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It’s all hands on deck as long-term care operators quickly develop implementation plans to comply with the new federal COVID-19 vaccination rule for workers with the first deadline just over three weeks away.  

The long-awaited rule, which was unveiled last week, applies to all Medicare- and Medicaid-certified providers and facilities and sets a Jan. 4, 2022, deadline for all eligible staff to be fully vaccinated against COVID-19. It also requires that facilities establish a policy ensuring all workers have received the first dose of a two-dose regimen or a one-dose vaccine prior to providing any care, treatment or services on Dec. 5, 2021.  

It allows for exemptions for medical conditions or religious beliefs, observances or practices. Facilities will be required to develop a plan for permitting these exemptions that align with the rule.  

It takes a village

The Evangelical Lutheran Good Samaritan Society, the nation’s second largest non-profit provider of senior care services, was among the first large skilled nursing organizations to announce a mandate back in July.

Staff at 142 nursing homes were required to complete their vaccination series effective Nov. 1 or face potential termination. Instead of firing workers in a razor-thin employment market, Good Sam has removed unvaccinated, non-exempt employees from its schedules for up to 60 days so they can consider again whether they will get immunized. 

“We’re nine days into it, and we’ve got less than 2% suspended,” Chief Medical Officer Gregory Johnson told McKnight’s Tuesday. “It took somewhat of a village when you consider the employee relations piece of it, the human resources pieces, the legal and communications pieces.”

Gregory Johnson, M.D.

South Dakota-based Good Sam merged with Sanford Health in 2019, and the hospital system shared resources that eased the development of vaccine-related policies for its skilled nursing facilities, Johnson said. In addition to the above departments, Johnson said the organizations also relied on input from its clinical and educational staff and IT teams before announcing its internal policy. 

While many of the early discussions were about value-setting and hypothetical scenarios, the organization also needed to assess its practical capabilities and consider additional resources it might need to buy or build.

“If you’re an individual operator, there’s a whole lot of work to be done around tracking and regulation,” Johnson noted. Adding new tools to an enterprise software program made it easier to know which staff members had been vaccinated and when — and provided a central place to store vaccination cards that can later be shared with surveyors if required.

Good Sam’s policy provides for both religious and medical exemptions, as does the CMS rule. Johnson said creating a consistent way of approaching requests for exemptions was critical in ensuring fairness and legitimacy. Good Sam created a centralized portal through which staff could submit their requests, and they were then vetted by a non-biased, off-site group using a standard rubric.

It’s critical that the policy and its implementation is “irreproachable,” Johnson added, because “people can begin to split hairs about what counts.” The organization settled on a policy that tries “to neither be stringent nor punitive” about exemptions.

Johnson said outside of any given policy, the most effective tool in his organization’s approach to the vaccine mandate was to continue to talk with staff before the mandate was announced through its effective date (and beyond). He, Good Sam’s chief nursing officer and other clinical staff took a listening tour of facilities from Florida to Arizona and through the Upper Midwest to address questions and concerns.

“We understood and wanted to respect the needs and values of the individual (unvaccinated staff member), but we, to some degree, came representing the other staff and the residents,” Johnson said. “The spirit of our listening tour was what we then tried to impart into all of this work.”

‘Top-down’ approach 

“It’ll be interesting to see what happens over the next couple of weeks in terms of the number of [exemption requests made and vaccinations completed],” Francis Kirley, owner, president and CEO of Nexion Health, told McKnight’s Long-Term Care News on Wednesday. 

Headshot of Francis Kirley, Nexion Health's President & CEO
Nexion Health President & CEO Francis Kirley,

Nexion Health, a Maryland-based operator with 42 skilled nursing and rehabilitation and more than 4,300 employees, is taking a “top-down approach” when it comes to ensuring each of its facilities is compliant with the regulation ahead of the deadlines. Kirley said that from the start the company wanted to ensure it was well prepared to meet any requirements and that started with the executive leadership team, human resources department and in-house attorneys to develop and establish related policies. 

Kirley said company leaders, along with its administrators, regional vice presidents of operations and clinical vice presidents, all participated in a “very open and dynamic conversation” earlier this week to go through every single component of the rule, answer any questions and establish the company’s expectations moving forward. 

“We basically articulated that this is what has to occur in our facilities in order to be compliant,” he said. “We have an amazing group of leaders in our facilities who understand it, who will own it and who will follow through with it [Nexion’s vaccine-related policies].” 

“Then, we shared with them the process for requesting a medical and a religious exemption. We designed a specific communication tool to [make sure] those requests are sent to our [HR] department and they will process those as quickly and timely as possible,” he added. 

On the medical side, Nexion’s medical directors are managing those requests — with employees being encouraged to immediately start making doctor appointments if they desire a medical exemption to the policy. 

Kirley expressed confidence in Nexion’s facility leaders to ensure their buildings are compliant come deadline time. Overall, the company has about a 68% vaccination rate among facility staff and a 99% rate among corporate and field staff. Fewer than 10 employees have voluntarily resigned due the vaccination mandate, and it has not terminated anyone, he added. 

“We internally have a good, effective strategy. It’s transparent, it’s not complicated,” he said. “People have to make their own decisions about what’s important to them but we’re trying to facilitate that vaccinations are the best solution, the most timely solution, but there are some [other] options.”