Federal vaccine mandate at local nursing homes likely to impact staffing – Daily Inter Lake

Montana long-term care facilities face workforce and financial uncertainties as the nation awaits a new directive from the Biden Administration that likely will require health-care personnel at federally funded nursing homes to be vaccinated against Covid-19 as a stipulation for those centers to continue receiving payments.

The Centers for Medicare & Medicaid Services (CMS), along with the Centers for Disease Control and Prevention (CDC), announced Aug. 18 that the agencies are developing an “emergency regulation” that aims to safeguard nursing home residents and staff from the coronavirus by making vaccines among staff at CMS-certified facilities mandatory.

A CMS spokesperson told the Daily Inter Lake Thursday that the agency intends to issue the regulation in late September — a rule that leaders at local Flathead Valley facilities say they will likely have to implement because they cannot risk losing federal funding, even though the decision to do so could prompt unvaccinated staff to leave.

“CMS strongly encourages nursing home residents and staff members to get vaccinated as the Agency undergoes the necessary steps in the rule-making process over the course of the next several weeks,” the spokesperson said via email. “CMS expects nursing home operators to act in the best interest of residents and their staff by complying with these new rules, which the Agency expects to issue in September. CMS also expects nursing home operators to use all available resources to support employees in getting vaccinated, including employee education and vaccination clinics, as they work to meet this staff vaccination requirement.”

THE PENDING regulation would impact more than 15,000 nursing homes across the nation that participate in, and to a large degree are propped up by, Medicare and Medicaid payments.

President Joe Biden has deemed it a necessary measure that will help protect a population the CDC says is adversely impacted by the virus. To date, more than 134,000 nursing home residents and 2,000 nursing home employees have died from Covid-19-related complications nationwide, according to CDC data.

But some caution the directive will take a particularly aggressive toll on facilities that are operating with lower-than-average vaccination rates among staff. And in rural areas such as Montana, where many facilities struggle to hire and retain a workforce, an exodus of those unwilling to get vaccinated would exacerbate the issue.

Joe Russell, health officer for the Flathead City-County Health Department, said Thursday that, while he understands the motive behind the new regulation and believes it would protect residents, he estimates nursing homes throughout the valley will experience as much as a 30% attrition rate once it goes into effect.

“A lot of these homes will have to mandate vaccines because so much of their income comes from federal agencies. They don’t really have a choice in that,” Russell said. “There are people who are vehemently opposed to the vaccine. So when that happens, those people will probably find work elsewhere.”

Russell’s statement aligns with what some facility managers throughout the Flathead Valley, where vaccination rates among staff range from 53% to 84%, have said about the possible rule.

“With staffing a tremendous challenge across the nation and the fact that our teams must wear protective gear continuously because the vaccine does not prevent the spread or prevent anyone from contracting covid, people do not want to have that stress or the stress that they may have brought it into the facility, so many are choosing different career paths,” said Wendy Soulek, chief operations officer for Lantis Enterprises, which owns and operates Lake View Care Center in Bigfork and Heritage Place in Kalispell. “We are reaching a point where the passion to care for others does not exceed the demands placed on them as nursing home employees.”

DATA FROM from the CDC shows the national average for vaccinated staff in a CMS-certified facility is 61.8%, while the average vaccination rate among residents is 83.6%. That is current as of Aug. 22, and is based on data that nursing homes are required to report regularly.

But at least 20 states in the nation fall below the national averages for vaccinations among nursing home staff, with Hawaii at 89.5% and Louisiana at 47.8% bookending the range. In Montana, the average percentage among reporting facilities slips in just below the national average at 59.2%, though that number likely has increased since Aug. 22 and fluctuates regularly based on staffing ratios and resident numbers.

The CDC database shows there are 70 CMS-certified nursing homes in the state, including at least six in Flathead County: the Montana Veterans Home, Lake View Care Center, Heritage Place, Immanuel Skilled Care Nursing Center, Logan Health Brendan House and Whitefish Care and Rehabilitation.

Whitefish Care, which underwent a deadly Covid-19 outbreak in the fall of 2020, is the only facility not reporting and therefore, vaccination numbers are unavailable for that center. The CMS spokesperson said when a facility has failed the CMS Quality Assurance check — which can happen for a number of reasons — all data for all weeks is excluded for that facility.

