Staffing concerns are thwarting nursing homes—the hub of Covid-19 spread—from mandating vaccines, illustrating the difficulty of ensuring widespread jabs everywhere.
Questions are mounting daily about the legality and practicality of requiring people to get vaccinated—whether it’s to get on an airplane, attend a packed indoor concert, go to college, or remain employed. The careful messaging from representatives across the health industry, with a few notable holdouts, shows that mandates are problematic in sectors with staffing woes but may be the only answer if people don’t get the shot voluntarily.
The leading nursing home trade group, American Health Care Association/National Center for Assisted Living, stopped short of calling for mandatory nursing home staff vaccinations, due mainly to severe staffing shortages since the pandemic began. The group was a notable exclusion in a July 26 statement from more than 50 health organizations that Covid shots be mandatory for all staff at health-care facilities.
“We continue to monitor the situation and have ongoing discussions about this topic,” Cristina Crawford, senior manager of public affairs at AHCA, said. “Currently, AHCA/NCAL is focused on educational efforts to increase vaccine confidence.”
The American College of Emergency Physicians didn’t support the statement initially, saying encouraging those wary of jabs is a better way to get to shots into arms. The group decided to sign the letter “given the new evidence around the dangers and trends of the Delta variant,” ACEP President Mark Rosenberg said. “While one statement alone may not shift the needle, we need to come together and focus on system-wide solutions if we’re to beat this pandemic.”
‘Terrified of Losing Staff’
Christopher Laxton, executive director at AMDA—The Society for Post-Acute and Long-Term Care Medicine, a different group that represents nursing home medical directors, said his members are “terrified of losing staff.”
“Covid has left nursing homes so dangerously understaffed. The fear that they might lose more staff if they make the vaccine a condition of employment is terrifying to them,” he said.
The growing push for mandatory vaccinations in health care has been a slow moving process. AMDA was in some ways an early adopter, joining six other health groups July 13 in calling for vaccinations as a condition of employment for health-care professionals in hospitals, nursing homes, and other settings. The American Hospital Association and America’s Essential Hospitals did the same July 21.
Even the AHA acknowledged a universal mandate might not always be the best answer. “The most effective approach to achieving high vaccination rates for a given hospital could vary based on local circumstances,” said AHA policy director Akin Demehin.
Some hospitals may not need to mandate shots because their staff are already mostly vaccinated. “Others feel that working closely with their staff to educate them about the vaccines and the importance of getting them is more likely to lead to high levels of vaccination than a mandate,” he said.
Any disconnect between health-care groups’ public statements and individual hospitals’ actions may also come from fear about compliance with state law. Several states are considering bills that would ban Covid-19 vaccine mandates for employers, which could tie hospitals’ hands.
LeadingAge, a group representing more than 5,000 nonprofit aging services providers, is encouraging members to make vaccines a condition of employment for all health-care workers, including contract staff. There are appropriate medical exemptions as specified by federal and state law, the group’s media relations director Lisa Sanders said.
‘The Next Step’
For months, AMDA supported voluntary appeals for staff vaccinations, but “we’ve evolved our position, for sure,” Laxton said. “Despite all our efforts, we weren’t able to move the needle” on a stated goal of getting nursing home staff vaccination rates to 75% by July 1. They currently stand at 58.4%, according to the Centers for Medicare & Medicaid Services. Residents, on the other hand, have an 81.3% jab rate.
Nursing home staffers continue to push back against vaccination appeals. “A lot of it has to do with hearsay and social media and conspiracy theories” that aren’t supported by science, he said.
Slowing shot rates among facility staffers prompted AMDA and others to change their tune on requiring vaccines. Other groups joining were the Society for Healthcare Epidemiology of America, the Association for Professionals in Infection Control and Epidemiology, the HIV Medicine Association, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.
“In the end, we signed on to the statement because it’s kind of like the last resort. We need to get our nursing home staffs vaccinated,” Laxton said. “While the first line is always persuasion and discussion and exploring with each person what the hesitancy is all about, in the end, if you can’t make any progress, you’ve got to take the next step.”
AMDA is telling its members to use a shot mandate as a bargaining chip. “It’s more about, ‘If we can’t come to some agreement around the vaccine, we’re going to have to mandate it as a condition of employment,’” Laxton said.
Lawsuits against employer vaccination mandates likely result from a take-it-or-leave-it approach. “The way an employer goes about introducing a condition-of-employment requirement is going to tell the difference between people being angry about it and, perhaps, even trying to take legal action, or reluctantly going ahead and doing it,” Laxton said.
To contact the reporters on this story: