Nursing Home Staffing Crisis Feared To Worsen After Worker Vaccine Mandate

Budgeting for Grafton County has been challenging this year, owing largely to the COVID-19 pandemic, which resulted in more than $1 million in lost revenues for the Grafton County Nursing Home, pictured here. (Courtesy)

After the Centers for Medicare and Medicaid Services on Nov. 4 mandated COVID-19 vaccinations for all eligible staff in nursing homes that receive federal funding, Grafton County officials, already experiencing dire staffing shortages at the county nursing home, are bracing for more losses after the county commission, in a split vote, adopted the policy and mandated vaccinations for GCNH staff.

Without a mandate, the alternative is a possible loss in Medicare and Medicaid funding, which the GCNH, a 135-bed skilled nursing facility that provides long-term care and rehabilitative services to its residents, depends on.

Under the policy adopted by the commission on Nov. 8, unvaccinated nursing home staff are to receive their first shot (Pfizer or Moderna) no later than Dec. 5 and their second no later than Jan. 4, and they must provide proof of vaccination.

Those who decline will be placed on administrative leave without pay and their employment status will be evaluated. They will also be prohibited from entering the nursing home.

Because of the deepening staffing shortages, the GCNH halted admissions of all new residents in September, and county officials are now considering asking sending some current residents to live with their loved ones and reducing nursing facility services.

“The nursing home is presently experiencing an employment crisis that has limited the county’s ability to provide needed residence and elder care to Grafton County’s most needy elderly,” Grafton County Administrator Andrew Dorsett said Thursday. “The county has halted admissions due to staffing issues, which has created strain and bed shortages at local hospitals as beds are being taken by individuals who would normally be put through intake here.”

Active critical vacancies include an assistant dietary supervisor, three full-time dietary aides, two part-time housekeepers, 10.8 full-time equivalent licensed practical nurses, 3.15 full-time equivalent registered nurses, and 16.5 licensed nursing assistants.

“The staff has been under stress and increased duties throughout the pandemic, the shortage of 36 positions for this rural facility has increased the pressure on those remaining staff,” said Dorsett. “The recent CMS vaccine mandate will only exacerbate this existing problem. I am told that at the nursing home alone, we have approximately 40 employees who have chosen not to participate in vaccination.”

It appears that those employees will leave either by their own choice or the county will be forced to separate with them due to their strongly held religious beliefs or underlying health issues, as the rules governing the CMS vaccine mandate seem to restrict those with such exemptions in ways that they can no longer effectively perform their jobs, he said.

“To date, I have been notified that a significant number of the kitchen staff at the Grafton County Nursing Home are planning on leaving due to the mandate,” said Dorsett. “Absent relief from the CMS vaccine mandate, the county has contemplated sending patients to live with their relatives and potentially reducing or discontinuing nursing home services.”

Exemptions under the Nov. 8 Grafton County Commission-adopted policy include a disability as defined under the Americans With Disabilities Act or other medical condition that their health care provider determines would be adversely impacted by the vaccine.

Exemptions can also be issued to those employees with “sincerely held religious beliefs that prohibit them from receiving a vaccine.”

According to a Nov. 4 statement by CMS, the Biden Administration is requiring vaccinations of eligible staff to prevent infection and spread of COVID-19 and to protect staff fighting on the front lines and protect nursing home residents and assure them and their families that they will be safe when seeking care.

According to the minutes from the commission’s Nov. 8 meeting, GCNH Administrator Craig Labore said he is expecting that there will be more requested exemptions from nursing home staff before the Dec. 1 deadline for an exemption, and if one is granted, the employee would have to move to a non-direct care position.

While exemptions are allowed, Dorsett said there are only so many non-direct care positions available and if the GCNH continues to accept CMS funding it will have to reduce or end some services provided because unvaccinated employees will have to be let go.

Any contract employee entering the nursing home must be vaccinated as well, said Labore.

Expressing concerns about the loss of staff, state Sen. Bob Guida, R-Warren, said the county’s obligation is to its residents and that must be the overriding focus and any loss of employees is the greatest risk.

Grafton County Commissioner Wendy Piper said she is not convinced that the loss of employees is the greatest risk to nursing facility operations and said the greatest risk is the loss of its primary funding source, the Medicare and Medicaid funding, the revenue from which is critical to delivering the services the GCNH is mandated to provide.

She said what she is seeing at facilities like Dartmouth-Hitchcock Medical Center and the Merrimack County Nursing Home is that employees are getting the vaccine when faced with an actual job loss.

“Also, as the vaccine mandate is becoming widespread in the health care industry, individuals may be running out of options on where to go for employment,” said Piper.

What would shut down the nursing home is the loss of its main source of revenue, she said.

County Commissioner Linda Lauer, of Bath, said she does not agree with the mandate, but said while losing employees will hurt GCNH operations, the loss of its funding will shut it down.

In addition to the loss of CMS funding that would eventually result from non-compliance, Labore said the nursing home would face thousands of dollars per day in fines if it does not comply.

Piper and Lauer voted in favor of adopting the policy required by CMS.

Dissenting in the 2-1 vote was Count Commissioner Omar Ahern, who said he is unsure why there are concerns about the consequences that can come from non-compliance and he cannot support the policy because it is a violation of basic freedoms.

Labore expressed concern about the exemption status and how it’s granted and said if employees have to be reassigned to non-direct care positions, it will take creative thinking to keep them whole.

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