Kansas long-term care facilities see low staff vaccination rates, but federal mandate may spur worker shortage

Jason Tidd
Topeka Capital-Journal
Brighton Place North, 1301 N.E. Jefferson St., has the best staff COVID-19 vaccination rate of any of the 15 Topeka long-term care facilities listed in data reported by the Centers for Medicare and Medicaid Services.

As federal health officials prepare a COVID-19 vaccine mandate for nursing home staff, Kansas advocates worry about unintended consequences.

LeadingAge Kansas president and CEO Debra Harmon Zehr said facilities will be put in a difficult position: Ignore the vaccine mandate and lose federal funding, or mandate the vaccine and lose staff.

The end result may be the same: Some facilities may be forced to close, harming the people the mandate was intended to protect.

"We want to encourage vaccination and our members are doing that mightily," Zehr said. "We are not in favor of a federal mandate, and certainly not a federal mandate that says if you don't do this, we are going to pull all your Medicaid and Medicare funding, which basically is the death knell for many nursing homes and slamming the door on access to nursing home care for senior Kansans in many places throughout the state."

President Joe Biden on Wednesday announced new efforts to use federal funding and enforcement powers to increase vaccination rates among nursing home staff.

More:President Biden says nursing homes must vaccinate workers against COVID-19

The White House said the Department of Health and Human Services is developing new regulations mandating that nursing homes require workers to be fully vaccinated against COVID-19 as a condition of participating in Medicare and Medicaid programs. Data from CMS and CDC "confirm a strong relationship between the increase of COVID-19 cases among nursing home residents and the rate of vaccination among nursing home workers."

No vaccination deadline has been announced.

"We don't know the scope of how many staff will leave," Zehr said, "but I will tell you that we have members who report that they already have letters of resignation on their desks from staff members who say they won't participate in the mandate."

"I think it is going to be particularly harmful in very small, very rural communities where they may only have one or two RNs," Zehr said. "And an RN walks off, you know, says I'm not going to do this, I'm going to go down and work at the hospital where they don't have a mandate or I'm going to go work in the physician's office or the healthcare clinic or whatever.

"And and then that puts the entire resident population there at risk. It definitely would result in enforcement action, they may not be able to stay open."

Staffing stretched thin Kansas long-term care facilities

Zehr said the workforce crisis in long-term care facilities in Kansas and nationwide is the worst she has seen in at least 30 years. Staffing is already stretched thin.

"We just did a survey last month of our members, and a third of our members are turning away new admissions of older people in their community because they don't have enough staff to take care of them," Zehr said.

Zehr said the association is opposed to a federal mandate but is supportive of individual facilities that make vaccines be a condition of employment.

"We think it needs to be a decision that is made at the local level, not through the federal government, and certainly not with the egregious enforcement mechanism that has been proposed — and that is taking away all Medicare and Medicaid funding," Zehr said.

"Kansas nursing homes on average, that's where 70% of their funding comes from, or more. So you're you're basically closing down nursing homes if that enforcement action would be put in place. There's no way that most of our nursing homes in our state could continue to operate if three-fourths of their funding was pulled by the federal government."

President Biden's administration is implementing a COVID-19 vaccine mandate for long-term care facilities. The Pfizer vaccine on Monday received full approval from the FDA.

The Pfizer vaccine received full approval for people aged 16 and older from the Food and Drug Administration on Monday.

Dana Hawkinson, an infectious disease specialist at The University of Kansas Health System, and Angela Myers, an infectious disease specialist at Children's Mercy Hospital, were hopeful during a Monday media briefing that full FDA approval may prompt more of the vaccine-hesitant to get the shot. It may also prompt companies to mandate vaccines for their employees.

Some Kansas facilities have already chosen to make it a condition of employment, Zehr said, but most of those policy changes haven't yet been implemented, so it is unknown how many workers will quit their jobs.

While a vaccine mandate will help protect residents, it won't be a 100% guarantee that breakthrough infections won't spread from vaccinated staff to residents, Zehr said. Additionally, there is a gap in the mandate because it doesn't include visitors or external health care providers. 

"The mandate across the board is a would be a more reasonable application of this idea that we need to protect vulnerable people, people who are seeking health care," Zehr said. "We're not really sure why we're being singled out, our nursing homes are being singled out, other than they have experienced a lot of tragedy, a lot of deaths."

Low vaccination rates at Kansas nursing homes

Industry organizations LeadingAge and the American Health Care Association and National Center for Assisted Living have established a goal of vaccinating 75% of staff.

Only 47 of the 325 federally licensed facilities in Kansas have fully vaccinated at least 75% of staff, according to Centers for Medicare & Medicaid Services data through Aug. 8.

In Kansas, an average of 57% of staff and 86% of residents had been fully vaccinated as of Aug. 8, CMS statistics show. Those rates are up from 55% of staff and 85% of residents as of June 27.

The current staff vaccination rate in Kansas ranks in the bottom half of states, but the resident rate is in the top half.

More:Kansas nursing homes fall short of staff vaccination goal as COVID-19 outbreaks continue

Seven federally licensed facilities reported a resident COVID-19 death during the week of Aug. 8, CMS data show. They were Via Christi Village Manhattan, Medicalodges Columbus, Via Christi Village Pittsburg, Atchison Senior Village, Avita Health and Rehab at Reeds Cove in Wichita, Ranch House Senior Living in Garden City and Logan County Senior Living in Oakley.

None of those facilities had met the industry's staff vaccination goal.

Kansas Department of Health and Environment data from last week showed 52 active outbreaks at long-term care facilities across the state. Those clusters had infected 370 people, hospitalized 27 and killed 31.

The state agency publicly identified seven of the exposure locations: Plaza West Healthcare and Rehab in Topeka, Vintage Park in Louisburg, Meadowbrook in Gardner, Comfort Care Homes Ridgewood in Wichita, Glen Carr Assisted Living in Derby, Brookdale Derby and Kenwood Plaza Assisted Living in St. John.

National organizations support vaccination

Earlier this month, AARP Executive Vice President and Chief Advocacy & Engagement Officer Nancy A. LeaMond called for vaccine mandates to protect nursing home residents and staff.

“The high COVID death rates of residents and staff in nursing homes have been a national disgrace," LeaMond said in the Aug. 12 statement. "As the new variants are emerging, facilities cannot let preventable problems be repeated.

"The key is to increase vaccinations, and do it now. AARP is calling on nursing homes to require vaccinations for staff and residents. The low levels of staff vaccinations in particular creates an unacceptable level of risk, since the disease spreads so easily in these environments."

Former Kansas Gov. Mark Parkinson, now the president and CEO of AHCA/NCAL, said last week that the mandate should apply to all health care settings.

"We appreciate the Administration’s efforts to increase COVID-19 vaccinations in long term care," Parkinson said in a statement. "Unfortunately, this action does not go far enough. The government should not single out one provider group for mandatory vaccinations. Vaccination mandates for health care personnel should be applied to all health care settings. Without this, nursing homes face a disastrous workforce challenge. 

"Focusing only on nursing homes will cause vaccine hesitant workers to flee to other health care providers and leave many centers without adequate staff to care for residents. It will make an already difficult workforce shortage even worse. The net effect of this action will be the opposite of its intent and will affect the ability to provide quality care to our residents. We look forward to working with the Administration in the coming days to develop solutions to overcome this challenge."