As many hospitals introduce vaccine requirements for their employees, advocates and industry associations are encouraging long-term care facilities to consider similar measures.
Nationwide and nationwide, vaccine uptake among residents of long-term care facilities is quite high, but staff rates are variable and quite low in some facilities.
This puts both residents and staff at continued risk of outbreaks, albeit much less than before the vaccines were introduced. In fact, vaccines in Washington have dramatically contained outbreaks in long-term care facilities.
In December 2020, up to 900 COVID-19 cases were confirmed within a week – all related to long-term care facilities – but once vaccines became available, that number dropped significantly. Now, according to the state, fewer than 100 cases are confirmed in long-term care facilities each week.
Now that vaccines are available to all, many residents and the state ombudsmen for long-term care are urging facilities to require vaccines for their caregivers to ensure the protection of residents.
“Residents’ vaccination rates were much, much higher than the staff’s vaccination rates, and the people who bear the costs are the residents,” said Patricia Hunter, Washington State ombudsman for long-term care, adding that it is the residents who lose the ability to have visitors or go into lockdown as transfer rates have increased over the past year.
The Delta variant has brought new challenges and the risk of a lingering outbreak – albeit less so – is still possible, especially with less vaccinated staff. The Delta variant is much more transmissible than previous variants and strains, and the Centers for Disease Control and Prevention has found that even fully vaccinated individuals can spread it, triggering a mask recommendation for everyone.
Breakthrough cases where a fully vaccinated person tests positive are to be expected and are very, very rare.
Of the only 4,241 breakthrough cases confirmed in Washington, 8% of those people were hospitalized. There have been 52 deaths from a groundbreaking COVID-19 case confirmed by the state health department, and half of the groundbreaking deaths are linked to outbreaks in a long-term care facility.
The Spokane Veterans Home, which had outbreaks in the pandemic before vaccines were available, recently had another outbreak. While research into how the virus got into the facility is ongoing, vaccination rates at the facility show that less than half of the staff there are fully vaccinated, while there are 89% of residents.
The Centers for Medicaid and Medicare Services have surveyed nursing home vaccination rates in each state, and this list shows similar trends in many Washington facilities where the vast majority, or in some cases, all residents are vaccinated while staff vaccination rates range from consistent Residents up to less than half.
For example, Lakeland Village, a government facility in Medical Lake, has a 99% vaccination rate among residents while only 48% of employees have their vaccinations. Similar to the Spokane Veterans Home, since Lakeland Village is run by a state agency, the governor could prescribe vaccines for employees there.
Robin Dale, CEO of the Washington Health Care Association, which represents 500 nursing homes and long-term care facilities, said his association was encouraging facilities to prescribe vaccines but added that the most effective type of vaccine mandate would come from the top of the state government.
“If you want to have mandatory vaccination, it has to be all health care providers, not just long-term care,” said Dale.
He added that a mandate for the entire health system would prevent workers from simply leaving one facility for another that has no mandate. He added that ombudsmen, surveyors and others who visit care facilities regularly should also be mandated when implemented.
Governor Jay Inslee could mandate vaccines not just in long-term care facilities but across the healthcare industry. He is considering a mandate for civil servants and a press conference is scheduled for this week that could provide more details on the possibility of a mandate.
Individual facilities are allowed to charge vaccines for their employees, but Dale said many facilities are cautious about doing so, especially if there is another center down the street that pays the same and doesn’t prescribe the vaccine. Long-term care was already under staff shortage before the pandemic, so the impending loss of manpower is a reality that many institutions regularly grapple with.
Dale said a general mandate similar to that in California would help facilities mitigate the risk of staff leaving. He added that two large companies operating long-term care homes in the state are in need of vaccines and have so far lost few, if any, staff.
“We have members who mandate vaccinations for all of their employees, and these providers have seen that they are not losing as many people as they thought,” said Dale.
To facilitate access for staff, making sure long-term caregivers have access to the vaccines, as well as knowing they can take time off in case they need to rest after the second dose, is critical, Hunter said.
“They most likely cannot afford to miss their job and are afraid of symptoms and whether or not they will be paid to get the vaccine,” Hunter said.
The Washington Health Care Association has recommended that facilities be flexible to help staff take time to vaccinate and recover if they get sick after the second dose.
With the virus circulating this fall and winter, vaccination rates in facilities could ultimately make the difference to the quality of life of those in need of care.
“If we really want to protect the weakest, do we have to honestly step back and ask ourselves how we can stop this?” Said Jäger. “It’s really not visitors, family or friends who bring it in, but the staff.”
Hunter said her hope is that with sufficient vaccination coverage, residents will not be re-locked and isolated later this year.
“Now that we know better, we have to do better,” said Hunter. “I hope we don’t just flip the switch and isolate everyone; There should be no reason to do these massive lockdowns. “