Nursing Homes Face Dilemma: Vaccinate Staff or Don’t Get Paid.

Marita Smith runs a nursing home in Seattle, while Janet Snipes manages one in Denver. They share years of experience in the industry and painful memories of Covid-19, but have sharply differing views of a new federal policy that will mandate vaccinations for all nursing home employees.

In Ms. Smith’s view, unvaccinated people should not be caring for a vulnerable population already hit hard by the pandemic. The industry is again experiencing rising infection rates and deaths among residents, although none approaching the peak figures of last year, and the mandate is intended to head off another surge.

“It’s great,” said Ms. Smith, administrator at St. Anne Nursing and Rehab Center, calling the policy a “pretty big deal” that would “flush out health care professionals who shouldn’t be in health care.”

Such departures are precisely what worry Ms. Snipes, executive director of Holly Heights Care Center in Denver. She, too, wants to see all nursing home workers vaccinated, but not at the risk of losing employees who won’t comply, amid a labor shortage in an industry with an already high turnover rate.

Of the 1.5 million nursing home staff in the United States, some 540,000 — 40 percent of the work force — are unvaccinated. Their fate could be directly impacted by a policy announced Wednesday by President Biden requiring all nursing home employees to be vaccinated, with the rules likely to take effect sometime in September. Facilities that fail to meet that target could face fines or lose eligibility to receive federal reimbursement, a vital source of income for many.

The practical effect of the policy is that workers will have to be vaccinated or lose their jobs. Ms. Snipes said several employees had told her that they might leave. One, whom she described as her best nurse, told her she was “very, very afraid” of the vaccine, in part because she is Black and concerned about medical experimentation of the past.

Getting vaccinated “is the safest thing for our residents and our staff, but we feel strongly he needs to mandate for all health care settings,” Ms. Snipes said of President Biden. “We can’t afford to lose staff to hospitals and assisted living facilities.”

Several major nursing home chains, and some states, have already imposed vaccine mandates. Industry officials said inoculations were strongly advised, but their position on the new policy echoed that of Ms. Snipes.

“We will lose tens of thousands, maybe hundred thousands, of workers,” said Mark Parkinson, president and chief executive of the American Health Care Association, a major nursing home trade group. He said he was hoping for policy modifications and had already spoken about them to Dr. Lee A. Fleisher, chief medical officer of the Centers for Medicare & Medicaid Services, and was seeking a meeting with Xavier Becerra, the secretary of health and human services.

The chief change sought by the industry is a signal from the administration that a mandate will eventually apply across all health care settings, so that nursing home employees recognize that there is nowhere else to go. “Mandate it for everybody,” Mr. Parkinson said.

In fact, roughly 2,000 hospitals have already issued vaccine mandates, reducing job options for unvaccinated health care workers.

Dr. Fleisher said that the C.M.S. and the Centers for Disease Control and Prevention had seen in recent data a “direct relationship” between rising infections at nursing homes and unvaccinated staff.

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“The higher the percentage of unvaccinated staff, the higher the percentage of cases we saw in those homes,” Dr. Fleisher said. “There was a strong relationship.”

Currently, 60 percent of nursing home staff nationwide are vaccinated, far below the industry’s earlier goal of 75 percent by the end of June.

Mr. Parkinson said the industry also was lobbying the government to start “a much more intense media campaign to influence workers” that vaccines are safe and effective. The trade organization also wants the government to create a grace period for hesitant staff.

Uy, a geriatrician and medical director of a nursing home in Philadelphia, said he had already seen the staffing challenges and was “ecstatic about the mandate.”

“I am exhausted,” he said. “The vaccine is like a mini fortress around the most vulnerable, where even though there is a fire raging outside, those inside stay safe.”

The mandate aims to avoid a surge in Covid cases and deaths in a highly vulnerable population.

Of the 625,000 Covid deaths in the United States to date, nearly one-fifth — 133,700 — have been nursing home residents, according to the C.D.C.

Understand the State of Vaccine and Mask Mandates in the U.S.

    • Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in indoor public places within areas experiencing outbreaks, a reversal of the guidance it offered in May. See where the C.D.C. guidance would apply, and where states have instituted their own mask policies. The battle over masks has become contentious in some states, with some local leaders defying state bans.
    • Vaccine rules . . . and businesses. Private companies are increasingly mandating coronavirus vaccines for employees, with varying approaches. Such mandates are legally allowed and have been upheld in court challenges.
    • College and universities. More than 400 colleges and universities are requiring students to be vaccinated against Covid-19. Almost all are in states that voted for President Biden.
    • Schools. On Aug. 11, California announced that it would require teachers and staff of both public and private schools to be vaccinated or face regular testing, the first state in the nation to do so. A survey released in August found that many American parents of school-age children are opposed to mandated vaccines for students, but were more supportive of mask mandates for students, teachers and staff members who do not have their shots.  
    • Hospitals and medical centers. Many hospitals and major health systems are requiring employees to get a Covid-19 vaccine, citing rising caseloads fueled by the Delta variant and stubbornly low vaccination rates in their communities, even within their work force.
    • New York. On Aug. 3, Mayor Bill de Blasio of New York announced that proof of vaccination would be required of workers and customers for indoor dining, gyms, performances and other indoor situations, becoming the first U.S. city to require vaccines for a broad range of activities. City hospital workers must also get a vaccine or be subjected to weekly testing. Similar rules are in place for New York State employees.
    • At the federal level. The Pentagon announced that it would seek to make coronavirus vaccinations mandatory for the country’s 1.3 million active-duty troops “no later” than the middle of September. President Biden announced that all civilian federal employees would have to be vaccinated against the coronavirus or submit to regular testing, social distancing, mask requirements and restrictions on most travel.

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