While Pennsylvania nursing homes and long-term care facilities already face major staffing challenges, the federal vaccine mandate and a new state-proposed minimum staffing requirement could devastate the industry.
President Joe Biden’s 100 percent vaccine mandate for healthcare workers is expected to throw thousands of employees out of a job, in an industry that has struggled to find workers in the last decade.
Around 35 percent of Pennsylvania’s nursing home workforce is unvaccinated. That amounts to roughly 33,000 workers who would lose their jobs if they don’t get the shots, Zach Shamberg, CEO of the Pennsylvania Health Care Association told The Epoch Times in a phone interview. That only counts nursing home workers. Add thousands of more workers at assisted living communities, personal care homes, hospitals, and doctor’s offices.
“The [Biden] administration has said, if we don’t terminate employees, it will withhold state and federal funding,” Shamberg said. “That is 80 percent of our funding. Nursing homes would be forced to close doors. The industry has been put in an impossible situation. It’s either terminate employees or risk losing funding. That’s difficult for providers who have been at the epicenter of this pandemic since March of 2020.”
The association, which advocates for nursing homes, assisted living communities, and personal care homes, is working to dispel misinformation about getting vaccinated, but many workers have good reasons for being hesitant about getting the shot. An alternative such as testing is needed to keep workers employed, Shamberg said. The association is advocating for this with policy makers in Harrisburg and Washington.
Already Short Staffed
A 2019 report by then Pennsylvania Auditor General Eugene DePasquale, predicted a senior citizen population explosion and examined an ongoing healthcare workforce shortage.Pennsylvania could be short more than 4,000 registered nurses by 2030 as some retire and new jobs are created, the report said. Difficulty getting licensed, emotionally demanding work, and low pay are barriers to attracting workers.
“We knew then there was a real need for workers,” Shamberg said. “Then when COVID started, we saw workers leave out of fear. Schools shut down and some workers had to return home to care for their kids. Now we are seeing an exodus from burn-out. We can’t afford to lose one worker. Losing 33,000 would be disastrous.”
The average wage for a Certified Nursing Assistant (CNA) is $15 an hour. In past years, nursing homes competed for workers mostly with other healthcare providers. As wages are becoming more competitive, they are competing with convenience stores, restaurants, and Walmart, which all pay the same or more.
CNAs are often called upon to handle tasks like bathing, dressing, feeding, and changing the diapers of residents.
“It’s difficult to find workers. This work takes a very special individual. It’s a passion,” Shamberg said. “Without an investment from state government first, nursing homes cannot invest in their workers. That means an investment in the state’s Medicaid program.” The amount provided by the government dictates how much facilities can pay workers.
Over the last two years, the Legislature and governor have stepped up to support nursing homes with money from the Cares Act and the American Rescue Plan. But that is one-time funding and may only be used for COVID-related expenses, Shamberg said.
Many Pennsylvania nursing homes are already so short-staffed that they are not able to take on more residents. Instead, they are putting people on waiting lists. Patients transitioning from hospital care to long-term care must wait and search for an opening.
“Some family members are being forced to travel 30 minutes or an hour away to receive care. A year ago, that was unthinkable. There is a real access to care issue in Pennsylvania today,” Shamberg said.
Quality Life Services is a family-run operation in Western Pennsylvania with 10 long-term care campuses and a home health and hospice business. Combined, the company has roughly 1,300 beds but just 900 are occupied right now, Steve Tack, Quality Life Services CEO told The Epoch Times in a phone interview.
Resident numbers are down in part because some succumbed to the virus before the vaccine was available, and at that time, families were hesitant to place loved ones in long-term care because of strict visitation rules and fear of the virus.
Quality Life Services has been trying to rebuild its population but it doesn’t have the staff. And because of that, the company declines 80 percent of patient referrals from hospitals. Patients in hospitals who are ready to be discharged to a nursing home are stuck waiting in the hospital, searching for a nursing home that will take them.
“We have about just over 200 positions open that we are recruiting for,” Tack said. “A month ago it was 250. We’ve been aggressive about recruiting.” Over 150 of those jobs are in direct care nursing positions and others are support positions.
“Just over 50 percent of our staff are vaccinated,” Tack said. “There is a large number that have told us they would resign before they would get vaccinated.”
Quality Life Services increased testing for unvaccinated workers and took precautions to keep everyone safe. Tack said the company is very concerned about how they will handle staffing after Biden’s vaccine mandate is put in place.
“We’ve been told to expect the regulation in the middle or end of October,” Tack said. “We don’t know when it will go into effect. We spend a lot of our time talking with unvaccinated staff and encouraging everyone to get vaccinated. We tell them, don’t quit on us until we know for sure. Maybe there will be testing.”
New State Staffing Regulation
Pennsylvania’s Department of Health added a layer of complication to nursing home staffing by proposing a new minimum staffing requirement.
Facilities currently must provide 2.7 hours of direct care per day for each resident. At the height of the pandemic, the department wrote a new regulation increasing the direct care requirement to 4.1 hours per resident. Before implementing it, the new rule must be approved by the Independent Regulatory Review Commission, but this week the commission sent it back to the Department of Health for a rewrite, saying the regulation did not offer enough information to allow the commission to determine if the regulation is in the public interest.
The Department of Health considers three job titles as direct care staff: registered nurse, Licensed practical nurse, and CNA. But the Centers for Medicaid and Medicare Services consider those titles plus wound care nurses, social workers, physical therapists and assistants, speech therapists, dieticians, activities staff, and more. Those won’t count toward direct care staff hours in Pennsylvania.
“If enacted tomorrow, 7,000 new care workers would have to be hired at a cost of more than $400 million in new annual wages,” Shamberg said. “Where do we find the workers? It just doesn’t work. There is not a single provider that doesn’t want to increase their staff. This climate is not the time to do this. We will continue to fight any proposal that would prevent access to care or force good providers out of the state.”
The Pennsylvania Health Care Association recently surveyed its members about the current state of long-term care. The responses are a sampling of the entire sector in the state. A total of 18 owner/operators participated in the survey which is expected to be released fully next week Shamberg said.
As an owner, they may operate one or more long-term care facilities in Pennsylvania, inclusive of nursing homes, personal care homes, and assisted living communities.
Seven owner/operators said they cannot afford to provide care for more than 12 months from now. Three owner/operators said they are currently planning to close or sell facilities, and four preferred not to answer the question.
When asked about how their organization plans to respond to the Biden vaccine mandate, 10 said they still were not sure and three already plans to terminate unvaccinated staff.
The survey also got responses from 64 facilities throughout the state.
When asked how many workers were on payroll in Feb 2020 and in Sept 2021, answers showed that on average, facilities have lost 18 percent of their workforce since the start of the pandemic; 43 percent of nursing homes have 21 or more jobs positions open.
In the survey, nursing homes responded the top four reasons workers were leaving were, burnout (70 percent); wages (66 percent); COVID-19 safety concerns (48 percent), and reluctance to comply with the COVID-19 vaccine mandates (34 percent).
Additionally, 96 percent of nursing home respondents said they would not be able to meet a 4.1 hours direct care per day staffing requirement if implemented today; 85 percent of nursing home respondents have limited or put on hold new admissions due to staffing shortages, and 50 percent of nursing home respondents currently have a waiting list for new admissions.
The Pennsylvania Department of Health did not respond to emails with questions about the minimum staffing requirement.
New York has said it will ask the National Guard to fill vacated health care jobs.
The Pennsylvania Department of Health also did not answer questions about what its plans are to fill any worker gaps in nursing homes and hospitals created by the vaccine mandate.
