With an impending vaccine mandate, care homes face more staffing issues

Jamie Smith, a staffing agency nurse who loves end-of-life care, said she was warmly welcomed by staff and residents at Frontier Health & Rehabilitation in the conservative St. Louis suburb of St. Charles.

And this even if she has not been vaccinated against covid-19.

But executives at the nursing home, where 22 residents died of covid before vaccines became available, are unlikely to be able to employ unvaccinated people like Smith any longer. On Jan. 13, the U.S. Supreme Court upheld a federal mandate requiring healthcare workers at facilities receiving Medicaid or Medicare funding to be fully immunized. If all staff – excluding those with approved religious or medical exemptions – are not fully vaccinated, the facility will lose that money.

Healthcare sites in Missouri and other states that have challenged the federal requirement have until March 15 to have their staff fully vaccinated, according to the Centers for Medicare & Medicaid Services, while facilities in states that did not sue to block the warrant have a February 28 deadline.

This poses a challenge for Frontier and its residents as the nursing home already does not have enough staff. And that’s in the state with the lowest rate of fully immunized nursing home healthcare workers, 67% as of Jan. 9, according to CMS data. The staff vaccination rate reported by Frontier was only 30% at the start of the year.

That compares to a national rate of 81%, according to federal data.

Although the mandate ensures that unvaccinated staff members are not caring for some of those most vulnerable to the virus, there are not enough workers who are willing to take on the low-paying and difficult jobs. If they quit to avoid getting shot or are fired because they won’t get them, nursing home residents might not be safer – because of the lack of care.

“Obviously we need good staff members to take care of residents, but residents also need to be safe,” said Marjorie Moore, who supports the mandate and is executive director of nonprofit Voyce. St. Louis nonprofit that advocates for nursing home residents. and their families.

“A person who lives in their own home has the ability to say, ‘I don’t want anyone in my house not to be vaccinated,'” she added. “In a nursing home, they don’t have the opportunity to say, ‘I don’t want someone who isn’t vaccinated to come and feed me. “”

The problem of nursing home understaffing predates the pandemic, and it has gotten worse.

As of March 2020, 3.3 million people were employed in nursing homes and residential care facilities in the United States, according to the Bureau of Labor Statistics. By December 2021, that number had fallen to 2.9 million, a loss of 400,000 workers.

Nursing home operators can’t find enough staff because they often don’t pay a lot. The average hourly wage for nursing assistants in Missouri was $13.33 in 2020, according to the statistics bureau. And homes require employees to take on a host of responsibilities, including feeding residents, changing adult diapers and caring for residents with dementia who are at risk of becoming combative.

Caregivers “can usually find jobs with better pay that are less physically and emotionally demanding,” said Brian McGarry, a professor at the University of Rochester who studies long-term care. “Someone’s life and dignity are in your hands, and that’s a huge responsibility, and you don’t get paid to live up to that responsibility.”

These job inconveniences often lead to high turnover. In 2017-18, Missouri’s nursing home employee turnover rate was 138%, the fourth highest in the nation, according to a study published in the journal Health Affairs. Frontier had a rate of over 300%, according to Huizi Yu, one of the study’s authors.

The management of the nursing home declined to comment.

Smith, the nurse who works for a healthcare staffing agency, said she was not vaccinated against covid because she had a rare cancer in 2017 and is “very particular about about what I put in my body”.

She said, “I don’t know if I could get it just to keep a job.”

But, she noted in a text message, “I always practice safely.”

And, indeed, no Frontier residents have died of covid since the outbreak began at the start of the pandemic, according to federal data. But the center reported having seven new confirmed cases among its residents and 10 new cases among its staff as of January 9. At the start of the year, 89% of residents were fully vaccinated against covid.

Low vaccination levels among staff put residents at increased risk, according to a recent analysis in the New England Journal of Medicine. Facilities in high-covid counties with an average staff vaccination rate of about 30% had nearly three times as many covid deaths among residents as facilities where about 82% of employees were vaccinated, according to analysis.

“I think unvaccinated or poorly vaccinated staff pretty clearly puts residents at risk – even if they are vaccinated,” said McGarry, one of the authors of the analysis.

The vaccination rate has risen from less than half of Missouri nursing home staff when President Joe Biden announced the nursing home mandate on August 18 to about two-thirds of staff now, according to federal data.

Like Frontier, Northview Village is understaffed and most of the people who work there have not been vaccinated. The facility — a retirement home in a predominantly black, low-income neighborhood in North St. Louis — held a vaccination drive in December to boost its staff vaccination rate by about 20%, but the numbers have not increased, according to federal data. And only half of the residents were fully vaccinated.

Northview management declined to comment.

Kimberly Watkins, a technician who works to keep Northview residents active, was hesitant to get any of the snaps, in part because she had heard the conspiracy theory that they contained a tracking chip. But she said she decided to go ahead and get vaccinated because she suffered from asthma and high blood pressure. Colleagues told him their doctors said they didn’t need the vaccine or they might be allergic to it.

Now that the mandate takes effect, Moore of the non-profit organization Voyce believes most staff at local care homes will comply.

She pointed to Mary, Queen and Mother Center, a nonprofit Catholic nursing home in St. Louis County, which announced its own mandate in August. Ahead of its September 30 deadline, the nursing home saw its staff vaccination rate rise from 67% to 92%, with the remainder going to people with a medical or religious exemption, according to the organization. The establishment retained almost all of its staff.

Not everyone is concerned about vaccinating nursing home staff, which in part reflects the community around them. Only 55% of Missourians are fully vaccinated.

“I don’t want to impose things on people,” said Antuan Diltz, a St. Louis firefighter whose mother is a 64-year-old retired nurse with dementia and diabetes living in Frontier. She received the vaccine; Diltz had not.

But others, like Bill Talton, who have family at Frontier, hope more staff will get vaccinated. Talton, a 77-year-old retired computer programmer, said he was pleased with the care his younger brother, who has dementia, has received, despite sometimes not being able to visit him during the covid-related shutdowns.

“It’s a bit late in the game,” said Talton, who is fully vaccinated and received a booster. “They will – I hope.”

Holly K. Hacker, KHN’s Data Editor, contributed to this report.