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A community nursing home with nearly 250 employees achieved 100% COVID-19 vaccine uptake after making shots a condition of employment, and a new case study details how leaders worked to minimize potential impacts on staffing.

The urban provider struggled to get just half of its employees vaccinated against COVID-19 prior to adopting a policy requiring inoculation. The case study conducted by a Philadelphia-based research team examined how the 180-bed, non-profit skilled nursing facility implemented vaccine policies and processes to promote vaccination on its way to a 100% vaccination rate.

The analysis began with the unnamed, non-chain facility’s first federally-sponsored clinic in early January. The provider’s decision to implement came after its first vaccine clinic on Jan. 5, when “it became clear that reaching target vaccination thresholds would be difficult without further intervention.” Staff were informed of the condition of employment, or COE, policy by Feb. 9 and given nearly three months to comply by May 1. 

The nursing home’s leadership conducted a variety of vaccination uptake activities with staff, which included written communication, education sessions and hosting five on-site vaccination clinics for staff. 

University of Pennsylvania-led research team said their findings show the importance of having buy-in from a majority of nursing home staff in driving a successful vaccination policy.

“The inclusion of staff members in decision making and COVID-19 information sharing can increase confidence in both the message and the institution,” lead author Ashley Z. Ritter, Ph.D., and team concluded. “Implementing a COVID-19 COE in nursing homes without acknowledging and addressing relevant underlying concerns could negatively impact patient care via staffing shortages and organizational mistrust among staff.” 

Three employees were exempt from the vaccination policy due to religious or medical exemptions, four employees were on a leave of absence, while a total of 17 employees (6.9%) resigned from their positions. Other providers around the country have also seen minimal job losses after implementing similar mandates. 

Researchers concluded the provider’s early announcement of the policy allowed for planning, conversation and high vaccine uptake among staff — allowing the move to be successful. 

“With nearly three months between the decision to pursue a COE and the COE effective date, both staff and leadership could make future plans. Staff could evaluate other employment options and the nursing home could explore contingency staffing plans,” the authors concluded. “Respectful and frequent face-to-face communication between staff and organization leaders was essential in creating community investment and acceptance of vaccination.” 

The full findings were published in the August edition of the Journal of Post-Acute and Long-Term Care Medicine.