Most Virginia hospitals and nursing homes aren't mandating COVID-19 vaccines for their employees - Virginia Hospital Center

Most Virginia hospitals and nursing homes aren’t mandating
COVID-19 vaccines for their employees

‘Underlying reluctance is more likely due to how it’s going to affect staffing’
BY: KATE MASTERS - AUGUST 18, 2021

                                                     For the third time in just over a year, Ballad
                                                     Health is suspending many of its elective
                                                     surgeries, citing a new surge of coronavirus cases
                                                     that have left its hospitals overwhelmed.

                                                     As serious infections have risen across the region,
                                                     driven by low immunization rates and the
                                                     aggressive Delta variant, the system’s
                                                     administrators have begged more residents to get
Physicians with the Carilion Clinic in Roanoke       vaccinated. But so far, Ballad — which serves
wear enhanced personal protective equipment
                                                     much of southwestern Virginia and northeastern
inside the health system’s facilities (Photo
courtesy of the Carilion Clinic).
                                                     Tennessee — has avoided requiring the shots for
                                                     its own workers.

“Of course we have encouraged it from the beginning in December when they became
available,” said Lisa Smithgall, the health system’s chief nursing executive. “And we
continue to foster communication on an ongoing basis. But as of today, we don’t have a
vaccine mandate for our team members.”

Ballad is far from alone. While some major hospital systems in Virginia have introduced
employee vaccine requirements — including Inova in Northern Virginia, VCU Health in
Richmond and Valley Health in the northwestern corner of the state — the majority of
Virginia’s roughly 27 health systems are not currently mandating vaccinations for their
employees. Those include major players such as Sentara, HCA and Bon Secours, which
together operate more than two dozen hospitals across the state.

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                                                    their-employees/

Bon Secours St. Mary’s Hospital, Richmond, Va. (Parker Michels-Boyce/ For The Virginia Mercury)

The same is true for many of Virginia’s long-term care facilities, which account for
nearly 30 percent of outbreaks and roughly 36 percent of all COVID-19 deaths, according
to data from the state Department of Health. Neither LeadingAge Virginia nor the
Virginia Health Care Association-Virginia Center for Assisted Living, which represent
hundreds of nursing homes and assisted living facilities across the state, could say how
many of their members have adopted the policies.

But Dr. Jim Wright, the medical director for Westminster Canterbury and Our Lady of
Hope in Richmond, said employee vaccine requirements are still rare throughout much of
the industry

“In conversations with other medical directors, vaccine mandates are definitely in the
minority in nursing homes in Virginia,” he said. “Westminster Canterbury, for example,
is one of the only facilities I’ve heard of recently that has put that requirement in place.”

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The holdout among health care providers has become a point of puzzlement and
sometimes frustration as mandates become more common across the state, spurred by
lingering resistance and grim warnings of future surges.

Nationwide, at least 30 percent of hospitals have required vaccinations as a condition of
employment, according to the industry publication Becker’s Hospital Review.

So far, Gov. Ralph Northam has stopped short of a statewide mandate for health care
workers — policies that have been enacted in California, New York, Maine,
Pennsylvania and New Jersey. But he did encourage private businesses to follow his lead
earlier this month when he announced vaccination and testing requirements for roughly
122,000 state employees.

Last week, Democratic gubernatorial candidate Terry McAuliffe also called on health
systems to mandate the shots, describing it as a vital step to ending the pandemic.

“The only way we’re going to end this pandemic and keep our economy strong is by
getting every eligible Virginian vaccinated as quickly as possible,” he said during a
campaign stop at Inova. “Leadership on this issue is critical.”

On Wednesday, President Joe Biden announced that nursing homes will be required to
ensure their staffers are vaccinated against COVID-19, or risk losing federal Medicare
and Medicaid dollars. The U.S. Department of Health and Human Services will develop
regulations to require vaccinations of nursing home staffers as a condition of participating
in Medicare and Medicaid programs.

“I’m using the power of the federal government as a payer of health care costs to ensure
we reduce those risks for our most vulnerable seniors,” Biden said during a news
conference detailing new federal actions. “If you visit, live or work in a nursing home,
you should not be at a high risk of contracting COVID from unvaccinated employees.”

The nursing home vaccination requirement will apply to staffers in 15,000 facilities,
which employ approximately 1.3 million workers and serve approximately 1.6 million
residents, according to the White House.
‘How it’s going to affect staffing’
Encouraging vaccinations has become a familiar refrain for officials and professional
associations across the state, virtually all of which — including LeadingAge, VHCA-
VCAL, and the Virginia Hospital and Healthcare Association — have at least “voiced
support” for employers that implement the policies.

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But without a mandate or increased political pressure, some experts say health systems
will remain reluctant to implement what they view as a risky policy decision.

Much of that risk can be traced to long-running concerns over the availability of qualified
workers. Even before the COVID-19 pandemic, Virginia was projecting shortages of
doctors, nurses and other health care professionals.

Nursing staff have been a concern for hospitals in particular, which are anticipating
growing numbers of high-needs patients as the general population grows older. At the
same time, more and more nurses are nearing retirement age.

(Getty Images)

“COVID has accelerated those types of things because we’ve seen all that happen in a
short period of time,” Baker said. The ongoing pandemic has led to increased
burnout among nurses and other health care providers, leading some to leave the field or
reduce their hours in frontline care. At the same time, there’s never been more
competition for qualified workers, according to Smithgall.

