While she continues to wear a mask, some staff are no longer taking the same precautions to control the spread of the virus. “It’s just horribly dangerous,” she said.

The declining effectiveness of vaccines first administered to many nursing home residents has also raised concerns in recent months.

“People are dying, residents are dying,” said Susan Reinhard, director of the AARP Public Policy Institute, which called for more transparency on vaccination rates in nursing homes. “They should be afraid.”

Lower vaccination rates mean more infections, and warrants are one way to increase those rates, said Dr. Ezekiel J. Emanuel, a bioethicist at the University of Pennsylvania who advised Biden during his transition. “We need to be clear that the mandates have worked and have worked in all industries that have tried them,” he said.

Vaccination rates among nursing home staff rose to 69% in early October, from 62% in early August, when Mr Biden announced the mandate, but some facilities are still reporting staffing rates of half or less, according to the latest federal data.

While some nursing homes have gone ahead with their own mandates, many are taking a wait-and-see approach, said Mark Neuberger, a lawyer at Foley & Lardner who advises healthcare organizations on employment issues.

“Will there be an alternative? Asked Zach Shamberg, chief executive of the Pennsylvania Health Care Association, a state trading group representing nursing homes that lobbies for employees to be tested instead of the vaccine. “It’s better than just losing these workers, especially as providers struggle with labor shortages. “

Many nursing homes “remain very concerned that we are not going to see vaccination acceptance rates increase,” he said.

“Our hope is that the fine print allows us to make a testing option,” said Mary Susan Tack-Yurek, Director of Quality and Partner of Quality Life Services. The western Pennsylvania chain of family nursing homes reports that just over half of the staff are vaccinated. “Are we satisfied with the vaccination rate of our staff? No, we are not satisfied with it, ”she said.

But if these workers left rather than being forced to get vaccinated, “we just couldn’t function,” Ms. Tack-Yurek said. “There aren’t enough resources in agency staff, in the National Guard, to come from other states, to compensate.”

The nursing home chain, which employs around 1,100 people, failed to persuade workers to get vaccinated, despite holding raffles offering rewards like a chance to go to Disneyworld or $ 5,000 in cash. “The response has been minimal,” Ms. Tack-Yurek said.

Other nursing home officials reject the option of testing as an alternative. “We already have tests,” said Brendan Williams, CEO of the New Hampshire Health Care Association, whose members have been more successful in vaccinating their employees. “It only preserves the status quo. “

Much depends on the communities where nursing homes attract their workers. If a region’s opposition to vaccination is strong, it becomes more difficult to influence recruits to be vaccinated, and vice versa.

At Chaparral House in Berkeley, Calif., Where vaccination rates are high, the vast majority of employees who received paperwork to get vaccinated were ready, nursing home financial director Chuck Cole said. “Most people didn’t read beyond the first paragraph,” he said, because they were already convinced they should get the vaccine. “It was very important.”

By chatting one-on-one with the small number of workers concerned about the vaccine, the nursing director and administrator were able to persuade the holdouts, he said. Only one in about 150 employees still refuses to be vaccinated.

Covid cases in the United States have declined significantly over the past month, as more people are vaccinated and the delta surge appears to be easing in most parts of the country.

State warrants are helping to increase levels of protection for all age groups, and about 14% of nursing home residents nationwide have already received a booster dose.

And some nursing homes that have been successful in imposing their own requirements are contributing to a higher pass rate, said Brian McGarry, a health researcher at the University of Rochester who studies levels in nursing homes. Genesis HealthCare, a large chain in Pennsylvania, said there have been a few departures, but all of its staff are now vaccinated.

“We are seeing the benefits of our resident safety policy, as our Covid rates (and in particular the severity of any infection) have declined significantly since we instituted our policy, despite overall infection rates in the area. community that remain very high, ”said Lori Mayer, a spokesperson for the company, in a statement.

“The warrants are starting to help,” said Dr. McGarry. The effective promulgation of a requirement by a state or a facility “is a heavy lever and signals to this group that this will no longer be optional”.

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