Gaps between resident and staff vaccination rates are common at nursing homes across the state. Both groups were among the earliest eligible for vaccines in Minnesota, as long-term care facilities were particularly hard hit by the virus in 2020.
A proposed federal vaccination mandate for workers could boost the rate, while also raising concerns about the impact it could have on already low staffing levels.
“Nobody in the senior provider field has enough staff,” said Teresa Hildebrandt, CEO/campus administrator at Benedictine Living Community in St. Peter. “So now if we’re mandated to not have staff working who are unvaccinated, I don’t know honestly what’s going to happen.”
President Joe Biden announced in August the federal Centers for Medicare & Medicaid Services, or CMS, would develop emergency regulations requiring nursing home staff to be vaccinated. The requirement would apply to the more than 15,000 nursing homes that accept Medicare or Medicaid, accounting for most such facilities in the U.S.
In the announcement, CMS Administrator Chiquita Brooks-LaSure stated the agency will work with the Centers for Disease Control and Prevention, long-term care associations and unions to advance the policy.
“The data are clear that higher levels of staff vaccination are linked to fewer outbreaks among residents, many of whom are at an increased risk of infection, hospitalization, or death,” she stated.
So far, there hasn’t been a date set for when the requirement would take effect. Patti Cullen, president/CEO at Care Providers of Minnesota, said she’s been looking at the federal docket every day for more information, to no avail.
More details could come in mid to late October. As an organization representing hundreds of nursing homes and other care providers in Minnesota, Cullen said the timing on any requirement is one of the main answers they need.
Raising the rates
In the interim, CMS data showed 67.1% of nursing home staff nationwide received the COVID-19 vaccine as of Sept. 26.
Nearly all nursing homes in south-central Minnesota, including the four in Mankato, have staff vaccination rates above the national average. Mankato’s nursing homes range between 68.6% to 77.3% for staff vaccinations.
Ecumen Pathstone Living in Mankato has the 77.3% rate. In a statement, Executive Director Rachael Evers said the protocol until CMS releases more information calls for team members to be vaccinated or complete a declination process, which includes education and weekly COVID-19 testing.
“We know that right now, the vaccine is our best defense against the virus and its variants, and we’re grateful to all — especially our team members, residents and their family members — who’ve chosen to get vaccinated,” she stated. “We hope that even more will do so in the coming weeks.”
Monarch Healthcare Management operates the Hillcrest, Laurels Peak and Oaklawn nursing homes in Mankato. Laurels Peak has a 74.8% staff vaccination rate, Hillcrest is at 74% and Oaklawn is at 68.6%.
As Monarch waits for more word on a mandate, Chief Operating Officer Marc Halpert said they continue to encourage vaccinations for the workers who haven’t gotten them yet.
“I’m hopeful that my staff will get the vaccine,” he said. “It’s been proven that it’s safe and helpful.”
He noted hospitals regularly report being filled with mostly unvaccinated patients. And vaccinated people who get breakthrough cases experience milder symptoms.
He estimated about 20% more staff would likely get the vaccine if it were mandated. Mandates in health settings elsewhere in the country resulted in the vast majority of workers getting the vaccine, with small percentages following through on threats to quit.
The issue with nursing homes is even a small percentage leaving would worsen existing shortages.
Statewide survey results released Thursday found more than 23,000 direct care positions are vacant at long-term care providers across Minnesota. The survey of 300 in-state providers by Long-Term Care Imperative, a collaboration working on changes in older adult services, identified nursing homes in every region with 10% or higher rates of unfilled positions.
The leaders at Monarch, Ecumen and Bendictine said their nursing homes aren’t exceptions on the staffing front. Facilities are employing similar strategies in the hopes of getting more workers vaccinated.
Ongoing conversations with unvaccinated workers are important parts of the strategy, Evers stated.
“Listening without judgment is key, and then addressing their questions with research-based facts, and offering additional trusted resources as well,” she stated.
Benedictine’s St. Peter nursing home has 81% of its staff vaccinated against COVID-19, the highest rate in the region. Hildebrandt said the goal is to “see everybody vaccinated that’s able to be vaccinated.”
The nursing home’s infection control nurse and director of nursing have done a good job getting unvaccinated staff the verified information they need, Hildebrandt said.
One-on-ones help them understand why staff members are opposed to the vaccine, she added. Then they’re in a better position to answer staff concerns.
“There’s a lot of misconceptions about the vaccine, and we try our best to provide information from legitimate sources,” Hildebrandt said.
Monarch uses one-on-ones to hear and respond to staff concerns about vaccinations as well. Getting to 100% is the goal in anticipation of the mandate, Halpert said, adding there are definitely worries about what a mandate would do to existing staffing issues.
Working as a care provider isn’t easy, he said, pointing out temp agencies also don’t have as many workers these days. Recent and upcoming wage increases are among the strategies Monarch used to keep workers.
“It’s a difficult job and a lot of responsibility,” he said. “We’ve tried a lot of things.”
Although a vaccine mandate could worsen existing staffing shortages, the proposal didn’t cause them. Staffing struggles in nursing, an issue for a while now, weren’t helped by the pandemic, Hildebrandt said,
“COVID-19 has made it worse,” she said. “Our facility had an outbreak last year, and people just quit.”
Less was known about COVID-19 at the time. Outbreaks in such high-risk settings led some to consider other careers.
Another result of the pandemic was older staff seeing it as a good time to retire, understandably so, Hildebrandt said.
Funding for emergency staffing could be one short-term solution for nursing homes. Evers stated Ecumen Pathstone is hopeful that the state will offer the funding, as well as “appropriate money to enhance caregiver wages to bolster retention and recruitment efforts in long-term care.”
Long-Term Care Imperative’s Thursday survey announcement named both proposals as possible solutions. The workforce problems need more than a one-time infusion of funding, said Gayle Kvenvold, CEO of LeadingAge Minnesota, in a release.
“Without more significant investments in the senior care workforce and changes to the reimbursement system to allow this to happen, this crisis will threaten the availability of care for the most vulnerable at a time when we are facing the largest population of seniors in American history,” she stated.
Follow Brian Arola @BrianArola
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