James M. Berklan

Ask a dozen industry experts what they think of nursing home operators’ pledge to get 75% of their staff members vaccinated against COVID-19 by June 30 and you’ll get about a dozen different opinions. Take my word for it.

One thing they’re unified about, however, is that it is a laudable goal. Of that there is no disagreement.

But beyond that back-patting, one has to ponder what the effect of coming up short could mean. The task at hand is essentially doubling the overall staffing vaccination rate in what will be a four-month period.

In setting that target, providers may have unintentionally slapped a bull’s eye on their own backs.

Already, we have seen numerous instances of lawmakers, patient advocates and certainly plaintiffs’ lawyers looking to heap blame on nursing home operators. (Yes, it is interesting that the aforementioned likely have spent the overwhelming majority of their pandemic days as safe as they choose at home or in spartan offices, not in the most dangerous places to be during this global pandemic. But I digress.)

So what if the 75% level isn’t met? By most guesses the vaccination rate is now closer to 50%, compared to 37% a month ago. But no one is certain, and things like the jarring halt to J&J vaccinations this week don’t figure to help persuade the many undecideds. Any more hiccups like that, and the momentum built to this point can be kissed good-bye.

As it is, many employees who were finally leaning toward getting the jab because J&J requires only one could be put off, especially if they were of the mind that the vaccines were developed “too fast.” A Johns Hopkins leader countered Thursday, however, that the pause is a good sign: It shows that even incredibly small risks are being taken seriously. 

But “never spook the already skittish” could be the cautionary theme of this one.

Keep the juice flowing

Leaders clearly must figure out ways to keep vaccines available for new staff and new residents after the federal free clinics are completed. States can help matters by allowing facilities to order doses through their long-term care pharmacies, as Massachusetts recently started doing. If they don’t, vaccinated percentages could actually drop due to staff and patient turnover.

Staff distrust of management in many places is another cultural force that needs to be overcome, and that could take a lot longer than 10 weeks.

Another danger is that the 75% goal was set just before the British COVID-19 variant started to spread around the US, along with flare-ups of other variants. Worse, could there be an even bigger one out there?

On top of that, pockets such as parts of Michigan have started to see significant upticks in infections this week. Outside community rates have always been affiliated with higher facility rates.

“As with all things COVID, the landscape shifts even as we speak,” one somber leader reminded me Thursday. 

At least it appears that operators are learning what works. They have refined approaches, listened more to skeptical staff and nudged numbers up via incentive-giving and appeals to integrity and sense of right. They also have promoted the #GetVaccinated campaign, which is rich with resources. There is something, too, to be said for the bandwagon appeal.

The end of this rainbow could wind up with mandates to get vaccinated. There are numerous signs that providers, both inside and outside long-term care, are poised to start mandating employee shots — once the Food and Drug Administration takes the  Emergency Use Authorization (EUA) label off of the vaccines.

Will that happen soon enough to make a difference? No one knows. The heck of it is, even then, how many already short-staffed buildings will be willing to lose more workers via self-imposed vaccine mandates? It’s a Gordian knot.

As I’ve written before, however, vaccine mandates have existed for many years with regular flu shots. If an employee isn’t granted an exemption due to medical, religious or other allowable reasons, he or she can still work — under layers of mandatory personal protective equipment.

My sense is that this is going to be a very close race to 75%, and it might come down to whose bean counter is doing the tabulating.

But regardless of what happens, there’s one thing nursing home leaders can hold their heads high about: At least they can’t be accused of sandbagging and setting artificially low expectations.

Follow Executive Editor James M. Berklan @JimBerklan.