On July 7, a staff member tested positive for the coronavirus, forcing my father’s facility into lockdown. Residents had assumed that the staff was fully vaccinated and were no longer wearing masks. Within a week, 19 out of about 70 skilled nursing residents had tested positive for the disease. Eighteen of these infected residents were vaccinated; two died of covid-19 and a third was hospitalized for serious illness. Genomic testing identified that alpha and delta strains were brought into the facility around July 4.
A total of six staff members tested positive for the coronavirus, four of whom were unvaccinated. Despite the outbreak, 13 percent of the staff remain unvaccinated. This is, in fact, better than at most facilities; last month, Medicare data showed that around 41 percent of nursing home staff refuse to be vaccinated.
My father, like most nursing home residents, has health conditions that forced him to surrender significant freedoms and cash in exchange for care to keep him safe. Yet he now depends on some staff who refuse to be vaccinated and who are permitted to hide their vaccination status.
The vaccinations that residents received certainly prevented the death count from being much higher. But even without underlying health conditions, people older than 80 have been shown to have weaker immune system responses to coronavirus vaccinations. Now that the delta variant accounts for more than 90 percent of the country’s infections, facilities such as my father’s are petri dishes primed for outbreaks.
Breakthrough infections and deaths are no longer rare in these communities, and most are thought to be brought in by unvaccinated staff. In April, the New York Times reported on an outbreak set off by an unvaccinated worker in Kentucky. The same thing seems to have happened in facilities in South Dakota, Indiana and Missouri, resulting in the deaths of nursing home residents from breakthrough infection. More such deaths may be ascribable to unvaccinated staff: The Centers for Disease Control and Prevention has yet to publish the results of its investigation of four nursing home breakthrough deaths in Grand Junction, Colo., and an assisted-living facility in Toms River, N.J., is now on lockdown, with dozens of staff members and vaccinated residents having tested positive.
The United States leaves vaccine mandates up to states. Most states leave it up to counties, and most counties punt to individual employers. Many employers mandate coronavirus vaccinations for on-site workers, but most nursing homes have yet to take this step.
What do our laws say about an unvaccinated worker whose mask falls below her nose while she removes a bed pan or performs other intimate tasks? Unfortunately, infection control regulations are lagging behind the current data on breakthrough infections.
On Aug. 6, I spoke to the nurse in the state health department who oversees licensing for all skilled nursing facilities in my father’s county. She asked what vaccine my father had received. When I said Pfizer, she said, “He should be fine.” When I reminded her that the outbreak last month had killed and hospitalized other Pfizer-vaccinated residents at his facility, she said, “They had co-morbidities.” But most people confined to nursing homes have co-morbidities!
On July 21, 28 residents and their family members sent a petition to the chief executive of my father’s elder-care chain requesting an immediate vaccine mandate of the staff and other contractors. He responded that unvaccinated staff members remain on the job and that no mandate can happen now due to “privacy issues, concerns over labor shortages, and appropriate and legal protocols for monitoring.”
Labor shortages in skilled nursing facilities are a problem. If a nursing home is understaffed, it can face $50,000 fines. But incentives such as higher pay and vacation days could accompany any vaccination deadline for those whom encouragement has failed to persuade. If the mandate is statewide — or better yet nationwide — nursing homes won’t lose many employees, since all employers would need to comply.