GOV. CHARLIE BAKER announced Wednesday that the state will require all nursing home and long-term care facility staff to be fully vaccinated for COVID-19 by October 10.
The decision marks an evolution for the Republican governor, who has resisted imposing vaccine mandates on public employees. The decision is intended to protect the population most vulnerable to COVID-19 — the elderly. Some major area hospitals have issued similar mandates to protect vulnerable patients.
“COVID-19 presents increased risk of severe illness, complications, and death to older adults and particularly those with chronic conditions,” acting public health commissioner Margret Cooke wrote in an order establishing the vaccine mandate. “Immunization is the most effective method for preventing and mitigating infection from COVID-19, including possible hospitalization or death.”
Several nursing home operators cheered the mandate as a way to create a safer environment for residents. But unions representing nursing home workers say they want workers to get vaccinated on their own volition, without the threat of job loss. “At a time when nursing home workers are short staffed and healing from the trauma they experienced, they shouldn’t suffer economic hardship due to delaying vaccination,” said Marlishia Aho, a spokesperson for 1199SEIU United Healthcare Workers East.
According to the Office of Health and Human Services, there are 378 skilled nursing facilities in Massachusetts and two state-run soldiers’ homes, all of which will be subject to the mandate. There will be exemptions for medical reasons or sincerely held religious beliefs, as long as workers can continue to perform their job with a “reasonable accommodation.”
According to the Massachusetts Senior Care Association, an advocacy group that represents nursing homes, 75 percent of nursing home staff are vaccinated. But public health officials said that, as of August 2, there were 155 facilities with less than 75 percent of their staff fully vaccinated.
Starting October 10, the order gives the Department of Public Health authority to order any nursing facility that has fewer than 75 percent of its staff vaccinated to stop accepting new admissions.
According to state data as of July 30, nursing home residents have accounted for 5 percent of COVID-19 cases and 31 percent of COVID-19 deaths in the state. While the biggest run of nursing home cases occurred before vaccines existed, and the state has made a major effort to vaccinate residents, Cooke’s order said there has been a five-fold increase in nursing home resident and staff cases the last 30 days and an increase in deaths.
Until now, Baker has generally resisted imposing vaccine mandates, saying he would rather focus on making vaccines as easily accessible as possible. Asked in May whether he would mandate vaccines for public workers, he said he would not “kick somebody out of a job” in this economy because they would not get vaccinated on an emergency use-approved vaccine. “I’m not going to play that game,” Baker said then.
But that was before the spread of the Delta variant of COVID-19, which is more contagious than the original virus and more likely to “break through” existing vaccines. The FDA is now expected to give full approval to Pfizer’s COVID vaccine in September.
One potential complication is that nursing homes have long suffered from staffing shortages, and low pay makes it hard to attract new workers. If employees leave a nursing home because they do not want to get a vaccine, it could worsen the staffing situation.
Despite that, the Massachusetts Senior Care Association favors a vaccine mandate. “The governor’s new state COVID-19 staff vaccination mandate for nursing home staff will save lives, especially since many workers move between jobs frequently or hold two jobs in different health care settings, and it aligns with public health goals to achieve herd immunity,” Tara Gregorio, president of the Massachusetts Senior Care Association, said in a statement.
Some nursing home operators said a statewide mandate alleviates concerns that staff will leave for another job.
Kevin Morris, president of BaneCare, which runs 11 nursing homes, said 77 percent of the firm’s 1,509 staff are fully vaccinated along with 92 percent of residents. Morris said BaneCare was considering imposing a staff vaccine mandate, but the organization worried about losing unvaccinated workers to other nursing homes, hospitals, or home care agencies that did not require the vaccine. Morris said he is happy there will be a statewide mandate, which he believes will keep residents safe. “It makes it a lot easier for us to take on this mandate when most of the health care sector are doing so as well, “Morris said.
