The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
At Auglaize Acres, more than 81% of the nursing home’s patients are vaccinated against COVID-19, compared to less than 30% of the caregivers, federal data shows.
The facility, located in Auglaize County off of Infirmary Road, asked its staff why they haven’t yet received the vaccine. Administrator Rick Hartline chalked it up to fear of the unknown. He said he requires stricter personal protective equipment and social distancing protocols for his staff caregivers who remain unvaccinated. However, he’s agnostic on a vaccine mandate.
“There’s already a workforce shortage in health care, I don’t know if mandating would increase that shortage or not,” he said. “I’d think so, but you never know.”
Among Ohio’s more than 930 operational nursing homes, about 61% of the health care work force is vaccinated against COVID-19, according to the most recent (week ending Nov. 21) survey data from the Centers for Medicare and Medicaid Services. About 83% of residents, meanwhile, are vaccinated.
Real-world evidence shows vaccination provides powerful protection, even for older people with weakened immune systems, against hospitalization and death from COVID-19. However, vaccines work best as a population-level tool rather than for individual protection. Vaccinated people are less likely to wind up infected, and nursing home residents are some of the most likely to suffer serious complications from a coronavirus infection.
Definitive answers are unavailable as to why a health care workforce, so familiar with the toils of COVID-19, would refrain from vaccination while caring for a population that bears a high risk of complications from infection. The Ohio Capital Journal reached out to 10 administrators for facilities where less than 33% of the staff members are vaccinated. Eight could not be reached, and one declined comment.
CMS, under President Joe Biden, announced a rule in November, effective Jan. 4 of 2022, requiring that all eligible staff get vaccinated against COVID-19 at facilities that receive federal funds. This would entail receiving a first dose by Dec. 6, 2021 and full vaccination by Jan. 4, 2022.
However, a federal judge in Missouri temporarily blocked the CMS rule via a preliminary injunction last week. Judge Matthew Schelp said the “unprecedented, controversial and health-related mandate” is “arbitrary and capricious” for several reasons and blocked its enactment. The Biden administration is appealing the matter.
Several states, including the state of Ohio as a plaintiff, filed a similar lawsuit in Louisiana, where U.S. District Judge Terry Doughty also filed a preliminary injunction temporarily blocking the rule. This case is also under appeal.
“The public interest is served by maintaining the constitutional structure and maintaining the liberty of individuals who do not want to take the COVID-19 vaccine,” he wrote.
Until the courts produce a sturdier resolution, CMS cannot implement the rule anywhere, according to Pete Van Runkle, a lobbyist and executive director of the Ohio Health Care Association, which represents for-profit nursing homes in Ohio.
“Our members have been working to get staff vaccinated before the first effective date of the rule, which was Dec. 6,” he said. “We are advising them to continue their efforts, both because it is the right thing to do and because the rule could come back in the future.”
This leaves providers in a “holding pattern” for now, according to Patrick Schwartz, a spokesman for LeadingAge Ohio, which represents nonprofit nursing homes. Some have halted their efforts to comply with the rule, others are moving ahead.
Schwartz said the mandate puts homes at risk of closure should they lose out on federal reimbursements. It comes at a trying time for the industry when wages and a labor force are already strapped thin.
“Particularly in rural and underserved areas, the vaccine mandate carries the potential to severely limit services to older adults relying on long-term care,” he said. “Adding a vaccine mandate to this challenging environment — before addressing the workforce crisis — puts additional pressure on an already stressed system of long-term services and supports.”
Tory Harper Hogan, an industry researcher and professor of health services management and policy at Ohio State University, said there are huge, pre-existing workforce shortages within the nursing home sector. The workforce was already “crushed” by lousy pay, and the pandemic only made things worse.
Now, some Ohio nursing homes are declining new patients, Hogan said. In Minnesota, the National Guard is deployed to help staff facilities. Even so, she said there should be some kind of mandate to fix the huge gap between staff and residents’ vaccination rates.
“We have our most vulnerable population that are really so reliant on caregivers, yet the caregivers are the people that are most likely going to be brining in COVID, and bringing them to their death bed,” she said. “So it just seems illogical to me.”
Nursing home residents and staff were some of the first Ohioans to receive COVID-19 vaccines upon their December 2020 release. A woman named Rebecca Meeker was featured in Gov. Mike DeWine’s regular COVID-19 press briefings when she became the first Ohio nursing home resident to get vaccinated.
However, a problem of vaccine refusal soon began to emerge. DeWine said later that month that as many as 60% of nursing home workers had refused vaccination. A union representing the workers later said there was a “trust issue” at hand resulting from low wages and dangerous work conditions through the pandemic. After surveying workers, a union official noted concerns about “fertility issues” — a common untruth about the vaccine that alleges they make recipients somehow impotent.
Several officials with the Service Employees International Union, which conducted the survey, did not respond to an email or call.