Nursing Homes Are Requiring Staff COVID-19 Vaccinations

Nursing Homes Are Requiring Staff COVID-19 Vaccinations

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For now, both CLC & Cappella and Asbury are sticking to strongly encouraging vaccinations, as they watch what other health care operators do. “We just want to play along with the larger group and really watch the health experts,” Leidig says.

Michael Wasserman, M.D., a geriatrician and past president of the California Association of Long Term Care Medicine — which represents doctors, nurses, pharmacists and others in the industry — long fought against such mandates. “Three words I’ve continuously used for months is respecting, honoring and valuing the frontline staff [of the pandemic], and in doing so, not coercing or requiring them to be vaccinated against their will,” he says.

But recent events changed his mind. An unvaccinated health care worker is believed to have been at the center of a March COVID-19 outbreak in a Kentucky nursing home where nearly 50 people were infected, including 18 fully vaccinated residents. Three residents — including one who was vaccinated — died.

And while deaths from the virus have declined sharply this year, almost 900 residents still lost their lives to COVID-19 from mid-March to mid-April, AARP’s analysis shows.

And the virus continues to mutate, presenting an ongoing risk. “If we required all nursing home staff to be vaccinated, we would save a finite number of resident and staff lives,” Wasserman says. “I’m just not sure how to ignore that.”

‘From nobodies to everybodies’

Mandates aren’t the only tool long-term care facilities are using to up staff vaccinations. A national campaign by LeadingAge and the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which represents more than 14,000 nursing homes and long-term care facilities, has set a goal of vaccinating 75 percent of the nation’s nursing home workers by June 30. Facilities are enlisting vaccinated workers, or “vaccine ambassadors,” to provide one-on-one education to hesitant staff. And some facilities are offering incentives, from bonuses to extra time off and discounted health insurance.

The Centers for Medicare & Medicaid Services, which regulates America’s 15,000-plus nursing homes, recently announced that all nursing homes will be required to offer and educate all residents and staff on COVID-19 vaccines, as well as publicly report vaccination rates.

But it’s hard to overcome the mistrust that many long-term care workers feel toward their employers, says Lori Porter, cofounder and CEO of the National Association of Health Care Assistants.

Certified nursing assistants (CNAs) make up the largest group of employees working in health care facilities, providing more than 90 percent of the direct patient care, according to the association. Most make just $13 per hour, and many don’t receive sick leave or benefits. Many work at multiple facilities to make ends meet. In doing so, some were villainized for unknowingly spreading COVID-19 to residents, even as other frontline health care workers were lauded for heroic work. CNAs in nursing homes had one of the deadliest jobs of 2020.

“CNAs went from nobodies to everybodies for the first time ever when everybody wanted them to take the vaccines,” Porter says. Starting late last year, nursing home staff were prioritized alongside residents and other health care workers as the nation’s first vaccine recipients. But many staff question the motivation behind their prioritization.

CNAs are asking: “Why now? Why this?” Porter says. “Why haven’t you fought for us to get raises? Why haven’t you fought so we can make a living wage and pay our bills? Why didn’t you fight to get us [personal protective equipment]? Why didn’t you fight to get us hero hazard pay?”

Enforcing a mandate may only deepen that mistrust, warns Gur-Arie of Johns Hopkins and Oxford. “If your workforce feels completely abandoned by you as an employer and has lost all trust in you as an employer, that ultimately can lead to negative health outcomes,” she says. “And not only for the patients that they’re serving in these facilities, but also for the workers themselves.”

Mike Wasserman sits on the board of AARP charitable affiliate Wish of a Lifetime.

Emily Paulin is a contributing writer who covers nursing homes, health care, and federal and state policy. Her work has also appeared in Broadsheet, an Australian lifestyle publication.