Similarly, Tom Lavallee, chief operating officer at Alliance Health and Human Services, which runs eight nursing homes, said about 75 percent of staff are already vaccinated, and the firm had been contemplating a vaccine mandate. But it too worried about losing staff to other homes. “This certainly takes the decision out of our hands, and we’re fine with that,” Lavallee said.
Some nursing homes already have imposed their own mandates.
Lou Woolf, president and CEO of Hebrew SeniorLife, which has 2,600 employees and cares for 2,400 long-term care residents, announced a vaccine mandate for staff last Monday. Around 85 percent of Hebrew SeniorLife employees are vaccinated, and the rest must be fully vaccinated by October 1, with exemptions for medical reasons and religious beliefs. Hebrew SeniorLife is offering on-site vaccination clinics, and workers who need time off to recover will be paid.
“We have a deep commitment to do everything we can to have the people we care for live their best lives possible, and that includes keeping them safe from something like COVID, but also putting them in a position where they can have activities and staff around them who can touch them or read to them or do activities with them,” Woolf said. Although almost all residents are vaccinated, Woolf said he worries about breakthrough cases among vulnerable residents and about unvaccinated staff getting other staff sick.
Woolf said the state mandate helps organizations like Hebrew SeniorLife, since workers who are vaccine hesitant will be less likely to move to another nursing home. He also said concern about employee turnover goes both ways. He worried that if Hebrew SeniorLife did not mandate vaccinations, vaccinated staff might leave for a place where they could be assured that all their coworkers were vaccinated.
“Do we expect ultimately there could be some who leave? I don’t think that’s unreasonable,” Woolf said. “There could be, but that’s okay because it’s still the right thing to do.”
Lasell Village, a senior living complex at Lasell University with independent apartments and a small nursing home, announced in May that all staff had to be fully vaccinated by September 1, becoming the first senior living complex to impose a mandate.
Anne Doyle, president of Lasell Village, said managers talked to staff one-on-one about their concerns and by the time the policy was announced, 91.5 percent of staff were vaccinated. Out of 160 employees, only three are still unvaccinated, all in the nursing home. Doyle anticipates that the governor’s mandate will convince them to get the shots. “I think that’s really going to help people who are just a little bit concerned or just maybe need that extra nudge to say now is the time for me to get vaccinated,” Doyle said.
Workers’ groups, however, have concerns.
Aho, of 1199 SEIU, said workers should be educated about the vaccine, and steps should be taken to boost vaccinations while also continuing measures like testing and masking. She does not want to see workers face punishment for delaying a vaccine. Aho said around 70 percent of union nursing home workers are vaccinated, and a poll earlier this year said 90 percent had gotten or anticipated getting the vaccine.
“We believe we will get there, but we don’t think we’ll get there with a heavy-handed approach,” Aho said.
Joe Markman, a spokesman for the Massachusetts Nurses Association, which represents nurses at the soldiers’ homes, said the union encouraged members to get the vaccine, but does not support mandating a vaccine that is still under emergency use authority. The union has asked facilities how they will deal with exemptions, and how they will handle it if someone has side effects and needs to take time off.
“We will be communicating with those facilities where we have members to evaluate the specifics of each policy to ensure the process is safe and respects our members’ rights and health needs,” Markman said.
Dr. Terrence O’Malley, a retired geriatrician from Mass. General Hospital, said he thinks a vaccine mandate for nursing home workers is “an excellent idea.” Since many nursing assistants work two or even three jobs to make ends meet, they can be vectors for carrying infection. Even if residents are vaccinated, O’Malley said, breakthrough cases are possible, and nursing home residents are the most vulnerable population in the state. “The most common source of new infections in nursing homes are staff members,” O’Malley said.
O’Malley said mandates do have to be paired with ways to make it easy for someone to get vaccinated, by providing paid time off for workers who need time to get a vaccine or to recover from side effects from the vaccine.
Sen. Pat Jehlen, a Somerville Democrat who co-chairs the Joint Committee on Elder Affairs, said she hears both sides, though she supports the mandate. “I’m happy that it will protect patients and other workers, and I’m worried about the continuing shortage of direct care workers,” Jehlen said.