Nursing homes fall short of vaccine mandates for staff

·7 min read

Oct. 17—Nursing homes are struggling to meet vaccination mandates for workers despite the likelihood of federal sanctions.

In Pennsylvania, about 28% of the state's 688 skilled care nursing facilities had met an 80% threshold for staff vaccination rates as of Oct. 3, according to the state Department of Health. Even fewer — only 18 facilities statewide, or about 3% — reported they had met the Biden administration's goal to have 100% of facility workers vaccinated this month.

Although the administration has yet to announce sanctions, many believe it could be as severe as withholding Medicare and Medicaid reimbursements. Those make up more than 75% of nursing home revenues.

That could lead some facilities to close, which would exacerbate a workforce shortage that already has prompted some facilities to halt admissions, industry officials warn.

Public health experts, however, insist vaccination is a must for those who work in the facilities that serve the nation's elderly and disabled.

They point to the harsh toll covid-19 exacted on nursing home residents before vaccines arrived. Although the facilities barred visitors and adopted strict infection control protocols in hopes of halting new infections, experts believe asymptomatic employees unknowingly brought the virus into nursing homes before testing was readily available.

That led officials to target nursing home patients and staff to receive the first doses of the vaccine last winter.

As of Oct. 3, nursing homes reported 137,678 resident deaths from covid-19 and 2,101 deaths among nursing employees.

Although many Pennsylvania nursing homes report resident vaccination rates above the national average of 85.3%, they've had a tougher time persuading workers.

Nationally, vaccination rates among nursing home workers hovered just above 69% last week.

Local rates range widely

When Gov. Tom Wolf's administration announced goals for Pennsylvania nursing home staff vaccinations in August, officials urged family members to check the state website for vaccination rate updates and contact nursing homes where their loved ones live with any concerns.

Some facilities have made progress toward meeting vaccination goals.

John Dickson is president and CEO of Redstone Highlands, a Greensburg-based nonprofit facility that serves 1,000 elderly and disabled residents through home care, personal care and skilled nursing facilities in Greensburg, Murrysville and North Huntingdon. Redstone recently made vaccination a condition of employment. It now is close to meeting Biden's goal.

Dickson credits Redstone's approach to talking to staff about their concerns, with persuading most that vaccination was necessary.

"Early on, we had a lot of communications and conversations with staff," he said.

Redstone permitted medical and religious exemptions, though it has granted only a handful. Dickson said many of those seeking religious exemptions were denied when their objections were classified as philosophical rather than related to specific religions.

More than 90% of Redstone employees are vaccinated, making Redstone the leader among nursing homes in Westmoreland County. Dickson said a handful of employees have been suspended, pending vaccination or exemption approval.

Elsewhere, facilities appear to be making little progress toward staff vaccination goals.

Westmoreland Manor, the county-owned 408-bed nursing home in Hempfield, has seen a barely perceptible uptick in employee vaccination rates in recent weeks.

In August, the facility reported that 65% of the staff had been vaccinated. According to the most recent report Manor officials filed with the Centers for Disease Control and Prevention, that percentage had climbed to 66.1% as of the end of September.

On Friday, county solicitor Melissa Guiddy said the staff vaccination rate at Westmoreland Manor is 60%. She did not respond when asked why that figure differed from what was reported to the CDC.

In Allegheny County, the four county-owned John J. Kane homes — which have 1,166 licensed beds — had slightly better staff vaccination rates, ranging from 77.3% to 82.2%.

Some facilities are faring far worse.

At Platinum Ridge, the 97-bed Brackenridge nursing home formerly known as Georgian Manor, only 23.6% of the staff was listed as vaccinated, according to the state Department of Health. Officials at the for-profit facility, owned by New York-based nursing home operator Prestige Health Care Group, did not return repeated calls for comment.

At the 589-bed Brighton Rehabilitation and Wellness Center in Beaver County, where there have been more than 80 resident deaths from covid-19 reported, the staff vaccination rate has hovered at 39%.

Only two Western Pennsylvania facilities — UPMC McKeesport Longterm Care, with 18 beds, and Promedica Skilled Nursing & Rehab in Ross, with 200 beds — report all staff have been vaccinated.

Matt Yarnell, president of SEIU HealthcarePA, which represents about 6,000 nursing home workers in 110 facilities across the state, including Westmoreland Manor and Brighton, said his members have seen the toll the virus takes up close and personal.

"As a union, I know of at least six of our caregivers who died," Yarnell said.

He said the union has recommended that all essential workers be vaccinated.

But he said it is important to talk to workers and address their concerns. He said some have put it off because of a lack of access and transportation to vaccination sites. Others worry about losing pay if they must take time off to be vaccinated and fear they will be forced to use up sick time if they suffer side effects.

For some, a mistrust of vaccines in general is an overriding factor in their decision not to be vaccinated.

Crystal Timko, 65, of North Versailles left her post at the Murrysville Rehabilitation and Wellness Center last year after 22 years as a certified nursing assistant, long before the vaccine was available. Fear of covid-19 had nothing to do with her decision, and she sympathizes with care workers who refuse to be vaccinated. She decided against it, despite pleas from her children, and watching her husband test positive.

"I don't believe in it," she said.

Impacting care

Industry trade associations fear that vaccine mandates are exacerbating an already critical nursing shortage.

Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, a Harrisburg-based trade association that represents more than 200 for-profit facilities, said his members say employee mistrust of government, a prior infection that left them with antibodies to the virus and fear that the vaccine could affect their fertility — a fear experts say is unfounded — are among the top objections to vaccine mandates.

He said some facilities are not accepting new residents because they can't staff beds.

"We have a real access-to-care issue," Shamberg said.

He said 74% of association members who participated in a survey last month said they have had to limit or halt admissions within the past six months. He cited one unnamed owner in Western Pennsylvania that reported its nursing homes had to decline 80% of referrals from hospitals in recent weeks because of staff shortages.

His members say proposed regulatory changes that would increase minimum nursing home staffing levels in the state from 2.7 hours of nursing care per patient per day to 4.1 hours would further aggravate the crisis.

Industry officials point to the Charles Morris Nursing & Rehabilitation Center in Pittsburgh, which closed this year, as a case in point.

The highly regarded nonprofit facility in Squirrel Hill operated by the Jewish Association on Aging closed last winter, citing the impact of the pandemic, low state and federal reimbursements, and a growing trend toward home care.

Christina Carden of LeadingAge PA, a group that represents nonprofit nursing home operators in Pennsylvania, said her group supports the federal mandate but, like Shamberg's group, fears it will worsen workforce shortages.

"Nursing facilities, in particular, are up against a significant challenge in more ways than one to meet this mandate, and it is highly likely that we'll see more out-of-state sales, closed doors and beds offline in Pennsylvania as a result of expected mandates and changes to regulations for the long-term care industry," she said.

Even facilities that are meeting vaccination goals are struggling to maintain staff levels.

Redstone Highlands has posted signs outside its facilities advertising $35 an hour for nurses, even allowing them to choose their hours.

It's a sign of the times, apparently.

"There is not anyone who does not have openings for RNs," Dickson said.

Deb Erdley is a Tribune-Review staff writer. You can contact Deb at 724-850-1209, derdley@triblive.com or via Twitter .

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