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“Hospitals are no longer the primary employment area,” she said. “There are lots of
different avenues — in outpatient surgery, in physician practices, in freestanding centers
— and a lot of those positions are Monday through Friday and day shifts.” Worker
shortages can vary by region, but Ballad currently has more than 500 open nursing
positions across its 21 hospitals. Many of those slots are currently backfilled by more
costly contract workers.

At the same time, roughly 37 percent of the system’s total workforce remains
unvaccinated (though rates are closer to 100 percent for what Smithgall described as
“advanced practice providers,” including doctors, nurse practitioners, and physician
assistants). Ballad has been forthcoming that its hesitation to adopt a vaccine requirement
is largely based on its fear of losing employees. The same is true in the long-term care
industry, though many administrators have said they’re waiting on full approval of the
vaccines by the U.S. Food and Drug Administration, according to Wright.

“I have to say that the underlying reluctance is more likely due to how it’s going to affect
staffing,” he said. A little more than 68 percent of nursing home employees are
vaccinated across Virginia, according to data from the U.S. Centers for Medicare and
Medicaid Services. But Wright said nursing homes are also seeing disparities between
more advanced providers — such as doctors and registered nurses — and those with
fewer credentials, including non-clinical staff and certified nurse aides.

Those positions, though, are also low-paid, even though CNAs often provide the bulk of
daily patient care. That means nursing homes are often facing competition from other
industries, including retail and food service.

“The challenges we’ve had before with staffing are compounded by how complex and
risky it is to work in nursing homes,” Wright said. “And if you can make about the same
or even a little bit more working at Target, it’s going to be very tempting.”

As cases continue to rise across Virginia, though, there’s growing skepticism that fears
among health care employers are grounded in reality. While some workers have protested
vaccine mandates — including nurses at Valley Health, one of the state’s earliest
adopters of immunization and testing requirements — courts across the country have
upheld the mandates. The U.S. Equal Employment Opportunity Commission also
updated its guidelines in May to specify that companies can require vaccines for
employees physically coming into work, Becker’s reported.

And so far, the mandates that have been implemented haven’t led to a mass exodus of
staff. As of last week, 76 percent of Valley employees were vaccinated, and attendance
has been dwindling at protests after an initial event in July, said Dr. Jeffrey Feit, the
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system’s community health officer. Melissa Andrews, the CEO of LeadingAge Virginia,
said she’s heard of facilities that have lost anywhere from one to eight employees out of
hundreds after implementing a vaccine requirement.

The risk could be higher for systems in regions with overall low vaccination rates, said
Paul Ginsburg, the director of public policy at the University of Southern California’s
Schaeffer Center for Health Policy and Economics.

“They’re the ones whose capacity is under stress, so they’re least in a position to afford
the loss of employees,” he said. “And they’re also in areas where they might get higher
rates of workers leaving, so I think it’s a real issue.” While vaccination rates at Ballad,
for example, are still hovering around 63 percent, uptake is far higher at other facilities
that have also hesitated to adopt the requirements. That includes the more urban Virginia
Hospital Center in Arlington, where about 85 percent of employees are fully vaccinated,
according to spokeswoman Maryanne Boster.

For hospitals that have implemented mandates, though, those concerns are far
outweighed by other risks. There’s growing evidence that even fully immunized
individuals can catch and transmit COVID-19 (though the risk is far greater among the
unvaccinated). Nationally, there are reports that unvaccinated employees are driving new
outbreaks at nursing homes.

There’s currently little data on whether vaccination rates among Virginia health care
providers have contributed to new outbreaks or infections. The Virginia Department of
Health stopped reporting facility-specific outbreaks on July 1, citing the end of the
governor’s state of emergency. The agency plans to resume that reporting “in the coming
days,” according to spokesman Logan Anderson.

But the state also hasn’t been collecting or publicizing data on vaccine uptake in health
care settings. When the Mercury requested more information, a VDH spokeswoman
referred back to the Virginia Hospital and Healthcare Association, a lobbying group for
the industry. Immunize Virginia, a nonprofit coalition of medical and public health
stakeholders, surveyed health care workers in December on their attitudes toward
vaccination. But the [resulting data] only included 515 respondents and skewed heavily
toward doctors and White providers. It hasn’t been updated since then, according to the
coalition.

Some states are publicly reporting similar data, including Maryland, which recently
ranked its nursing homes by staff vaccination rates. Dr. Christian Bergman, a geriatrician
at VCU Health’s Center for Advanced Health Management, said public pressure is likely
one of the only ways to drive wide-scale mandates.
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VCU Emergency hospital entrance in Richmond, Va. (Parker Michels-Boyce/ For The Virginia Mercury)

“There’s a sense of burnout on the ground about vaccine education,” he said. “We’ve
thrown the kitchen sink at this issue only to not move the needle very much in the last
three months.”

Stagnating vaccination rates across VCU Health contributed to its decision to launch
its own employee requirements earlier this month. Just a few months earlier, in mid-
December, more than 130 employees had tested positive for COVID-19 in the same
week. The system’s CEO, Dr. Art Kellermann, said many of those were linked to
unvaccinated employees interacting outside patient care settings — in break rooms and
other communal spaces.

“Frankly, we had to make the decision: if we have another wave of infections, are we
comfortable losing many of our team members to illness?” he said. “And I’m concerned
if we get there — and it’s almost more likely to be ‘when’ than ‘if’ — there aren’t going
to be a lot of options to bring people in from elsewhere. Everywhere is going to be
challenged.”

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