Ohio nursing homes fear crunch after Biden mandates staff get vaccine
When Ohio hospitals and other health care facilities began requiring the COVID-19 vaccine for staff earlier this month, most nursing homes held off on doing so.
Now, they’re likely to have no choice.
Shattering any remaining sense of calm in Ohio’s long-term care sphere, President Joe Biden announced late Wednesday that he was going to order facilities to require their workers get the COVID-19 vaccine – or the facilities would lose Medicaid and Medicare funding. Most residents benefit from at least one of the programs.
“I’m scared to death of what that’s going to look like,” said Pete Van Runkle, head of the Ohio Health Care Association, which represents the state’s for-profit long-term care facilities.
The latest move is part of the Biden administration’s campaign to increase low vaccination rates across the country. He noted the vaccination rate among nursing home workers lags the national rate.
The requirement won’t immediately go into effect. It’s likely to go into effect in September after more detailed regulations are written out by federal agencies. But in the meantime, Ohioans are trying to process what this means.
How poorly the new mandate fares for already short-staffed nursing homes will heavily depend on how nursing home staff react to the news.
“Staffing is just going to get worse. I work in a LTC (long-term care) facility and many of us are willing to be fired,” said Amanda Nutt, a nurse at West Liberty-based Green Hills Community, in a Facebook comment.
In Ohio, around 54.3% of nursing home staff have been vaccinated, according to federal data last week. Roughly a third of facilities face staffing shortages as of late July.
A facility in Ohio on average has 19 open positions it can’t fill, according to a recent OHCA survey. That could get worse with the mandate, and in turn, hurt care for residents, said Van Runkle.
“Most of them are not vaccinated because that is their choice,” he said of the unvaccinated half. “That is their strong feeling. And they’re refusing to be vaccinated.”
Since the federal order only applies to skilled nursing facilities, many workers could simply walk on to other health care areas. And with Medicaid and Medicare being the largest payers in long-term care settings, most if not all facilities would have to require vaccinations or face shutting down entirely.
Staying fully staffed is a chronic problem the industry has faced and was exacerbated by the COVID-19 pandemic.
Van Runkle noted there was one large long-term care company that decided to mandate vaccines, only to walk it back later. Workers threatened to leave, and even one location had almost all staff planning to do so.
“We can’t do that,” he said. “We’re leaving all of our residents high and dry.”
Mandate didn’t hurt one provider
At the beginning of August, suburban Cincinnati-based Episcopal Retirement Services was one of the few facilities in the state to mandate the vaccine for staff. It’s turned out better than what many predicted.
“We haven’t lost an extraordinary amount of people,” said CEO Laura Lamb. “It hasn’t been a mass exodus by any stretch of the imagination.”
Before the requirement, between 60% to 80% of staff were inoculated, she said. Now, it’s above 80% and still well before EPS’ deadline of Sept. 25.
A lot of planning was involved, however, as well as a long timeframe. The facility had many candid talks with individuals, providing scientific information or data and being intentional about acknowledging any hesitations. It was able to quantify how many would leave versus how many accept the vaccine if it was mandated, then have contingency plans.
“The first step is to have a discussion with staff to make sure that they know that we care about them,” Lamb said. “One thing that I’ve learned in talking to the staff is sometimes they’re getting their data sources from not credible outlets.”
In fact, Lamb said she’s seen an uptick in job applications since her facility announced the vaccine requirement, but clarified she doesn’t know if the two incidents are related.
“Our vaccinated staff has said, ‘We want to work in a fully vaccinated environment,’ ” said Lamb. “Because it’s safer, it’s safer for them, it’s safer for their families. And ultimately, it’s safer for the residents.”
Not all nursing home workers have disapproved of the administration’s mandate.
“As someone who seen huge losses in the nursing home I work at, 33 deaths in 2-3 months, I can see why,” commented Darla Marie Wieging on Facebook.
Acting for the sake of the vulnerable
The nursing home industry believes those who care about residents should also be against Biden’s new rule.
“How many eligible residents will not receive monoclonal antibody treatment because the nursing home simply can’t spare the staff for this time-intensive treatment?” said Patrick Schwartz, spokesperson for LeadingAge Ohio, the trade group for non-profit facilities. “We now have nursing homes that have shut down entire wings of their buildings and have growing waiting lists.”
It’s an argument that Barbara Riley, of the Ohio Aging Advocacy Coalition, understands. She noted the industry does support as many vaccinations as possible and pinned the problem on the vaccine-resistant.
“Because if you can’t get staff, it’s true. You cannot provide quality care and if you can’t provide quality care, you shouldn’t be in the business,” she said.
But AARP Ohio said that the lives of the elderly are a far more urgent problem and needs to take priority. It noted recently that only 7.9% of Ohio nursing homes had at least 75% of staff vaccinated, the industry’s benchmark goal.
“The low levels of staff vaccinations in particular creates an unacceptable level of risk, since the disease spreads so easily in these environments,” said Holly Holtzen, AARP’s Ohio director, calling for vaccine requirements for both residents and staff.
It may be for the best that Biden has mandated inoculation, some patient advocates say. The workers who don’t vaccinate are harming the vulnerable and shouldn’t be on the job.
For patients and their families, it may be best to move to facilities that require full vaccination, said Riley. Having COVID-19 outbreaks can cause further isolation for residents, and that’s known to be dangerous as well for elderly people.
The industry is hoping to have some sway in how the regulations are written before they go into effect, said Van Runkle. It’s hoping the federal government will allow some exceptions or even allow constant COVID-19 testing in place of not getting vaccinated.
If that fails, facilities will have to live with and adapt to whatever comes.
“If that means that we have to get through this period of trying to be creative or innovative or find a way to attract people to our industry and our workforce, then I think the lives of our elders are important enough for us to do that,” said Lamb.
Titus Wu is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.