Will COVID vaccine mandate drive Iowa nursing home workers away?

This article was originally published by Michaela Ramm on The Gazette on Oct, 2021.

CEDAR RAPIDS — As an employee at a long-term care facility, Pam Guilford was one of the first Iowans to be fully vaccinated against COVID-19 in February.

At first, she was unsure is she wanted the new vaccine, Guilford admits. She wondered, are there long-term side effects we don’t know about?

“I am not an anti-vaxxer,” Guilford said. “I think what annoys me is people who are hesitant about the vaccines, we’re calling them anti-vaxxers. That’s not the case. I have had other vaccines, and I believe in vaccines.”

She decided to get the shots after all because of her line of work. Guilford, a former nursing home administrator, is director of admissions and marketing for Evergreen Estates in Cedar Rapids. Her facility’s residents are more likely to face bad outcomes if they were infected with the novel coronavirus, Guilford said. That ultimately outweighed her hesitancy.

“When you’re working with an older population, you need to take other precautions to keep them safe,” she said. “That’s the job I signed up for, to take care of seniors who need my help. If part of me helping is making sure I don’t bring something in to them, then that’s what I need to do.”

Since March 2020, federal officials estimate the disease has killed about 2,500 nursing home residents in Iowa. And the virus continues to make its way into the facilities.

As the country continues to experience surges in COVID-19, nursing home leaders across the state emphasize it’s important that more employees to get vaccinated. But federal vaccine requirements for employees could create a crisis, they say.

Should the Biden administration move forward with a plan to mandate COVID-19 vaccination for nursing home staff across the country, officials in Iowa’s long-term care industry say they expect dozens of workers to leave their jobs rather than get the shots.

It may be nearly impossible to find replacement workers in that scenario, they say. The industry long has faced challenges when it comes to recruiting and retaining health care and other support staff, especially in rural areas.

“The scope of the mandate announced several weeks ago is highly problematic for the staffing situation for Iowa nursing homes,” said Brent Willett, president and chief executive officer of the Iowa Health Care Association.

Mandate expected in late October

In August, the Biden administration announced nursing homes receiving federal Medicare and Medicaid funding must require staff be vaccinated against COVID-19. Facilities that don’t comply risk losing federal funds Officials say they expect regulations from the Centers for Medicare and Medicaid Services by later this month.

The regulation would apply to about 15,000 nursing homes and their 1.6 million employees nationwide. A total of 31,998 employees — including ull-time and part-time — work in nursing homes across Iowa, according to the Iowa Health Care Association. Of that, 22,418 were fully vaccinated as of Oct. 3. That’s a 70.1 percent vaccination rate.

It’s unclear how many of the remaining 30 percent of unvaccinated workers would walk off the job if forced to get the jab, Willett said. But even if a portion leaves the sector, it “exasperates the already severe workforce crisis” the industry is facing.

Among the three facilities that comprise Evergreen Estates in Cedar Rapids, the vaccination rate is about 92 percent of staff, said President and CEO Pat Giorgio. She expects to lose the remaining 8 percent if the mandate goes into effect.

“In an age where we have a shortage of workforce, the mandate is counterproductive,” Giorgio said. “I understand the intent and I can respect the intent, but I think the results can end up with greater workforce challenges.“

In a worst-case scenario, nursing homes could be left without enough staff to care for residents, which also poses severe risks for those individuals.

“So are residents actually safer? They’re not getting better care if there’s less workers to care for people,” said Richard Curphey, administrator for West Ridge Care Center in Cedar Rapids.

Nursing home leaders want vaccinated staff, but not mandates

West Ridge Care Center, an independent 60-bed facility, mandated the vaccine for its nearly 80 staff members earlier this year, Curphey said. It did lose a handful of staff in the process, but as of October, the nursing home has a 100 percent vaccine rate.

Though the vaccine is mandated at his facility, Curphey is opposed to an across-the-board mandate from the federal government. That’s because federal officials aren’t taking the important step that West Ridge Care Center did first.

Curphey said he and other leaders spent weeks talking with staff to answer questions and address each individual’s hesitancy. Though time consuming, this strategy would be a better solution in the effort to improve the rate in nursing homes, he said.

Giorgio, who still is speaking with staff members about the importance of getting the vaccine, agreed. “A mandate is not the answer. Education is the answer,” she said.

The Iowa Health Care Association, along with other advocacy organizations nationwide, has called on the federal government to instead direct resources to facilities for education campaigns and other efforts to address vaccine hesitancy. The association also called for $6 billion in additional funding to mitigate the workforce shortage.

“This is a very complex problem that requires a comprehensive solution,” Willett said.

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