On a recent afternoon, the mood was festive, and not only because the staff were dotting the floor with stars for a special, Hollywood-Walk-of-Fame-theme brunch for Father’s Day.
It’s been more than four months since the last coronavirus case here. But while a year of heartache and painful isolation is behind them, their confidence is buoyed by something else.
A banner outside the building says it all: “Staff 100% Vaccinated. You Rock!”
Credit: Jenni Girtman
That’s far from the norm. Georgia is lagging all but three states — Florida, Mississippi and Wyoming — in the percentage of nursing home staff that has completed vaccination, according to federal data. Overall, only about 42% of staff in the state have completed vaccination, the data show.
Senior care facilities have been trying for months to persuade workers to get the shots, with some offering bonuses, extra time off or other incentives. They brought in medical experts, circulated myths-versus-facts sheets and hosted one-on-one and small-group sessions to discuss the issue with staff. Those efforts, though, didn’t bump up rates much, as many workers worried about side effects, or hesitated because the vaccines are so new.
Canterbury Court’s milestone didn’t come easily.
When COVID-19 vaccines were available on-site in early January, more than 99% of residents opted to get vaccinated. But only a third of staff at the complex, which includes including independent living apartments, personal care and nursing home care, did so.
So Canterbury made a bold decision: It required all staff to be vaccinated by June 1 as a condition of employment. As of June 15, all but one of the 186 employees are vaccinated, according to Debi McNeil, president & CEO. The one who isn’t vaccinated has a medical exemption.
A small but growing number of long-term care providers in Georgia and across the country also have started requiring COVID-19 vaccination for workers, citing low vaccine uptake rates, ample supply, more data supporting the safety and efficacy of the shots, and the ongoing threat of the coronavirus as it mutates. Many more providers are considering such requirements.
Adopting them is hardly an easy choice. Losing staff is a major concern. Staffing shortages —a long-standing problem within the long-term care industry — have been exacerbated by the pandemic, with at least 20% of nursing homes nationwide reporting a shortage of nurses or aides every month since May 2020, according to an AARP analysis of government data.
McNeil said Canterbury Court lost 10 staff members, including seven nurses, to the vaccination requirement.
Still, some operators said they didn’t feel like they have any choice but to require vaccines after a devastating year. Residents in long-term care communities were among the hardest hit during the pandemic, with the virus spreading rapidly in close quarters among people with weakened immune systems.
“I am not going to lie. I was nervous when we announced this,” said McNeil. “But I felt like who are we if we can’t protect our community? I felt like we had to take this stand, that we had to step up. I just feel that if this is the industry you want to work with, this is something you need to accept.”
Liz Woltzen, the home’s administrator, agreed, saying it was the only path to residents’ getting their lives back.
“I looked at our residents and what they had to be put through, and they had to endure way more than any us of and bore the brunt of the pandemic more than any other segment of the population,” Woltzen said. “And with the sparse visitation, it was a lot to ask of them and they accepted it with grace. They would say, ‘I know we need to do our part.’
“They shouldn’t have to feel like they are in prison indefinitely,” she added.
Northside Gwinnett Extended Care Center in Lawrenceville is the only other Georgia nursing home with 100% of staff vaccinated, according to the Centers for Medicare and Medicaid Services, which recently began requiring nursing homes to report vaccination rates.
Employees there who chose not to be vaccinated were assigned to other facilities within the Northside Hospital system, said spokesperson Katherine G. Watson.
“We recognize what a critically vulnerable population our patients at Northside Gwinnett Extended Care Center are,” Watson said.
The William Breman Jewish Home in Atlanta had to back off a vaccination requirement, however.
It had set a June 1 deadline for 100% vaccinations, a spokesperson said. In May, though, it decided to drop the requirement, at least for now, because it couldn’t afford to lose any remaining staff who planned to leave over the mandate.
Still, the home has one of the higher vaccination levels among staff in Georgia, at 81%.
Vaccination rates at other senior care facilities, such as assisted living, are not regulated by the federal government and not readily available.
Since vaccines arrived in Georgia, COVID-19 infection and death rates have plummeted from their winter peaks.
In a June 6 report to the federal government, Georgia nursing homes listed a total of only four weekly confirmed coronavirus cases among residents, down from 730 cases in a one-week period in early January,.
The federal data show something else: More nursing home staff than residents had recently tested positive. Over the one-week period ending June 6, nine cases among staff were confirmed.
While the number of weekly confirmed cases, for residents or staff, depends on nursing homes continuing to do tests and to report accurately, the overall trend is clear.
Even so, an April report by the Centers for Disease Control and Prevention underscores why emerging variants continue to pose a threat, especially to vulnerable populations.
