Kevin Lawrence
Kevin Lawrence

Many people might not fully realize what long-term care operators are facing when it comes to whether to require COVID-19 vaccinations as a condition of employment. Here’s a breakdown in simple terms.

First, you can require staff be vaccinated, lose even more staff, lower occupancy to meet staffing requirements, but have more liability protection. Or do not mandate staff vaccinations, keep current staffing levels, keep current census levels, but if a resident or a staff member catches COVID-19, you risk a lawsuit.

The ‘damned if you do’

Staffing shortages were a problem long before the pandemic started, but since 2020, the problem has gotten much worse. The staffing shortage has spread throughout the entire healthcare industry. From clinics to acutes, everyone is hurting.   According to the U.S Bureau of Labor Statistics, nursing home staffing is at approximately 70% of what is needed. These staffing shortages are inhibiting facilities’ ability to accept new patients. 

It has been well documented that occupancy rates are down nationwide. Occupancy levels before the pandemic were around 85%. Based on the most recent data, national occupancy levels are around 71% to 72%. Occupancy levels are at historic lows — not because of a lack of patients, however, but because a lack of staffing is prohibiting many facilities from taking more patients.

According to data from the Centers for Disease Control and Prevention, 45% of nursing home staff are unvaccinated. It is unknown how many nurses will choose to join the unemployment line rather than get vaccinated, but if only 1 in 5 decide to quit, it will cause a 10% reduction in the workforce. Ten percent fewer staff means 10% fewer residents.

I have been in the long-term care industry for nearly 30 years, and in my experience, a facility with a standard patient mix cannot survive on less than 80% occupancy. Facilities made it through 2020 because of the increase in Medicare admissions and Provider Relief Fund payments. Mandating vaccinations will likely cause several good nursing homes to fail. A good number of these facilities will be independent operators and they will be gobbled up by the giant chains. 

The ‘damned if you don’t’

Facilities that decide not to implement or enforce vaccine mandates facing considerable risk. If a resident of a staff member contracts COVID, it is highly likely that the facility will be sued. 

All the other pandemic protocols will be meaningless in the court of public opinion and in the trial. The facility will lose the public relations battle because incidents like these will be front page news, with headlines like “Anti-vaxxer owners chose profits over care.” These same types of accusations also will be told over and over to the jury, resulting in many lost lawsuits and even larger awards. Many independent operators and many chains have gone bankrupt from lawsuits such as this.

Implement vaccine mandates and go bankrupt due to low census, or keep the nursing staff and occupancy you have, but go bankrupt from lawsuits. 

Or in other words: Damned if you do and damned if you don’t. 

Kevin Lawrence is the president of Foster & Lawrence Accountancy Corp, a CPA firm specializing in long-term care cost reporting, financial reporting and reimbursement for more than 20 years.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.