No data is provided for Whitefish Care for the following provided reason: the ratio of total confirmed Covid-19 cases among residents, compared to the number of all beds, is greater than or equal to 1.75. That is, resident cases are at least 75% larger than total facility beds.

Management at Whitefish Care did not respond to calls from the Daily Inter Lake.

As for the other five facilities, vaccination rates among staff range from 53.2% at Lake View Care Center in Bigfork, to 84% at the Montana Veterans Home in Columbia Falls, with the other four facilities falling in between. Lake View and Brendan House, which is owned and operated by Logan Health, are the only two in Flathead County that fall below the national average, though for perspective, the two facilities are outpacing at least 23 others across the state.

With the exception of Brendan House, all facilities fall well above the national average for resident vaccination rates. However, while the Aug. 22 data shows roughly 77% of residents at the Brendan House were vaccinated, hospital spokeswoman Mellody Sharpton said that figure is now at 81%.

WHEN ASKED if facilities plan on implementing the new rule should it be released, representatives with Immanuel Lutheran, Lake View and Heritage Place acknowledged that vaccines among staff would help reduce transmission rates and offer an added level of protection for residents, but they also noted they feel backed into a corner by the directive. While they cannot suffer additional blows to staffing levels, they also can’t sacrifice federal funding, which accounts for 90% of their facilities’ revenue streams.

“We can’t risk the chance of losing federal funding, and that’s something we’ve been transparent about with our staff,” said Jason Cronk, longtime CEO of Immanuel Lutheran. “Our next steps will be to continue educating our staff on the importance of being vaccinated. We won’t have a choice if this rule comes out. We’ll have to adopt it.”

Cronk said he expects the skilled care center will lose some staff should the rule go into effect, but anticipates he will be able to bring on vaccinated people to replace those that leave.

Roughly 60% of staff are vaccinated at the center, which is the only arm of the Immanuel Lutheran system that is CMS-certified. Aside from assisted living, the “life plan community” also provides memory care and post-acute care services.

Cronk said this continuum of care will allow Immanuel Lutheran to withstand the upcoming mandate better than stand-alone entities because, among other things, the system isn’t solely financially reliant on CMS.

But such is the case for Heritage Place and Lake View, where, Soulek said, because so much of their funding is federally subsidized, “if the Biden-Harris Administration ties vaccination to reimbursement, no nursing home or their staff will have a say [as to whether the rule should be adopted].”

Soulek pointed to other concerns including a pandemic-driven increase in costs associated with staffing, overtime expenses, and supplies, as well as regulatory demands on the industry. She said, “quite frankly, nursing homes will soon reach the point where they cannot continue to operate due to the current circumstances.”

While many of the nation’s nursing homes received financial assistance through the CARES Act, Cronk and others say those funds helped offset only a portion of expenses accrued due to the pandemic. And financial burdens associated with Covid-19 are ongoing and more support is needed, he said.

For example, because Flathead County has a high transmission rate, all non-vaccinated staff at CMS-certified homes must be tested twice weekly. If a positive case is detected, the facility must go into “lock-down mode,” meaning they cannot accept new residents or visitors for at least two weeks.

“That’s where our census suffers. When we can’t accept more residents our income is impacted and we also end up having to pay more for other things like overtime for people to cover the person that is now in quarantine,” said Cronk, adding that Immanuel Lutheran is roughly 75% occupied due to recent lockdowns and ongoing staffing shortages.

On Thursday, Russell estimated 10 long-term care facilities, some of which are CMS-certified, were under lockdown orders.

AT THIS point, it is unclear what sort of financial or workforce support may come from state and federal leaders. The Department of Public Health and Human Resources did not answer questions from the Daily Inter Lake by the publication date of this article.

The state took a hard stance on mandated vaccines earlier this year with the passing of House Bill 702. The recently enacted law prohibits the vast majority of businesses in the state from requiring their employees to be vaccinated.

An exemption in the bill, however, allows long-term care facilities to require shots if their federal funding is at stake — an exception that has prompted some nursing home executives to turn to state leaders for support.

House Bill 702 was even extended to hospitals and health-care settings, which adds an extra layer of confusion as to how long-term care facilities that operate within a hospital system, such as the Brendan House, should navigate the potential new rule. Sharpton, speaking for Brendan House, said via email “we are aware of the potential requirement and are working with other hospitals across the state to evaluate the next path.”

Reporter Kianna Gardner may be reached at kgardner@dailyinterlake.com.