The CDC reported that at a Kentucky nursing home this spring, an unvaccinated health worker set off a COVID-19 outbreak. Dozens were infected, including 22 residents and employees who already were fully vaccinated.
Fewer of those vaccinated were infected than those who had not been vaccinated, and they were far less likely to develop symptoms or require hospitalization. But one vaccinated individual died, according to the CDC.
The outbreak involved a variant of the virus that had multiple mutations in the spike protein, the kind that can make the vaccines less effective.
And while vaccination levels among residents are well over 90% at several Georgia senior communities, the number varies home to home. According to the latest federal data, overall only about 70% of nursing home residents here are vaccinated. The number also fluctuates over time, as new residents move in.
Long-term care facilities will have to remain vigilant to keep vulnerable residents protected.
Credit: Jenni Girtman
A change in thinking
Guidance from the U.S. Equal Employment Opportunity Commission (EEOC) suggests employers have the legal right to require employees to show proof of vaccination, as long as they allow for medical or religious exemptions.
And while some have questioned whether employers can legally require vaccination, given that the U.S. Food and Drug Administration has only granted the COVID-19 vaccines emergency use authorization, labor and employment attorney Ken Winkler, with the Atlanta law firm Berman Fink Van Horn, said the EAU status, “may be legally irrelevant.”
Winkler pointed to a recent ruling in Texas where a federal judge confirmed the legality of a Houston hospital’s vaccination mandate. In reaching the decision, the judge rejected the workers’ claims that the vaccines were experimental and dangerous, saying such claims were false and irrelevant.
While it’s important to remember that the EEOC’s guidance is not binding law and the Texas decision is subject to appeal, Winkler said it appears “employers in all industries are on solid footing to mandate vaccination.”
He added one could expect policies supporting vaccine mandates in nursing homes and other long-term care communities “where safety of those under their care is paramount.”
Mandates aren’t the only tool long-term care facilities are using to boost staff vaccinations. A national campaign by LeadingAge, the American Health Care Association and National Center for Assisted Living, which represents more than 14,000 nursing homes and other long-term care facilities, set a goal of vaccinating 75% of senior care workers across the country by June 30. Facilities have enlisted vaccinated workers, or “vaccine ambassadors,” to provide one-on-one education to hesitant staff, and some are offering incentives.
But as time goes by and vaccination rates still lag, “there is a more of a conversation of whether this will be a requirement,” said Ginny Helms, president and CEO of LeadingAge Georgia, which represents nonprofit and mission-driven senior care organizations.
“We are talking about the frailest of the frail,” she said. “And the surest way to protect them is to get vaccinated.”
Stanley Archille, a nurse manager at Canterbury, was among the majority of staff initially hesitant, with the vaccine “being so new.”
He had wanted to wait for full FDA approval. He said wasn’t overly concerned about getting seriously sick because he was 34 and in good health. But over time his thinking changed, he said. He got his first dose of the vaccine in April, second in May.
“I love my job, and people may not realize how close we get to the residents,” said Archille, who has worked at the facility for 13 years. “And I just realized, it is bigger than me.”
Credit: Jenni Girtman
Howell Adams, who has lived in an independent apartment at Canterbury since 2006, applauds the staff for getting the shots.
“It makes me feel safe and protected,” he said. “Makes me feel they care about us, and we care about them, too.”
He’s back to enjoying his favorite activities, including exercising and dining with friends, traveling, and spending time with family.
On a recent afternoon, Adams kept his front door wide open, welcoming neighbors to casually stop by. It’s as if the door wide open is a way to make up for lost time, and a symbol of his life now — full of possibilities.
“As far as I am concerned, the pandemic is over,” he said.
Staff writer Carrie Teegardin and data specialist Eric Fan contributed to this article.
Vaccination rates at Georgia nursing homes
According to new federal data for the week ending June 6, the following nursing homes have 70% of more of staff fully vaccinated.
Northside Gwinnett Extended Care, Lawrenceville, 100%
PruittHealth – Ashburn, 86.42%
Treutlen County Health and Rehab, 82.759%
Kentwood Nursing Facility in August, 78.082%
Heritage Inn of Barnesville, 77.922%
Keysville Nursing Home & Rehab, Blythe, 77.049%
Palemon Gaskins Memorial Nursing Home, Ocilla, 75.758%
PruittHealth – Forsyth, 72.549%
Oaks Health Center at the Marshes of Skidaway Island, Savannah, 72%
Riverside Health and Rehabilitation, Thomaston, 70.37%
Syl-View Health Care Center, Sylvania, 70.313%
Note: The Centers for Medicare & Medicaid Services, a federal agency, announced the requirement for reporting vaccination rates on May 11. Many nursing homes have not yet reported their rates and must report by June 20 or face penalties.