ORLANDO, Fla. — COVID-19 cases in Florida nursing homes have surged more than 20-fold since June as vaccination rates among staff continue to lag far below the national average. Still, the industry is pushing back against a new Biden administration vaccine mandate for its workers over concerns that many will quit rather than comply.
“By the federal government singling out nursing homes with a vaccination requirement that does not apply to health care personnel at other locations and in other health care sectors, we fear that our already critical workforce shortages will worsen,” said Emmett Reed, CEO of the Florida Health Care Association, which represents 310 of the state’s 700 nursing homes.
Already, 88% of nursing homes surveyed by the association in July said they faced a staffing shortage in the previous month, and more than half said they had cut admissions because of labor challenges. Nearly three-fourths said they needed to bring in temporary workers through a staffing agency to cover shifts, and all but a few had to ask staff to work overtime or take on extra shifts.
More critically, nearly two-thirds said their budgets can’t sustain those staffing expenses for more than the next six months. Nearly 60% said they were already operating at a loss.
Under the new mandate, expected to go into effect next month, administrators will need to get their staff vaccinated or risk the loss of vital Medicare and Medicaid funding. Although the federal government is still working out the details of the plan, Florida nursing home administrators say any level of cut is too much. Statewide, only 48% of workers are fully vaccinated, compared to 62% nationally.
“I don’t think it’s right, because basically they’re being forced to take it, but it’s what we have to do,” said Casey Hollis, administrator at the 55-bed University West Rehabilitation Center in DeLand. “I just tell them: ‘If I want a paycheck, I need to get vaccinated. If you want a paycheck, you need to get vaccinated. Otherwise, this place goes under.’”
Hollis, who was vaccinated late last year, estimates at least 80% of his workers have gotten the shots too — many after they witnessed family members get sick with the virus. But he worries most about the 20% who actually were infected with COVID-19.
“They think they’re OK because they had it already,” he said. “They think they don’t need the vaccine.”
Brian Lee, executive director of the nonprofit advocacy group Families for Better Care, said while he rarely sides with administrators, he’s also concerned a mandate is heavy-handed.
“Look, I’m a vaccine proponent, especially for nursing homes and assisted living facilities, where you have very elderly, vulnerable residents,” Lee said. “But I don’t think having a punitive approach is the way to go. We don’t know how many (workers) are just going to throw up their hands and say, ‘I’m done with this,’ and go work for a home health agency or some place that doesn’t mandate it.”
Lee prefers the use of financial incentives to persuade reluctant staffers, many of whom work at or below sustainable wages.
For residents and their families, though, the fear over staffing losses doesn’t outweigh the fear of spreading a potentially deadly infection. Although vaccination rates are much higher among the state’s 71,000 nursing home residents than workers — about 73% to 48% — many residents were inoculated during the first wave of shots nine months ago, and scientists caution that their immunity has likely begun to wane.
Add in the arrival of the highly contagious COVID-19 delta variant, and infections and deaths of nursing home residents have increased sharply since July 1. Cases, for instance, had reached a low of 28 statewide for the last week in June. For the week ending Aug. 22, they hit 1,080.
Deaths over the same time frame went from three per week to 72.
“My position is and always has been that if you are working in an in-patient setting, where you have the possibility of bringing in the virus from the outside world, you need to be vaccinated,” said Mary Daniel, whose 67-year-old husband lives in a Jacksonville long-term care facility because of Alzheimer’s disease.
In July 2020, Daniel took a job as a dishwasher at the facility just to be able to see him. She also launched a movement protesting the isolation of residents — Florida Caregivers for Compromise — after the closure dragged on for months.
“The lock-down didn’t work — the virus still got in — so we know it got in through the workers,” she said. “If the staff loves the residents as much as they say they do, and I believe they do, then they have to do everything in their power to protect them. And in my opinion, that includes getting vaccinated.”
Now that the Pfizer COVID-19 vaccine has full authorization from the U.S. Food and Drug Administration, as opposed to its previous emergency use authorization, Daniel has little sympathy for holdouts.
“I’m all for personal freedom, but I spent 10 years managing a pediatric practice and I know that we’ve been mandating vaccines for decades for the good of our communities, for the good of our society,” she said. “And that includes mandating certain vaccines for health care workers.”
The union that covers nursing home workers, 1199SEIU United Healthcare Workers East, has previously supported the vaccination efforts while opposing vaccine mandates, but it has not yet released an official position on the issue.
Still, other states and nursing home chains are already moving ahead with the requirement, even before the federal order takes effect.
Genesis Healthcare Inc., which operates nearly 250 skilled nursing centers nationwide, announced early this month it was adopting a universal vaccine requirement for workers.
“Despite vaccination rates above the national average, the growing spread of the delta variant makes clear that we need to increase our vaccination rates substantially to better protect our patients, residents and employees,” the company said in an announcement on its website. “While we would have greatly preferred a strictly voluntary process, our commitment to health and safety outweighs concerns about imposing a requirement.”
