James M. Berklan
James M. Berklan

Results of the annual McKnight’s Mood of the Market survey will soon be released, and some of the findings are going to be eye-opening, to say the least. 

But one thread among them won’t be a shocker: Long-term care administrators, directors of nursing and other key players overwhelmingly feel they are doing meaningful work. Almost to a fault, one might say.

Percentages in the upper 90s show that people are here to make a difference and won’t be easily deterred from their mission. Yet there are limits to that. There are always limits.

Will Wednesday’s White House announcement that COVID-19 vaccinations will be mandated for nursing home employees be a dealbreaker? It depends.

The great suspense is whether the 38% of unvaccinated SNF staff will eventually agree to this new condition of employment for working with frail elders or simply walk off the job. Many will comply, there is no question. But others will head to some less-stringent industry or employer. 

(And let’s be clear that President Biden’s announcement is essentially a condition of employment. If providers don’t like trying to run their business with loads of regulations or staff shortages, that’s nothing compared to trying to cope with the financial hit they would take if Medicaid or Medicare funding were taken away. The latter is virtually undoable.)

As top nursing home lobbyists and McKnights.com commenters have forcefully pointed out, it appears that as it now stands, their patron is setting them up for a fall. While the Centers for Medicare & Medicaid Services is rightly emphasizing that healthcare workers should follow the best currently known healthcare practices, it is also picking on one sector over others.

If one restaurant in town has to mandate its employees wear hair nets in the kitchen and wash their hands before reporting back to work, then all public places serving food to the public should have to as well, right? Oh, wait, that is already the law of the land.

And so it goes with the much more high-profile battle over COVID (and other) vaccinations. If you want to work in healthcare — especially government-funded healthcare — you have to play by the rules. Just create the rules so there’s a level playing field for all involved. 

If a vaccine-adverse nurse, aide or any number of other LTC professionals wants to find work elsewhere, he or she currently has a wide-open door. And possibly a welcome mat in other workplaces.

That needs to change. CMS needs to finish the job. Don’t punch a hole in the bottom of long-term care’s already leaky workforce boat and walk away. 

Punch holes in other healthcare sectors’ boats, too, so the challenge then becomes how to keep them all afloat, collectively.

That’s why the next month or so is going to be very interesting. Just how will CMS craft a workable plan for nursing homes? (And will it expand to hospitals and other settings, as there have been some whispers.) Surely the Baltimore braintrust at CMS headquarters knows the crucial questions ahead of it. It usually does. That’s said with conviction, not sarcasm, for no one could possibly open this can of worms without foreseeing the turmoil it would cause.

Nagging questions

Among the questions choking in LTC operators’ throats: How long do we have to get to 100%? Will 99% do? What will penalties be, and when will they start? What help do we get if many workers quit and we’re already staffing challenged? Will visitors have to be vaccinated, too? 

These questions are all legitimate. If there’s anything that’s struck me over the past few weeks, it is how many readers have written us, frantic that their livelihoods — and their personal missions to deliver good care — could be undermined by a mandate that could make sustaining an already complicated business all but impossible.

We’ve received letters and notes from frontliners who profess their faith in vaccinations but say they simply have nowhere to turn to find new employees, often including managers. As a result, new resident admissions have had to be restricted in some places, which tugs them into a downward spiral. 

These are not anti-vaxers nor political stalwarts agitating just to pick a fight. These are well-intentioned professionals yearning to do a good job. They might not have a couple of years to hope the surrounding potential labor pool will come around to dealing with a new employment reality.

CMS and the administration, the ball is in your court to make this feasible. You are, after all, both sponsor and regulator of this noble industry. 

Make it workable. Make it fair.

Follow Executive Editor James M. Berklan @JimBerklan.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.