CINCINNATI — Many Tri-State nursing homes are already facing staffing shortages worsened by the pandemic and a tight labor market.
Now one industry lobbyist warns that a federal vaccine mandate for nursing home workers could make staffing shortages so extreme that it forces facilities, especially ones in rural areas, to close.
“If you don't have enough staff to operate, you basically have to close down. There's no in-between,” said Pete Van Runkle, executive director of the Ohio Health Care Association, which represents hundreds of nursing homes in Ohio. “The worst-case scenario is that we have significant closures across the state, and significant dislocation of residents.”
President Joe Biden announced on Aug. 18 that all nursing homes must require employees to be fully vaccinated against COVID-19 if they want to continue receiving Medicare and Medicaid funding – which most facilities rely on to stay open. The new rule could take effect as soon as next month.
The mandate brought mixed reactions from those in the industry.
The AARP applauded the news with executive vice president and chief advocacy and engagement officer Nancy LeaMond saying it “is a significant step in the fight against this pandemic.”
Locally, Laura Lamb, president and CEO of Episcopal Retirement Services, also supported the vaccine mandate as “an important step toward eradicating COVID-19.”
ERS, which operates nearly 30 retirement communities across the Tri-State, was one of the first in the area to announce in July that it would require all workers to get fully vaccinated against COVID-19.
But Van Runkle warns that many nursing home workers will quit if they are required to take a COVID vaccine, which could ultimately exacerbate a staffing shortage, hurt patient care, and cause facilities to close.
“We have a lot of folks who work in long-term care, whether we like that or not, who are not vaccinated,” Van Runkle said. “It’s their body and their choice.”
Van Runkle and the latest federal data show that 46 to 47 percent of Ohio nursing home health workers are not vaccinated against COVID, which he estimates at 50,000 workers.
“Who’s going to take care of people if we have a mass exodus or even a partial mass exodus of staff?” Van Runkle asked.
Van Runkle warns that facilities in rural areas with lower vaccination rates could be the most at-risk for closing. In Southwest Ohio, the counties with the lowest nursing home worker vaccination rates are Brown, Highland, Adams and Preble.
The latest federal data put Ohio, Kentucky and Indiana in the bottom 15 states with the lowest percentage of vaccinated nursing home staff per facility.
Dennis Paulik, of Butler County, worries that his near 100-year-old mother, Helen, could face cold meals and delays in receiving personal care if the vaccine mandate is enforced.
She lived in isolation for months when visitors were banned from nursing homes during the height of the pandemic. He saw firsthand how staffing shortages impacted her care back then.
“If you need help getting dressed, there's nobody to help you get dressed in the morning,” he said, noting that his mother would sit for hours in a chair waiting for breakfast, often falling back asleep. She used her walker to go to the bathroom alone, despite being a fall risk, because no workers were available to help her.
“You need help going to the bathroom, and nobody answers the bell,” he said.
Paulik complained and the nursing home, which he said is one of the best in the area, made improvements. But now he worries that a vaccine mandate will cause an extreme staff shortage and make life much harder for his mother – again.
“Even outside of COVID times, nursing homes have a hard time retaining staff, especially the nursing assistants who are the primary caregivers,” Paulik said. “It’s a minimum-paying job. It’s hard work. And a lot of people kind of pass through and figure out it’s not for them … so when you compound that with COVID restrictions, it’s been tough.”
An average nursing home in Ohio has 19 job openings, out of roughly 100 to 125 employees at an average facility, Van Runkle said.
“And that’s before this mandate,” Van Runkle said. “We’re already very short and then looking at this would just be disastrous.”
In the meantime, Van Runkle said, his parent organization, the American Health Care Association, is lobbying the Biden administration for federal funding to boost nursing home staff wages. He hopes any vaccine mandate includes exceptions for religious beliefs and medical conditions, while offering an alternative of more frequent COVID-19 testing for those who are opposed to taking the vaccine.
Paulik, who has been advocating for nursing home residents since the pandemic began, urges families to ask questions of nursing home administrators and stay in touch about staffing concerns or worries that a facility could close.
“Family councils may be another way of addressing the issue,” said Bob Vines, managing ombudsman at the nonprofit Pro Seniors Inc. “These are groups families have the right to form without interference to address any issue of concern to residents. We encourage all families to start one in the facility where their loved one resides.”
In the meantime, Paulik is planning a small outside picnic with a few family members to celebrate his mother’s 100th birthday on Saturday and is hoping for the best.
“If I was an administrator and a director of nursing, I’d be really scared,” Paulik said.