Biden to Require Vaccination of All Nursing Home Workers

Aug. 24, 2021
Healthcare Innovation spoke with Regenstrief’s Dr. Unroe about how nursing home leaders can talk to their staff about vaccination requirements and worries about staffing shortages

According to an Aug. 19 article from The New York Times by Matt Richtel, a policy from President Biden will require all nursing home workers to be vaccinated against COVID-19 and facilities that do not comply could be penalized or lose federal funding.

Richtel writes that “Of the 1.5 million nursing home staff in the United States, some 540,000—40 percent of the work force—are unvaccinated. Their fate could be directly impacted by a policy announced Wednesday by President Biden requiring all nursing home employees to be vaccinated, with the rules likely to take effect sometime in September. Facilities that fail to meet that target could face fines or lose eligibility to receive federal reimbursement, a vital source of income for many.”

Healthcare Innovation had the opportunity to speak with Kathleen Tschantz Unroe, M.D., research scientist at the Indiana University Center for Aging Research at the Regenstrief Institute, and associate professor of medicine at Indiana University School of Medicine, about how leaders in nursing homes can talk with their staff about getting the COVID-19 vaccine or losing their job.

How can nursing home leaders talk to their staff about vaccination requirements while they are worried about staff shortages?

That is such a real worry. We’ve been talking about vaccinations for nursing home staff since even before they became available, in early December, as soon as we learned that not just nursing home residents, but nursing home staff, would be among the first group to have the opportunity to become vaccinated. And a majority of staff are vaccinated—but some companies already had moved toward mandating vaccines. But this was huge news that there will be what amounts to a federal mandate for all nursing home staff. In terms of how to talk directly to staff about it, we very much want to retain our qualified staff in nursing homes. There are chronic staffing shortage issues and chronic turnover issues in nursing homes. So, anything that has a consequence of causing staff to leave is a very big deal. I think the way to talk about it, is a lot of the way that we have been talking about it, understanding why people are hesitant. They have the same concerns that anyone who is hesitant has. And a lot of those concerns stem from rampant misinformation.

Over these last several months a lot of organizations working with longer-term care have been developing materials to speak to the concerns of frontliners. So, at the same time as this mandate is communicated, we need to communicate all of the positive things. It was one thing to be hesitant back in December or January—"I don’t know if I want to be the first”—but now we have millions of data points on the efficacy of vaccines.

As we communicate the mandate, we have to keep addressing the concerns of staff in a direct and respectful manner. Nursing home staff who have been working in this setting for years and working through the pandemic deserve that. It will be a shame if we lose some of them due to the mandate. The reality is that if you want to work in healthcare then, this [mandate] is going to be part of it.

Without federal mandates in other sectors, this [vaccine hesitant] person could jump to home care, or to outpatient clinics, or maybe there’s some hospitals that aren’t mandating right now. So, it needs to be more about making a choice if you want to provide patient care.

Can you talk a little bit more about the materials that are being provided to staff about the COVID-19 vaccine?

One of my colleagues, a medical director in a good-sized facility in Indianapolis, a week after the vaccines became available did multiple open webinars for all staff. Anyone who was hesitant, she offered to talk to one on one. Our director of nursing did that as well. I think these one-on-one conversations are really important.

When you ask what leaders can do, clinical and administrative leaders and medical directors of nursing facilities need to do what a lot of us have been doing, which is look for any opportunity to have these conversations—especially now. It forces the conversation because people will have to make choices.

Do you think staff will consider this requirement “all about the bottom line?”

You literally can’t operate if you don’t have Medicare and Medicaid financing. It’s not like the executive director is getting cash in his or her pocket, it’s we aren’t going to be able to keep the nursing home open without Medicare and Medicaid financing.

What’s a diplomatic way to handle staff that just flat out refuse to get vaccinated?

I think the diplomatic way, and I have heard of folks that communicated it this way, is, if you change your mind come back. If you change your mind and get your vaccine, we will welcome you back with open arms. We would love to have you on our team.

What do you think of incentives for staff to get vaccinated? How do you feel they are working?

There are tons of them! They work for some people. Like get an extra pair of scrubs, a drawing for an iPad giveaway, cash incentives, extra paid day offs, etc. I think that a lot of companies and facilities are trying to put those positive incentives in place, and they have worked for some people. There are some people that just are very hesitant and are disinformed. And this news today about the Pfizer vaccine may help some people who were worried for that reason.

I think incentives have been utilized and it certainly always feels better to use carrots rather than sticks. But a mandate is what will get us to full vaccination of staff. I think a lot of us in healthcare have had an expectation that this was coming. The health system I work for already mandated it, so, it’s been coming.

It is a change for nursing homes. Although hospitals have mandated flu vaccinations for quite a while, most nursing homes haven’t done that. It’s a change in culture and that should be respected. It doesn’t change the importance of it in my mind. It does speak to why this is hard and why we need to acknowledge why this is hard, though.