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Nursing home workers aren’t getting vaccinated — prompting worries about the elderly, staffing, and a coming federal mandate

With a federal vaccine mandate pending, nursing home workers will eventually have to be vaccinated or face losing their jobs. For now, many have ignored Pennsylvania's request to do so.

A health-care worker prepares a vaccine dose at a community COVID-19 vaccination clinic run by the Philadelphia Department of Public Health at University of the Sciences' Bobby Morgan Arena in West Philadelphia in February.
A health-care worker prepares a vaccine dose at a community COVID-19 vaccination clinic run by the Philadelphia Department of Public Health at University of the Sciences' Bobby Morgan Arena in West Philadelphia in February.Read moreTIM TAI / Staff Photographer

Most Pennsylvania nursing homes have failed to achieve an 80% vaccination rate among staff members, missing the COVID-19 vaccination goal the Department of Health had aimed to reach by Friday.

Only 19.6% of the 700 nursing homes statewide had at least 80% of their staff fully vaccinated by Sept. 19, the state Department of Health said Thursday. In the Philadelphia region, a little more than 40% of skilled nursing facilities had met or exceeded the goal, according to an Inquirer analysis.

“Each day we go by with staff not vaccinated, the risk increases … for the most vulnerable members of our community,” said Karen Buck, executive director of the Philadelphia-based SeniorLAW Center. “We can’t be playing Russian roulette with the vulnerable in long-term care facilities.”

The state’s benchmark will be superseded by a federal vaccine mandate that’s on the way for all nursing home workers. But the fact that Pennsylvania’s nursing homes fell so short of the state’s benchmark underscores the widespread resistance to the vaccine among workers.

Many of them, industry experts said, have been swayed by misinformation or believe they don’t need it because they were previously infected, which isn’t true. That could portend difficulty for accomplishing the federal mandate, which may already be challenging to enforce, and indicates more education efforts are needed to address workers’ concerns, experts said.

In Philadelphia, which told health-care workers to be vaccinated by Oct. 15 in order to stay employed, nursing home providers and other employers are worrying about losing staff. Meanwhile, senior advocates are concerned the vaccination push isn’t moving fast enough.

» READ MORE: Health-care and higher-ed workers, students must get vaccinated by mid-October, Philadelphia announces

The federal plan will require all workers in Medicaid- and Medicare-certified facilities to be vaccinated, but the proposed rule, expected in October, has not yet been issued. Nursing homes with an overall staff vaccination rate of 75% or lower have higher rates of COVID-19 infections, according to the federal Centers for Medicare and Medicaid Services.

“The [Pennsylvania] Department of Health is supportive of the direction the federal government is taking, and the department’s 80% expectation still holds,” said Pennsylvania Department of Health spokesperson Maggi Barton. “Getting eligible Pennsylvanians vaccinated, especially those caring for some of our most vulnerable residents, remains a top priority even after our goal date.”

This week, the country watched as New York forced unvaccinated health workers to get immunized or lose their jobs. Thousands got last-minute vaccinations, with 92% of hospital and nursing home workers fully or partially vaccinated by Monday.

Though some workers there and at other health systems have quit instead of getting vaccinated, various mandates so far have yielded 90% or better vaccination rates among employees, including major health systems in California, North Carolina, and Delaware.

Uptake of the vaccine among Philadelphia-area nursing home staff is higher than in the rest of the state, with slightly more than 40% of facilities in the Southeast meeting the state’s benchmark compared with about 10% of facilities in the state’s 62 other counties, according to the Centers for Medicare and Medicaid Services data.

Half of Pennsylvania’s nursing homes had less than 66% of staff fully vaccinated as of Sept 19. In contrast, the vast majority of nursing home residents have been fully vaccinated, according to the data — in half of nursing homes, 90% or more of the residents have been vaccinated.

The commonwealth, Barton said, will continue efforts to educate nursing home staff and increase the vaccination rate, but she did not specify what those entailed. Barton said the department had gathered best practices from successful facilities and had reached out to the least-vaccinated ones.

Unvaccinated nursing home staff are tested twice a week under federal guidance, the Pennsylvania Department of Health said. The state will use federal grant funding to help facilities that reached the 80% goal do surveillance testing, as planned, but will not implement extra testing requirements on those that did not reach the goal.

In Pennsylvania and New Jersey, there have been nearly 150,000 confirmed coronavirus cases among long-term care residents and staff and more than 22,600 residents have died.

The New Jersey Health Department was unable to provide staff vaccination numbers specifically for skilled nursing facilities. But according to federal data, an average of 75% of its nursing home workers in reporting facilities have been vaccinated, compared with 65% in Pennsylvania.

Neither Pennsylvania nor New Jersey has instituted a blanket vaccine mandate for health-care workers; both states have vaccine-or-test mandates for certain employees that don’t carry a threat of job loss.

» READ MORE: Only a third of Philly city employees and half of Pa. state health workers have reported being vaccinated

With staffing shortages already a problem, industry advocates worry vaccination requirements could drive out employees and say nursing facilities have not received enough support from the state and federal government throughout the pandemic, including for vaccination efforts.

“I hope that President Biden and CMS [Center for Medicare Services] decide that there are alternatives to mandatory vaccinations,” such as regular testing, said Pennsylvania Health Care Association president Zach Shamberg.

There has already been an uptick in workers leaving their jobs in Pennsylvania, he said.

Some senior advocates said the delta surge underscores why a mandate is necessary.

“They’re so worried about losing their staff. I think they should be more worried about losing their residents to death,” said Diane Menio, executive director of the Center for Advocacy for the Rights & Interests of the Elderly, which is based in Philadelphia.

And when staff aren’t vaccinated, residents aren’t just at increased risk of physical illness and death, said Buck, of the SeniorLAW Center, but also prolonged isolation during outbreaks.

With a mostly female workforce, misinformation about the vaccine’s effect on fertility has made workers reluctant, Shamberg said, and because so many workers caught the virus, some think they don’t need the vaccine. In fact, there is no evidence that the vaccine affects fertility. Contracting the virus poses a much greater risk to pregnant people than the vaccine does, and even people who had the virus receive protection against reinfection if vaccinated.

» READ MORE: Nervous about getting the COVID-19 vaccine? Don’t believe these myths.

Shamberg said Pennsylvania needed to work more closely with facilities to persuade workers to be vaccinated, suggesting the Department of Health should have done more to help educate employees and assist facilities in combating misinformation.

Others also said the state should already have taken more action, including implementing a strict mandate for nursing home employees, providing more data, and taking greater steps to find out exactly why workers aren’t getting shots. They said it’s indicative of a historic failure to prioritize these frontline workers.

“We don’t invest in the ones we depend on to care for our loved ones in the beginning of life and at the end of life,” Buck said. “It’s about time that we take a fresh look at that. It’s just appalling.”

Staff writer Jonathan Lai contributed to this article.