Seniors and those who care for them have been a prime target for vaccination since the pandemic’s early days when the bulk of deaths from COVID-19 were reported in nursing and assisted living facilities.
The push has taken on new urgency since the delta variant of the virus began fueling an uptick in cases that includes seniors, with some facilities requiring shots for caregivers who now make up the majority of their cases.
But like vaccinations in hospitals, and elsewhere, mandates at nursing homes and assisting living centers are being instituted on a piecemeal basis, and that has lead to uneven levels of protection.
Overall, more than 83% of residents and 73% of staff of such facilities in Maryland have been fully vaccinated, according to state health data recently made available. Among staff, however, the range is significant — with facilities reporting between 39% and 97% of workers are fully vaccinated.
There is agreement that vaccinations are crucial to control outbreaks. Cases are recorded at more than three dozen facilities in the state, mostly among staff. But some in the industry fear that vaccine mandates that don’t apply to all facilities will exacerbate a labor shortage.
“Across the country, many departments of health and governors are considering vaccine mandates, including in health care settings, from home health care to hospitals to skilled nursing and rehab centers and assisted living,” said Joe DeMattos, president and CEO the Health Facilities Association of Maryland, which has endorsed mandates for all facilities.
“If state vaccine mandates are not comprehensive, we risk the possibility of an employee in one health care setting who is unwilling to participate in mandatory vaccination moving to another health care setting that is not mandating the vaccine.”
So far, Republican Gov. Larry Hogan has called for long-term care facilities to mandate staff vaccinations, but stopped short of a statewide requirement like one he imposed on some state-run health care facilities. Hospitals, too, have all agreed to mandates, with varying deadlines and conditions, such as full approval of the vaccines from the U.S. Food and Drug Administration.
Among the most recent to require staff vaccinations is LifeBridge Health, a network that includes Sinai Hospital and Levindale Hebrew Geriatric Center and Hospital in Baltimore and Northwest Hospital in Randallstown.
Deborah Graves, Levindale’s president and CEO, said the long-term care facility and rehabilitation center lobbied state officials to require all workers at such centers in Maryland to get the vaccine. Ultimately, given the rapidly changing rate of delta variant cases, Levindale officials decided to move ahead on their own.
All LifeBridge employees must be vaccinated by Nov. 1. Currently, about 71% are vaccinated, spokeswoman Sharon Boston said, including about 58% of the long-term care workers at Levindale.
LifeBridge trails some other hospital systems in instituting a mandate, including the University of Maryland Medical System and Johns Hopkins Medicine, which set Sept. 1 deadlines for full vaccination.
“We don’t want to operate from a place of fear, but we do want to be thoughtful about our decision-making,” said Graves. “The mandate may feel like a lot, but when you’re in a supportive work environment and your voice is heard, I think that will, in most cases, outweigh the trepidation of getting vaccinated.”
Graves said she anticipates some workers will resign rather than get the shots. But delta could be a motivator for employees to become vaccinated, she said, as well as full federal approval of the vaccines by the FDA in the coming weeks or months.
Other long-term care facilities recently announcing mandates include Charles E. Smith Life Communities, Sava Senior Care, and Genesis HealthCare, with about 20 facilities combined in Maryland.
Genesis HealthCare will require universal vaccination by Sept. 22 of on-site staff, vendors and visiting providers, according to a release from the national nursing home chain. Genesis CEO Harry Wilson attributed the mandate decision to the delta variant.
”Our commitment to health and safety outweighs concerns about imposing a requirement,” he said in a statement. “Universal COVID-19 vaccination provides the safest and most effective course of action to ensure the health and welfare of our patients, residents and staff.”
Company data shows Genesis’ Maryland-based centers typically have higher vaccination rates than the average, with most centers reporting at least 75% of staff vaccinated, compared with 65% overall workers. About 85% of residents are vaccinated overall.
Still, there is a range: At Salisbury Rehabilitation and Nursing Center, only about 48% of the staff has been immunized, according to the company.
Lori Mayer, a company spokeswoman, said they plan to approach staff with sensitivity and expect more vaccinations but are preparing “contingency plans” for facilities if the policy leads to vacancies.
“The need to ensure the health and safety of our patients and residents must outweigh other considerations,” she said in an email.
The Maryland Department of Health recently started including data from specific facilities on its coronavirus dashboard and began making public those at the top and bottom of the vaccination spectrum.
The high rate of vaccinations among residents of such centers helped stem the number of infections from early the pandemic, but staffs proved far more hesitant, at least early on. The gap has since closed somewhat since December.
That’s slowed the pace of infections in nursing homes, group homes and assisted living facilities, where since the pandemic began there have been more than 33,000 cases and more than 3,500 deaths.
However, cases are again on the rise among those age 60 and older. A seven-day average of new cases for that age group Sunday was 81, the highest since May, although far below a peak of 576 in December, according to state data.
Currently, there are 37 nursing homes with confirmed COVID-19 cases, predominantly among staff, said Charles Gischlar, a department spokesman.
“Last week, the governor announced that the state is calling on nursing home operators to institute vaccine requirements for staff,” he said. “Our department is prepared to take further action if necessary.”
“Further action is under consideration,” Mike Ricci, a spokesman for the governor’s office, said.
Neither Gischlar nor Ricci was specific about what action the state may take.
Public health experts say those in long-term care facilities are vulnerable and vaccinations should be mandatory for workers and staff, but they understand the pressures on individual facilities.
Anita Hawkins, assistant dean of Morgan State University’s School of Community Health and Policy, said low-wage nursing home and long-term care staffers may be inclined to resign when a universal vaccination mandate goes into effect due to personal, cultural or religious beliefs that have held them back from getting immunized.
The competitive nature of the industry could allow them to move to another facility, or another industry, with relative ease.
As the threat of the delta variant grows, Hawkins said the state or federal government should institute a requirement to prevent mass defection of the workforce.
“They have to do it across the board,” she said. “It’s hard, because an institution might feel, ‘If I do this and no one else does, I’m going to be hurting.’ But the best strategy is a mandate across all institutions: vaccinated unless there’s an exception.”
Hawkins said masking and testing requirements aren’t enough to stave off delta, especially among geriatric populations.
“Unfortunately, with the delta variant and all the other variants, we need to not wait,” Hawkins said. “Persons who are unvaccinated increase the likelihood of various variants developing.”
Baltimore Sun data journalist Steve Earley contributed to this article.