Credit: valentinrussanov/Getty Images
Credit: valentinrussanov/Getty Images

Leaders in Pennsylvania are sounding the alarm about a municipal COVID-19 vaccine mandate for frontline workers that is expected to kick in Friday.

The Pennsylvania Health Care Association on Tuesday sent a letter to Philadelphia’s acting health commissioner, asking for an extension and warning that an estimated 25% of the roughly 9,500 nursing home employees working in the city could be terminated upon the Oct. 15 deadline.

Philadelphia is among several cities and states to adopt their own mandates ahead of federal rule for healthcare workers that is expected later this month. Fast-approaching deadlines may trigger an avalanche of firings and resignations, leaving providers grappling with staffing shortages that have already caused many to limit admissions.

Some providers, including those in Maine, have received a reprieve in response to dire staffing shortages. Philadelphia operators may not be so fortunate. Officials have so far denied the request, saying staff still have an opportunity to get vaccinated.

On Tuesday, Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, asked the city to consider how it “will support its vulnerable residents” if mass terminations happen.

“Without those caregivers — our healthcare heroes — facilities simply cannot provide care,” he wrote. “The city may reach its vaccination goal, but this loss of staff could force resident discharges, facility mergers or even closures.”

Cities and states, coast to coast

Philadelphia’s mandate has already been extended once, giving nursing home and hospital staff more time to get fully vaccinated. Anyone who receives a first dose by Oct. 15 has until Nov. 15 to finish the series as needed. They must show proof of a follow-up appointment, be tested for COVID twice-weekly and double mask or use a KN95 respirator during that period.

In addition to another delay, Pennsylvania nursing homes are asking the city to provide a testing or other alternative to vaccination moving forward.

But top health official Cheryl Bettigole said Tuesday night that she would not grant an extension, and declined to address plans for mass workforce losses.

“We know from evidence in Philadelphia and from other states that mandates are very effective at increasing vaccination rates,” Bettigole said in a response to the nursing home association cited by the Philadelphia Inquirer.

For now, operators who can’t get 100% compliance will either have to let highly needed staff go or face penalties of up to $2,000 per violation, per day, depending on the severity of the failure and the level of risk to patients, staff and the public.  

Officials in other states have promised support as mandates went into effect.

In New York, for instance, the governor offered to send in the National Guard if buildings found themselves woefully understaffed after that state’s Sept. 27 deadline. But Stephen Hanse, president of the New York Health Care Facilities Association, said Wednesday that he is unaware of any short-staffed facilities that have been able to tap that resource.

San Francisco was one of the first U.S. cities to require vaccination of employees in high-risk settings, including nursing homes, hospitals and jails. The city is now mandating shots for city contractors who may work alongside staff in nursing homes, too.

But San Francisco is one of the most highly vaccinated cities in the U.S., with 80% of residents 12 and older having had at least one shot. That means workers, at least those who live in the city, are more likely to have been vaccinated than in some other cities and states.

Statewide, California nursing home workers have the third-highest vaccination rate in the country at 88.47%, according to the Centers for Medicare & Medicaid Services.

Needed lifelines?

In Maine, the worker vaccination figure is now up to 83.49% with some enforcement of a mandate to begin Oct. 29, nearly a month later than initially expected. The state saw a rash of facility closures in the fall in rural areas, several of them attributed to staffing issues exacerbated by vaccine requirements.

The state said early this month the change should allow more time for residential care and hospital workers to become vaccinated and for the state to distribute $146 million in new aid to address recruitment and retention efforts and maintain capacity.

The Maine Health Care Association welcomed that extension, according to President and CEO Angela Cole Westhoff. Wednesday, the state responded to stakeholder suggestions and said it will use enforcement discretion for a “time-limited period” at facilities during the transition to the new rule in November.

“This will allow healthcare facilities to hire new employees who have at least had a first dose of an authorized COVID-19 vaccine prior to the employee’s start date,” Westhoff said in an email to McKnight’s Long-Term Care News. “This is conditional on the employer ensuring that the employee uses proper PPE and is tested at least weekly until the employee is fully vaccinated.”

Back in Philadelphia, there looks to be no such lifeline coming. Shamberg pointed out that even temporary staffing agencies are avoiding assignments in the city to avoid the mandate, “leaving providers with nowhere to turn for assistance.”