How the federal vaccine mandate may effect assisted living facilities

Vincent Marshall
Dodge City Daily Globe
The Shepherd's Center in Cimarron is one of many rural nursing home and assisted living facilities being hit with staff shortages due to the federal COVID-19 vaccine mandate.

The time of how the federal vaccine mandate for COVID-19 will effect area nursing homes and assisted living facilities is fast approaching.

According to the Centers for Medicare & Medicaid Services in a Nov. 9 press release, "Facilities covered by this regulation must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services by Dec. 6. All eligible staff must have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna or one dose of Johnson & Johnson – by Jan. 4, 2022. The regulation also provides for exemptions based on recognized medical conditions or religious beliefs, observances, or practices. Facilities must develop a similar process or plan for permitting exemptions in alignment with federal law."

The ruling is regarding President Joe Biden's administration  requiring COVID-19 vaccinations of all eligible staff at health care facilities that participate in the Medicare and Medicaid programs. With the goal being, according to CMS, to protect frontline workers fighting the virus to better protect individuals and families seeking care.

For local and rural nursing home administrators, the mandate has opened up a whole other issue they are fighting: keeping their facilities fully staffed.

In Cimarron, according to The Shepherd's Center administrator Tabitha Rincon, all employees, vendors, contractors, are having to be vaccinated but not residents or visitors coming into the home.

"If doing the 2-series vaccination — the first one will have to be by or on Dec. 4 and fully vaccinated by Jan. 4, 2022," said Rincon.

The Shepherd's Center, according to Rincon, is different than more traditional homes. Built in Nov. 16, 2016, with 14 rooms and a open kitchen and dining room on both its north and south sides, there are no other hallways for foot traffic.

"So I like to be able to staff on each side, the south a CMA and CNA," Rincon said, "north is nurse and aide, which I like to have an extra aide to take the nurse out of the equation."

Rincon gave a breakdown of the staff scheduling over the Shepherd's Center 12-hour shifts.

The 12-hour shift runs 6 a.m. to 6 p.m, with one night aide working 10 p.m. to 6 a.m. For the 6 to 10 p.m. shift, it's covered by a high school student with a college student working 2 to 10 p.m.

The night shift runs from 10 p.m. to 6 a.m. with a nurse on the north side and an aide on the south side.

"(I) would like to have an extra aide on night shift," said Rincon. "These are bare minimums right now. I am a 28-bed facility and right now I have 23 residents and I cannot admit anyone yet until I know what staff is going to do."

Currently The Shepherd's Center has 15 unvaccinated workers out of 35, which includes all nursing, dietary, office, and HSKP/laundry departments.

"I will have to get creative if I lose a lot," said Rincon.

When asked what some of the reasoning is for employees choosing not get vaccinated, Rincon said it depends on the individual.

"A lot of them is because they are seeing individuals fully vaccinated and still dying or getting sick," said Rincon. "There is no consistency with the vaccine — why are people having reactions from the shot and still getting COVID?

"I understand it is supposed to lower the symptoms but individuals are still dying. I have a staff member that has had bad side effects, an upper state lady informed me that she now has a blood clot behind her knee. The fear of the unknown, and yes people will say 'Well, you get in a car everyday not knowing' and yes but I personally made that choice, I wasn’t made to do it."

Rincon reiterated she is not against vaccines as long as they work and have been studied long enough but feels there is still a lot of misinformation out there and that it should come to an individuals choice.

"I feel like it should be a choice to take the vaccine," Rincon said. "Just like the flu, health care workers should take it but they also have a choice — take a flu shot or wear a mask. It is not the healthcare workers that are the main spreader. I do understand why people would think that but while at work, we are testing regularly and wear our PPE. Some of the vaccinated individuals do not have symptoms which is scary."

As the mandate deadline gets closer, fear of the unknown and fear of what could happen next has Rincon the most concerned if The Shepherd's Center is not fully-staffed.

"Worst case scenario, we would have to close," Rincon said. "I feel we can make it but it will be some adjustments, for example, lowering our bed count, maybe closing a side.

"There are options but not very good ones and (I) would like to add, What happens to the residents if facilities are having to close? What kind of quality of care are they getting? Are we forgetting about them and the care, the quality of life they should be getting?"

At the Hill Top House in Bucklin, according to administrator Judy Kregar, the leadership at the facility is not in favor of the mandate, however, the facility must have the funds received from Medicare and Medicaid to operate.

On Thursday, Nov. 11, Hill Top House leadership did implement its mandatory COVID-19 vaccination policy.

"Therefore, our staff are forced to take action for continued employment," Kregar said. "Forty-five percent of our current staff are unvaccinated and will need to decide if they will take the first vaccine by Dec. 5, submit an exemption request, or resign.

"We have such a good team of skilled employees and many of the unvaccinated are not comfortable receiving the vaccine. For them, the decision to vaccinate or resign is a huge decision. Unfortunately, I’ve received a few resignations to date and expect more. We must have sufficient staff to adequately care for our elders. They deserve the best."

For CMS, it stated it will ensure requirement compliance through survey and enforcement processes such as for example, if a provider does not comply, it will be given a citation by a surveyor as being non-compliant but the provider will be able to be to return to compliance.

CMS said its goal is to have the health care providers as compliant but also said it will use its full authority of enforcement, to protect its patients.

“Ensuring patient safety and protection from COVID-19 has been the focus of our efforts in combatting the pandemic and the constantly evolving challenges we’re seeing,” said CMS administrator Chiquita Brooks-LaSure in the CMS news release. “Today’s action addresses the risk of unvaccinated health care staff to patient safety and provides stability and uniformity across the nation’s healthcare system to strengthen the health of people and the providers who care for them.”

To contact the writer email vmarshall@gannett.com