Thousands of Philadelphia’s home health care aides remain unvaccinated, making it unlikely many in the industry will get shots in time to meet the city’s Oct. 15 vaccination mandate for health care workers.

“The numbers are pretty low and pretty stark,” said Teri Henning, chief executive for the Pennsylvania Home Care Association. “There’s a lot of work to do in a pretty short amount of time.”

The mandate requires, with few exceptions, anyone working in health care in the city to be vaccinated by the deadline. The vaccination numbers are so low, the industry is seeking an extension from the Philadelphia Department of Public Health. It’s a possibility, spokesperson James Garrow said, but he questioned whether more time would make a difference.

“Given that the deadline was announced on Aug. 13, giving folks more than two months to get their vaccine,” he said, “it could be debatable that providing an extension at this point will spur people to action.”

Home health care can include trained nursing care, hospice caregivers, and home health aides who don’t have specific medical training, and it’s the latter group that’s particularly concerning, Henning said. There’s no precise tally of vaccinations among them, but she said conversations with providers and business owners indicated about half of the city’s approximately 50,000 aides have not been vaccinated. The people they serve are among the city’s vulnerable, with many at risk of suffering COVID-19′s worst effects due to age, illness, or disability.

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The Philadelphia Department of Public Health acknowledged the significant number of home care workers who are not vaccinated. Some nursing homes, too, had not done better than fully vaccinating about half their workers, Garrow said, though the median vaccination rate among the city’s nursing homes was 74%.

A handful of large Philadelphia nursing homes did not return calls seeking information on their vaccination rates.

In Pennsylvania, which does not have a vaccination mandate for health care workers, about 65% of nursing home workers are vaccinated, roughly the same as the national vaccination rate for those workers. A federal vaccination mandate for all Medicare- and Medicaid-certified health care facilities is expected to be finalized in October.

The city’s mandate has so far prompted varied compliance. Several large hospital systems -- some of which imposed mandates before the city -- have already reported more than 90% of their workers vaccinated.

Unless unvaccinated workers decide to take the one-dose Johnson & Johnson vaccine by Friday, they will not meet the city’s Oct. 15 deadline. Even if a worker got one shot of the two-dose vaccine options, Moderna or Pfizer, Friday, that person would not receive their second dose before the deadline.

“We are most concerned with low vaccine rates in nursing homes because of the high rates of hospitalization and death that took place in those facilities earlier in the pandemic,” Garrow said.

The city is not hosting any clinics over the next two weeks specifically directed at care providers, but Garrow noted there are 350 vaccination sites citywide, and many of them allow people to get shots without an appointment.

The mandate allows for exemptions based on documented health concerns or religion, and exempted workers could wear masks and submit to frequent testing instead.

Home health care agencies are concerned their staffs will be gutted.

“I honestly believe I would lose 50% of my workforce,” said Michael Spivak, chief executive officer at All American Home Care, which includes a Philadelphia location employing about 1,000.

Spivak applauded the mandate when the city announced it in August. He was glad it removed the onus from business owners to require vaccination, and thought it would quickly boost vaccination rates. It hasn’t worked out that way, he said.

“I really thought that it would start from the city and then other cities would pick it up, and then the state would pick it up, and then they would have no choice,” Spivak said.

Providers have been scrambling to get unvaccinated workers to accept doses. Lolita Owens, a home health aide with Liberty Resources Home Choices and a representative with SEIU, the labor union that represents some health workers, has had one-on-one conversations with coworkers to encourage vaccination. She was hesitant herself when the vaccine was first available, she said. Two people she cares for persuaded her the shot was safe and necessary.

“When you’re coming in and out of people’s homes, when you’re going to work with your colleagues,” she said, “you should be vaccinated, not just for yourself, but for them as well.”

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Owens hears from coworkers that they don’t want to get shots for religious reasons, but few expressed fear of the vaccine. Many simply don’t want to be told what to do.

“I heard a person say, ‘why are they trying to tell me what to do with my body?’ ” she said. “I think they realize [having COVID-19] possibly could be that bad, but then you’ve got people who could be like, ‘well I’ll take that chance.’ Or even you’ve got some who say ‘I won’t be the one to get [sick] because I do this, that and the third to take care of myself.’ ”

Liberty held a raffle to encourage vaccination, Owens said, and expects to have two more before the deadline. Spivak is partnering with a vaccine provider to host a clinic in his office, he said.

Home health providers, Henning said, have spoken with the city health department about extending the deadline.

The mandate as it stands, she said, “would leave an awful lot of caregivers unable to work.”

Anyone seeking a vaccination in the city can go to phila.gov/vaccine or vaccines.gov.

Staff writers Jonathan Lai, Justine McDaniel, and Erin McCarthy contributed to this report.