‘Dangling by a thread’: Nursing home industry warns of staff exodus over vaccine mandates

Missouri has outpaced only Florida and Louisiana in vaccinating nursing home healthcare workers

By: and - September 15, 2021 6:30 am

An advocate representing the nursing home industry warned Missouri lawmakers healthcare staff might leave because of a coming COVID-19 vaccine mandate. (Credit: Katarzyna Bialasiewicz/Getty Images)

A federal mandate requiring nursing home staff members to be vaccinated against COVID-19 could worsen an already severe worker shortage, an advocate for the industry warned Missouri lawmakers Tuesday.

Nikki Strong, executive director of the Missouri Health Care Association, told members of a Missouri House subcommittee on Tuesday that she didn’t believe the federal mandate to be the best way to get more nursing home employees vaccinated. 

“We have got to have healthcare workers, and we are dangling by a thread right now,” Strong said.

Missouri lags all but two states — Florida and Louisiana — in the number of its nursing home personnel who have received a COVID vaccine. On average, 50.2% of nursing home staff are vaccinated in the state even though they, along with residents, were among the first Americans to be eligible for the vaccine last winter.

Residents in Missouri nursing homes have more enthusiastically embraced the COVID vaccine in order to regain freedom after many nursing homes instituted strict lockdown measures to control the spread. About 84% of Missouri nursing home residents have been vaccinated. 

Tuesday’s committee hearing was billed as a discussion of a coming mandate from the Centers for Medicare and Medicaid Services that nursing home staff be vaccinated. CMS has yet to issue the rules. 

But despite weeks of rising numbers of COVID cases in Missouri nursing homes, much of the discussion centered on whether the vaccine mandate would drive staff away from nursing homes and how Missouri could respond. Missouri Department of Health and Senior Services staff told members there was likely no way around the mandate. 

Rep. Dirk Deaton, a Noel Republican who chairs the subcommittee, said he thought it was important to have workers who are around the elderly get vaccinated. But he said having a dearth of healthcare workers was the only thing worse than having unvaccinated ones. 

“That’s what I fear. I hope it doesn’t come to that, and I hope we don’t see that, but I'd feel really terrible if we cross that bridge and that happens and no one ever said anything,” he said.

COVID rising again 

COVID cases have been climbing in Missouri nursing homes since June. 

During the week ending Aug. 29, Missouri nursing homes reported 153 infections among staff and 121 resident infections, according to data homes reported to CMS. That represented a dip compared to early August when weekly staff infections rose above 200 for the first time since January when the vaccine was still rolling out. 

During the virus’ peak this winter, nursing home residents outpaced staff in COVID infections. Infections for both groups dropped off precipitously in February after the vaccine arrived. 

But now, it’s staff who are becoming ill, the CMS data show. 

Rep. Peter Merideth, a St. Louis Democrat, said he was frustrated by the discussion because requiring healthcare workers to be vaccinated seemed like “common sense.” 

Merideth noted nursing home residents have no choice but to be in close proximity to the staff who take care of them, meaning they don’t have as much say in their level of risk exposure as someone deciding whether or not to eat at a restaurant. 

Strong said she wanted residents to be safe, but homes need caregivers. 

“We had facilities begging their staff not to leave at just the threat of an order,” Strong said. 

Merideth responded: “Well, frankly, you have them begging to leave even without any conversations about vaccines, don’t you?” 

He said the crisis of understaffing in nursing homes is a product of the difficult work and low pay and committee members should be working on how to solve that without making homes less safe.

Lenny Jones, state director for SEIU Healthcare Missouri, a union representing healthcare workers, supported the vaccine mandate in a statement released as the subcommittee meeting began. 

“There is an urgent need for action to boost vaccination rates in Missouri with new variants threatening to prolong this ongoing crisis,” Jones said. 

The regulations had also been welcome news to AARP Missouri. The chapter's parent organization has urged for vaccinations to be mandatory for both nursing home residents and staff.
"Getting vaccinated is literally the least that a person working in a nursing home can do to protect the people in their care," Jay Hardenbrook, the advocacy director for AARP Missouri, said last month.

CMS is also expected to issue a vaccine mandate for nurses and healthcare workers in hospitals. 

When asked earlier Tuesday about vaccine mandates for nurses and healthcare workers in hospitals and if taking a vaccine is a personal choice, Donald Kauerauf, the director of the Department of Health and Senior Services, said vaccinations will stop the virus’ spread and taking a vaccine has been a personal decision throughout the process. 

He said he was worried about the effects the rule could have on staffing in those facilities, but stressed federal regulations have not yet been drafted by CMS.

“We’re not even to that point yet. Sometimes I get a little hesitant to go too quickly on decisions based on hearsay,” Kauerauf said. “Let’s wait and see what the law says. We’re not near that point yet.”

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Allison Kite
Allison Kite

Allison Kite is a data reporter for The Missouri Independent and Kansas Reflector, with a focus on energy, the environment and agriculture. A graduate of the University of Kansas, she previously covered City Hall for The Kansas City Star, as well as state government in both Topeka and Jefferson City.

Tessa Weinberg
Tessa Weinberg

Tessa Weinberg covered education, health care and the legislature with the Missouri Independent. She previously covered the Missouri statehouse for The Kansas City Star and The Columbia Missourian, where her reporting into social media use by the governor prompted an investigation by the Attorney General’s office. She also covered state government in Texas for The Fort Worth Star-Telegram.