How a COVID vaccine rule for nursing home staff could backfire in Michigan

Sept. 13: Despite protests, 98% of Henry Ford Hospital workers get COVID vaccinations
Sept. 10: Required COVID vaccines put Michigan hospital worker hesitancy to the test
Aug. 24: COVID still isolates some in Michigan nursing homes. It may get worse.

Three workers left their job at a senior living facility as soon as Joanna LaFleur told staff in February they must get a COVID vaccine.

But LaFleur remained steadfast: The residents she and staff serve at three Memory Lane adult foster care sites in Ypsilanti are elderly and particularly vulnerable to COVID-19, the virus linked to the deaths of more than 3,500 nursing home residents in Michigan.

“Even as we’re hiring now, that’s our first question: ‘Are you vaccinated, or are you willing?’

“If the answer is no, they’re not going to work for us,” she said.

Related:

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But LaFleur finds herself mostly alone in a state with one of the nation’s lowest vaccination rates among workers who care for the elderly.  

Just over half the state’s nursing home workers (53 percent) were fully vaccinated as of Aug. 8, according to the U.S. Centers for Medicare & Medicaid Services.

That’s the 12th lowest staff vaccination rate in the nation, far below the national average of 60.5 percent. By comparison, 81 percent of the state’s nursing home residents are vaccinated, according to CMS. 

On Wednesday, the Biden administration announced it would require the nation’s nursing homes to mandate vaccines among their staff to continue to receive Medicaid and Medicare funds — the financial lifeblood of most nursing homes. The decision would affect more than 15,000 U.S. nursing homes that employ 1.3 million workers.

The plan is intended to staunch another surge of COVID-19. But the announcement has sent waves of concern through an industry that struggles to attract staff, a challenge made worse by the pandemic. Staffing levels are particularly acute in Michigan, where 1-in-3 nursing homes recently reported shortages. 

And that even has nursing home watchdogs concerned that many workers will simply quit.  

Vaccinations certainly protect residents and staff, said Jane Straker, a Miami University gerontologist and researcher, who has long pushed for better quality in nursing homes.

But to force staff to take them?

“I want staff to be vaccinated for the residents. I want staff to be vaccinated for their own health. But the unintended consequences (of requiring vaccines) make me very worried,” she said Wednesday, just hours after the White House announcement. 

“I can picture people just walking out and saying ‘I’ve had it.’” 

The Health Care Association of Michigan, a lobbying group representing more than 350 long-term care facilities in Michigan, said it knows of no members requiring staff vaccines. (LaFleur isn’t an HCAM member.) 

According to CMS data, just 42 of 436 Michigan nursing facilities have a vaccination rate of 75 percent or above among staff. Among them is a nursing facility attached to Spectrum Health United Hospital in Greenville, which has a 100-percent staff vaccination rate. (In July, Spectrum ordered vaccines for all health system employees.)

Many Michigan facilities also can’t find enough workers. In a month-long period ending July 18, 1 in 3 Michigan nursing homes reported shortages, compared to fewer than 1 in 4 nationally. (More than 36,000 Michiganders live in long-term care facilities, according to the San Francisco-based health research nonprofit, KFF.)

Industry officials, as well as families and advocates, say the problem worsened during COVID, as staff became sick, left jobs to care for ill family members or for children no longer in school, or because they feared getting the virus. According to the data collected since June, staff shortages in Michigan have been consistently higher for more than a year.

HCAM, the industry group, said it “appreciates” Biden’s effort to boost vaccine rates to “full compliance,” but worries a vaccine mandate “will further exacerbate critical staffing challenges.”

Chaunte Jones, a certified nurse assistant in Macomb County, said the White House strategy may turn off workers who might be on the fence about getting a vaccine. She worries they may now oppose it based on principle rather than science.

“It’s like you're losing your rights to your own body, and now people are going to be more rebellious about it, just for a short period of time,” she speculated. 

Jones said she loves her work at Mission Point of Madison Heights, a nursing home and rehabilitation center. She said she has been vaccinated and, with her union, has urged others to be vaccinated. 

In the past few days, she believes she’s convinced at least two coworkers of the safety of the two-dose mRNA vaccines made by Pfizer and Moderna. But a mandate, she said, makes workers — already working long hours for little pay — feel even more undervalued.

Ultimately, she said, it will boost vaccination rates among the best workers because they not only rely on the jobs, they love what they do. As for others? 

“We're always short” staffed, Jones said, “and people are ready to walk.” 

Vaccines saved lives. 

The medical consensus is clear: Vaccines save lives. A Yale University study estimated the vaccine saved 279,000 American lives by the end of June.

Other recent studies indicate the vast majority of vaccinated people are better protected against the worst effects of the coronavirus, even as the delta variant surges and vaccine immunity wanes, Centers for Disease Control and Prevention Director Rochelle Walensky said Wednesday, in announcing vaccine boosters will be made available to the general public and nursing home residents beginning Sept. 20.

Among the factors was a review of nursing home data that found vaccine effectiveness among nursing home residents fell from 75 percent in March to 53 percent in June and July as the more transmissible delta variant took hold.

In Michigan, infections among nursing home staff have started to rise, even as resident cases remain relatively unchanged. Even so, elderly residents remain far more vulnerable: 71 residents have died of COVID-19 since the last reported staff death in April.

The Michigan Long-Term Care Ombudsman program has been inundated with complaints over the past year from residents and families unable to see each other — a problem rooted as much by short staffing as COVID restrictions, said Salli Pung, who oversees the program responsible for advocating for residents in nursing homes, adult foster care and other long-term facilities.

With strict visitation policies, nursing homes are getting less help from families and volunteers who used to stop by throughout the week — sometimes assisting at mealtimes, helping with personal care, tidying rooms, and keeping residents engaged.

For some time, she said, “residents even have a difficult time getting a phone call. There were times when we would call the facilities and the phones would just ring. No one answered because there weren't enough staff to answer the phones,” she said.

Vaccine mandates, she said, may help control the virus but the threat it may pose to staffing levels may pose a different kind of risk.  

Kevin Lignell, spokesman for the Service Employees International Union,  which represents many of Michigan’s nursing home staff and has urged members to get vaccinated, nevertheless defended those who have yet to get shots. 

Nursing home aides and other staff have been overwhelmed by the pandemic, he said, with little time to sort through the information — and disinformation — on vaccines. The Biden administration’s mandate puts union leaders in an awkward position — torn between supporting vaccines to protect workers and residents and protecting the rights of individual workers. 

“You're working very hard shifts on low wages. You have to go back and take care of your family every day, and you already have this perceived notion that this vaccine could be harmful or it's going to put me out of work for a few days,” Lignell said. “Your mental capacity for doing research on a vaccine … is very limited.” 

Faced with a glut of competing claims about vaccines, some workers “just shut down.”

In Ypsilanti, LaFleur — the woman who required vaccinations at Memory Lane — said she was surprised when the three workers left. And it’s tough to find new employees, she acknowledged.

But for her, the mandate was worth the effort.

“We're looking for people that have integrity and do things with excellence,” she said. “To me, if you have integrity, if you want to do the right thing for the right reason for the right people, then you get the vaccine.”