If there’s a team of nursing home policy researchers that has done more to study the effects of the pandemic on the nursing home population and their institutional caregivers than the crew that published a letter in the New England Journal of Medicine Wednesday, let it step forward.
Yet, whether they’re the most prolific or not, is beside the point. They are a part of an academic complex that has, in aggregate, produced a multitude of research about what’s happened to and around long-term care providers, and what should be done.
Wednesday’s letter delivers a very pointed message in its 400 words: The longer that nursing home staff members keep COVID-19 vaccination numbers low, the more people are going to unnecessarily die because of it.
We won’t ask coy questions about the common mission of every long-term care provider, or what it should be. But one can assume it isn’t to hasten the odds of death among the frail charges entrusted to them.
The McGarry-Barnett-Grabowski-Gandhi team that produced the NEJM letter is one of the most distinguished around. Their findings have received wide attention for their stark implications: An estimated 700 people wouldn’t have died had more staff been vaccinated. And that’s over just a two-month study period.
Meanwhile, on another front, the National Investment Center for Seniors Housing & Care revealed this week that occupancy gains stalled out or even retrenched a little after seven months of gains.
Operators, it seems, are stuck in a leaky bucket conundrum. Which should they fear most: That they will lose employees if they mandate vaccinations (as numerous leading care organizations have nonetheless mandated already)? Or should they worry that this week’s research demonstrates that if they don’t create safer workforces, they should resign themselves to losing more residents? There will be more unnecessary COVID-related infections and deaths, and prospective residents may shun facilities where staff don’t care to get vaccines that demonstrably keep everyone safer.
For sure, both staff and residents are needed. Without one, however, you don’t need the other.
Some would call it a classic case of the tail wagging the dog. Some would take it further and call it the tail holding the rest hostage: We work on our terms or we walk. What’s an operator to do? There are no easy answers here. This time it happens to be a threat over vaccines that have been proven beyond any reasonable doubt to make long-term care living areas and workplaces safer. What will the next hold-up(s) be over?
The hope I’ve heard from numerous operators is that staff vaccination rates gradually continue to rise with steady prodding and pressure. Then, when enough are vaccinated, they can tell staff who don’t want to observe one of the most common tenets of healthcare to take a hike. At current rates of progress, however, this could take a very long time.
There are various offshoots of the Hippocratic Oath, which has been practiced by ethical physicians for centuries. One of them is, “Practice two things in your dealings with disease: Either help or do not harm the patient.”
The numbers in this week’s NEJM study say this isn’t always happening, especially without an active vaccination mandate.
“The argument is, if you’re not willing to get vaccinated, you shouldn’t be caring for this population,” lead researcher Brian McGarry, PT, Ph.D., of the University of Rochester, told me while discussing the results. “No nursing home is eager to shed staff. But the first order of business is keeping residents safe, and highly unvaccinated staff coming and going seriously puts that population at risk.”
Put another way, the hostage-takers are winning in many places. Time, as in many such situations, however, could be on the vulnerable individuals’ side. Unless the hostage-takers decide to outright sacrifice those in their care, those vulnerable individuals could emerge in a system that gives them better chances. At least that is the hope.
The alternative to outlasting vaccination holdouts is for operators to resign themselves to offering sub-optimal care, with an eternally leaky bucket. If they think they hear complaints when an elevator is broken or the food is disliked now, imagine how low staff vaccination rates and an unreliable care record are going to play as time wears on.
There’s another way providers may look at it. There’s a common credo among sports referees regarding officials who may “give a wink” or allow undesired activity to continue. The motto is, “That which you permit you promote.” So what is being permitted/promoted here, and at what cost?
These are tough operating conditions, no doubt. That’s a point long-term care providers have contended with for many years — long before vaccination and census woes commandeered center stage so heavily.
But the burdens are liable to get even heavier as new COVID-19 variants threaten patient and public safety, as they are predicted to do. May operators have the resolve and ethical stamina to do everything they can now to help bring this to a timely end.
James M. Berklan is McKnight’s Long-Term Care News Executive Editor.
Opinions expressed in McKnight’s columns are not necessarily those of McKnight’s.