As long-term care staff vaccines lag, a federal mandate could force change

A close up of a vial and needle.
Registered nurse Darcey McCampbell draws a dose of the COVID-19 vaccine on Jan. 21, at a vaccination site in Brooklyn Center. The White House announced a new federal vaccine mandate for nursing home staff on Aug. 18, 2021. Staff in Minnesota are currently around 66 percent vaccinated.
Christine T. Nguyen | MPR News File

The delta variant of COVID-19 raised the urgency to vaccinate, especially among those who work with older people. The Biden administration took the urgency a step further, but the reaction in Minnesota is mixed.

Last week, President Joe Biden took the unusual step of mandating vaccinations in a particular industry, saying that employees of nursing homes whose residents are on Medicare or Medicaid, will need to get vaccinated.

Kristine Sundberg, Executive Director of Elder Voice Family Advocates, called the news “long overdue, but we need much more than that."

The mandate, with details and effective date still to come, appears focused on nursing homes, not other types of care homes. Sundberg works on behalf of families and residents. She says assisted living needs to be included in that mandate.

"If you're caring for people who are vulnerable, who are ill, you need to make sure that you are as safe as possible. And vaccination is clearly that way," Sundberg said.

The vast majority of Minnesota residents of long-term care are vaccinated; 95 percent of assisted living residents and 91 percent of people living in skilled nursing.

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During the pandemic, residents of these long-term care facilities made up the large majority of deaths from COVID-19 in the state. Before the vaccine, they accounted for around 70 percent of Minnesota's COVID deaths. That number has dropped by about 12 percent.

But staff did not seek shots at the same rate. Around 66 percent of nursing home and assisted living staff are vaccinated, according to the Minnesota Department of Health. That's about the same level as everyone 16 years and older.

Patti Cullen, the president and CEO of Care Providers of Minnesota, which represents long-term care facilities across the state, says facilities want their staff to get vaccinated, but they also worry about losing workers at a time when many are already short-staffed.

Cullen says vaccination rates are hovering around 50 percent in rural facilities.

She said care homes are trying to educate employees, with some implementing what she calls “mandate light.”

"Everyone is going to have to get vaccinated. Otherwise, you're going to have to get tested every week and educated on a regular basis," Cullen said.

Some facilities hesitate to put in a vaccine mandate for fear staff would leave for another facility without the requirement, some say that’s another argument for the federal policy.

"At least this type of mandate, at least offers a level of uniformity across the sector," said Kris Ehresmann, Minnesota's infectious disease director. But she adds a potential downside of the federal mandate requiring staff get shots is workers may just leave the industry altogether.

But one long-term care facility in the state has already taken this approach. Episcopal Homes, which runs ten facilities across the Twin Cities, decided last month to implement a vaccine mandate for all employees.

"Everybody in our industry wants everybody vaccinated, because the most vulnerable, of course, to this disease are the elderly, and those with pre-existing conditions,” said Marvin Plakut, CEO of Episcopal Homes.

Education programs and one-on-one discussions with those who are hesitant, has helped get more than 80 percent of the staff vaccinated, which he says put them in a good position to make the decision to require vaccinations by September.

"From that advantage point, we were able to then finally say, 'Look, we have a moral duty to protect those we care for as much as we possibly can,’” Plakut said.

It's not clear yet when the federal mandate for nursing homes will go into effect.