Nobody can ever accuse long-term care providers of not being passionate. 

Credit must also be given because they are pretty good teachers.

When this scribe recently asked operators for personal notes about true employee losses they suffered from the mass employee exits that industry leaders predicted for when the mandate deadlines kicked in, the industry responded in force.

Now, the findings. In a nutshell: If you’ve heard about the challenges and triumphs of one provider’s experience with the mandate, you’ve heard about one provider’s experiences.

(The industry, of course, did not collapse, as providers creatively have worked with and around the mandate.)

The struggles, workarounds and, yes, successes, are as varied as the different configurations of nursing facilities from coast to coast.

I also learned once again that dedication runs true and providers take advantage of every opportunity they can to stay in business, whether it means granting plenty of exemptions or doing just the opposite.

Take, for example, the small North Carolina operator who wrote to me that if it had not been for the opportunity to offer religious exemptions, the small facility he runs would have had to close. An eye-popping 40%-plus received an exemption, he confided. 

He understandably chafed at the federal edict that unvaccinated employees had to wear an N95 mask, and others surgical versions, despite a 1% infection rate in the county. He was not the only one to blame “political pressure” for the predicament.

Then, there was the Iowa operator who said her business office and 20% of the CNA crop wouldn’t be around if not for the exemptions allowed. Although her clinical colleagues might tend to disagree, she claimed that masking makes no difference in transmission rates, reminding that the long-term care profession is not a homogenous club.

A human resources manager from Wisconsin vented in a 1,000-word email. She masks in public, shops at low-traffic times, has not traveled during the pandemic and has stayed COVID-free throughout. She says she’s glad to do it for the sake of her patients’ health and feels great after following various Centers for Disease Control and Prevention recommendations.

But she still balks at shots.

“I do not qualify under a medical exemption and I will not lie and say I have a fake religious exemption. These are all fake as the claims they base this on are not scientifically valid anyway,” she asserted. 

Faced with either leaving the profession she’s passionate about or getting a shot, however, she wound up doing the latter. But she says she will not get a booster.

Oh, the job losses due to the mandate? Just two nurse aides, but leaving a short staff even shorter.

Capacity shrinking

The director of a “good,” progressive nonprofit nursing center in rural Michigan wrote to me say staffing is so impossible, it has closed three of its units and is struggling to keep four others open. 

“I want to be clear that I personally support COVID-19 vaccination and am up-to-date on my vaccinations,” she explained. “That is not the case for many in our community and surrounding areas. I see both sides of the coin and am conflicted with my thoughts on the mandated vaccination. It depends on the day and the moment. Right now, I resent it.”

Some 13% of the 167 staff have left due to the mandates since November 2021. There are no nurse aide or nurse applications to consider, she added somberly. More than half of the 14 applications for waivers were turned down, she explained. Most were filed on religious grounds at the last moment.

A Massachusetts provider proudly reported just two of his 200 employees fled rather than get inoculated. One, however, was a veteran manager and “We continue to struggle to hire staff, so any loss of a valued team member is problematic.”

Then there’s the Kansas operator whose campus has a strong religious affiliation so vaccines, mask-wearing and other safety measures are not followed. Fully one-fourth of the employees (32) have exemptions. Without them, the doors would be closed. As it is, the work roster has dropped by 23%. Capacity has been lowered by one-third due to staffing shortages.

A Virginia note-writer painted a recurring theme: “Only 1 or 2” employees were lost due to the vaccine mandate, but 25 — some 36% of staff — had been granted exemptions. Most would have left without them, he feels.

Pennsylvania was represented by the operator who said only one of 200 employees left due to the mandate. All others were vaccinated or given a waiver.

Mandate improved staff levels?

Another Iowa operator gave a clearly bullish view of the staff mandate. Some: 57 of 59 employees were vaccinated.

“The mandate may have saved some staff,” he told me. “If we didn’t have such a great response, some would have quit because of the danger non-vaccinated employees present.”

Hard hit rural Maine also was heard from. 

“Fortunately, we had staff who either had been vaccinated or had gotten medical exemptions.   We went from 24 staff members to 18 and holding, with bated breath, not to lose anymore,” she wrote me. 

Because it’s “near impossible to find replacement staff,” she is seriously contemplating dissolving the company. New admissions were not being accepted due to staff shortages. Merging with or selling to another nonprofit is not even possible, she believes.

She is hoping for changes at the regulatory level that will allow more employee recognition of “natural immunity” and testing in lieu of vaccinations. 

There was 100% vaccination and no departures as the vaccine mandate deadlines arrived for a secluded, small Massachusetts facility owner and operator who rang in.

“We fully support the mandate and believe that well-run facilities with healthy management-staff relationships can get through this without a crisis,” the provider wrote.

Then he hit upon a line of thinking that many embrace. And he concluded with a management thought is invariably true — in any era. Yet many providers, from virtually every kind of business or political background, realize they would not be able to achieve this type of operating nirvana, for various reasons. Whether that’s reason to preclude them from continuing to do business, or accepting certain government funding, can be debated until well past the time the cows come home.

“Those staff unwilling to do what’s best for their residents probably shouldn’t be in this industry to begin with,” the 100% vaccinated operator observed. “And management that doesn’t have the trust of their staff probably have turnover anyway.”

A final lesson, deftly delivered from the diverse teaching corps otherwise known as the impassioned pool of long-term care providers wrangling with the federal COVID-19 staff vaccination mandate.

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.