Health care worker vaccination requirement could have biggest impact on nursing homes

Nov. 6—Local health care employees will be required to have a COVID-19 vaccine by Jan. 4, according to details published Thursday by the Biden administration.

Many health care organizations including the major hospitals in the region — Dayton Children's, Kettering Health and Premier Health — already were implementing vaccination policies.

One of the biggest impacts could be on local nursing homes. The facilities are both home to some of the most vulnerable residents and had health staff vaccination rates hovering around 56% as of September in Ohio after inching up for several months.

Nursing home residents overall have high vaccination rates. But then cases recently surged in the community, exploited asymptomatic carriers and unvaccinated contacts, and still got into some facilities.

About two out of every 1,000 Ohio nursing home residents died of COVID-19 from mid August to mid September, according to AARP. That's still muted by vaccines from the height of over 33 deaths per 1,000 but also about five times as high as the summer lull.

"We want to advocate for as few risks as possible for nursing home residents and having a vaccine mandate is another way of making sure they're protected," said Chip Wilkins, Dayton-area long term care ombudsman, who advocates for the rights of residents.

The industry is also already plagued by high turnover of direct care staff. One of the key issues Wilkins advocates on is problems related staffing shortages, and he is also concerned about whether the rule will mean more staffing shortages.

"Regardless of mandates, staffing is already an issue. I can't imagine what's going to happen come January for that. That's the one unknown that is concerning for all of us," Wilkins said.

While the big Dayton hospitals already have mandates, some of the hospitals around the edge of the region such as Wayne Healthcare in Greenville, Wilson Health Network in Sidney, and Grand Lake Health System in St. Mary's area will all be impacted.

Sarah Hackenbracht, president and CEO of the Greater Dayton Area Hospital Association, noted under federal rules there's no exemption for testing or antibodies from a previous infection. There are medical and religious exemptions.

"The goal is to help more people get vaccinated so that we come out on the other side of the global pandemic," she said.

Nursing homes, assisted living facilities and other long-term care homes are still recovering from an early fall surge that's now in the downswing.

The latest round of Ohio COVID-19 nursing home data shows that deaths, worker cases, and worker shortages all increased from July to September, before community cases started to fall.

For the four weeks before Sept. 19, Ohio nursing home resident cases increased from 6 to 19.2 per 1,000 residents, and reported new staff cases increased from 12 to nearly 30 per 1,000 residents, according to the latest data from AARP's Nursing Home COVID-19 Dashboard, created with the Scripps Gerontology Center at Miami University.

Cases of COVID-19 usually reflect the community's COVID status, said ProMedica Senior Care spokeswoman Julie Beckert said.

"However, with availability of the vaccine and now the booster, testing, daily monitoring and our infection control protocols, we feel the risk of spread has been greatly reduced in our facilities and the impact of the virus has lessened," Beckert said.

In Ohio, vaccination rates among nursing home residents and staff grew to 81.7% of residents.

Schwartz had said a long-term care provider in the Dayton area shared that with residents and many visitors being vaccinated, "there was a false sense of security before the Delta variant became more widely known as the cause of many breakthrough cases." Resident cases at the facility began to be linked to non-symptomatic visitors.

"The provider shared that it took a lot of work to ensure any positive test results among visitors within 14 days of visiting the facility were reported to them so they could take proper precautions with residents and staff. Eventually, all visitors, were required to wear N95s to help mitigate the chances of breakthrough cases," he said.

At Otterbein, one of the largest long term care nonprofits in the region, about 70% of employees have been fully vaccinated and majority also have a booster. Otterbein has about 3,000 residents and 1,600 employees.

"The number would be higher but for two issues — it includes all employees, including maintenance and others that aren't resident facing," said Gary Horning, VP of marketing and communications, earlier in the week prior to the federal announcement. "And more importantly there are still a couple of rural Ohio counties where the communities remain resistant to the vaccine, and Otterbein employees often align with the local community.

At Otterbein Lebanon, the flagship location with about 1,250 residents and employees, the vaccination rate among residents is 90% and among employees just under 80%, both apparently higher than the local community, he said.

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