Should there be a COVID-19 vaccine mandate for nursing home staff? | Pro/Con

One of the communities hit hardest by COVID-19 is our elderly citizens, particularly those living in nursing homes. In Pennsylvania, more than 10,000 residents have died so far. Although this group was among the first to be offered the COVID-19 vaccine, only two-thirds of nursing home staff in the state have accepted it, leaving a substantial number unvaccinated.

Pennsylvania has fallen short of its goal of vaccinating 80% of nursing home staff by this month, leaving facilities to face a looming federal mandate. In Philadelphia, staff at long-term care facilities could lose their job if they don’t get their first shot by Oct. 15, unless they receive a medical or religious exemption.

The Inquirer tapped two local leaders who fight for the rights of nursing home residents and staff to debate: Is it fair to ask unvaccinated staff at nursing homes to choose between the shot and their jobs?

By Zach Shamberg

Remember the phrase “health-care heroes”?

Throughout the COVID-19 pandemic, our frontline caregivers more than earned that title.

But today, it seems we have forgotten their heroic efforts because we are now being told to fire them.

In mid-August, instead of appreciation, many of our frontline workers were given notice of a pending pink slip. President Joe Biden directed the Centers for Medicare and Medicaid Services (CMS) to develop regulations requiring all nursing home workers to receive the COVID-19 vaccine — without exception. Any nursing home provider that employs unvaccinated workers will have to forfeit the government funding that tens of thousands of Pennsylvania nursing home residents rely on for their care.

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

The reality is, there is no choice. Without Medicaid and Medicare funding — which pays for most of all care delivered in Pennsylvania nursing homes — facilities will be forced to close their doors, evict their residents, and erase the future of care in a state with one of the oldest populations in the country.

So much for standing with our heroes — and the residents they care for.

Why are nursing homes subject to this unfair practice of “mandates without exception”? Gov. Tom Wolf has not forced state-run nursing homes to get rid of unvaccinated employees, who can keep their jobs if they submit to weekly testing. President Biden’s mandate for large businesses in the private sector also gives workers the option of regular testing instead of the shot.

Oddly, a testing option doesn’t exist for nursing homes, which have spent the last year setting the standard on testing. In areas with high levels of COVID-19, unvaccinated workers are tested twice a week. Yet our governing bodies moved the goalpost for a sector in the midst of navigating a dire workforce crisis.

“So much for standing with our heroes — and the residents they care for.”

The Pennsylvania Health Care Association (PHCA), where I am president and CEO, recently surveyed member facilities, revealing their struggle to simply meet minimum staffing requirements. That is why 85% of nursing home respondents are currently limiting new admissions, and 50% of facilities say they have a waiting list, all due to a lack of staff. Firing workers and cutting funding will only exacerbate the problem.

It’s clear vaccine hesitancy exists. The vaccination rate for Pennsylvania nursing home workers mirrors the state population rate at 66%. But the need for care also exists, and vaccination rates will be irrelevant if a facility cannot remain open.

This isn’t just a problem here. In New York, state leaders are preparing to send in the National Guard to fill shifts of terminated unvaccinated health-care workers.

With a workforce crisis, the loss of even one worker is significant. And Pennsylvania nursing homes could lose many workers: The 34% of unvaccinated workers equates, by our calculations, to about 32,000 people who are admirably working at the epicenter of the COVID-19 pandemic.

The COVID-19 vaccine provides a level of protection for everyone. And providers continue to educate their workers about its benefits.

But a mandate that disregards the concerns of providers — experts on the front line of care — will cause more harm than good. Instead, it’s beyond time for our government leaders to assist and collaborate with long-term care, rather than hurl threats and punishments. And it’s time to once again rally around our health-care heroes with support and trust, to create success and sustainability for residents in long-term care.

Zach Shamberg is the president and CEO of the Pennsylvania Health Care Association (PHCA), a statewide advocacy organization for Pennsylvania’s most vulnerable residents in long-term care and their providers of care.

By David R. Hoffman

Pennsylvanians residing in nursing homes want to live, which explains why 87% have been vaccinated. But without a mandate, too many staff are unnecessarily exposing them to danger from COVID-19, a now preventable disease.

Approximately 66% of nursing home staff in the state are vaccinated, leaving the remaining 34% to pose a significant health risk to our most frail and vulnerable population. That vaccination rate is an average; I have recently been in nursing homes where the rate among staff is much lower.

That vaccination rate is a national average; I have recently been in nursing homes where the rate among staff is much lower.

We have learned a very costly lesson from the pandemic — approximately 155,000 lost lives among nursing home residents and frontline health-care staff. And even though nursing home residents and staff were among the first to be offered the COVID-19 vaccine, they remain at substantial risk: Following the rise of the delta variant, nursing homes in the U.S. reported almost 1,800 deaths among residents and staff in August, the most since February.

So we need mandates. But we must also provide support that addresses the many reasons why nursing home staff are saying no to the vaccine. First, nursing home providers must provide one-to-one education regarding the safety of the vaccine, listen to staff concerns, and address them in a meaningful way. Respected members of the community or leaders within the facility who have been vaccinated should participate in those discussions.

“Health-care workers have taken oaths to do no harm, to treat patients’ interests and protection as paramount.”

Next, nursing home owners must ensure the vaccine is available to staff during all shifts, so those only there overnight do not miss their opportunity for the shot. Most importantly, facilities must offer staff paid time off if they have any reaction to the vaccine and require time to recover.

Providers have claimed that vaccine mandates will force them to lose staff. However, if there is an industry-wide mandate, there is no alternative workplace available.

Importantly, I view the recent mandate through both an ethical and legal lens. Vaccine mandates have been upheld by the Supreme Court dating back to the early 1900s. Federal law also mandates that nursing home residents have a right to live free from “neglect,” defined as “failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish, or emotional distress.” I know of several breakthrough COVID-19 cases experienced by fully vaccinated nursing home residents. I suspect that those cases were caused by exposure to unvaccinated staff and, as such, the facility violated its legal and ethical duty to ensure that residents are free from neglect.

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

The more compelling argument is the ethical obligation to protect nursing home residents. This must be the compass that points us out of this pandemic. Health-care workers have taken oaths to do no harm, to treat patients’ interests and protection as paramount. The vast majority of nursing home personnel have shown a strong commitment to protecting our most vulnerable population segment against harm by, for example, getting flu shots in the fall.

And yet, after months of having access to a lifesaving vaccine that will protect them and the residents they care so deeply for, too many nursing home staff remain willing to place residents in harm’s way. Even if an unvaccinated staff member doesn’t infect anyone, if they test positive, the facility may go into lockdown — again — which affects residents’ quality of life and causes psychological damage.

Some nursing home providers have already successfully implemented a vaccine mandate, and it is time for all to do so.

David R. Hoffman is the president of David Hoffman and Associates, a national health-care consulting firm that focuses on patient and resident safety and compliance.