Gigi Acevedo-Parker headshot
Gigi Acevedo-Parker

The accelerating rollout of coronavirus vaccines holds some promise of relief to senior living organizations after a solid 12 months of unrelenting pandemic pressure. But the reluctance of some workers in long-term care facilities to get vaccinated poses a worrisome roadblock to recovery.

It’s impossible to escape the impact of the pandemic on the industry when almost 40% of COVID deaths have occurred among residents and some 1,500 caregivers have died of the virus. Yet according to a recent report by the Centers for Disease Control and Prevention, 77.8% of nursing home residents accepted vaccinations compared with a median of only 37.5% of staff in the first month of the federal vaccination drive.

The senior living and care industry tends to be tough on caregivers anyway, with a worsening shortage of caregivers for the growing numbers of aging baby boomers, lagging pay rates and work that can be physically and emotionally taxing. COVID may have made their jobs among our most dangerous. It makes vaccinations an imperative for everyone’s future. Organizations that make COVID vaccinations part of their health and wellness programs will put everyone in a better position for what’s ahead.

But vaccination programs should be approached strategically. That approach requires a concerted effort to explain how they work and what employees should expect, ensuring an approach that meets federal and state workplace regulations. Here are points to consider.

1. Create better buy-in to vaccinations

Senior living and care workers may distrust the COVID vaccines, fearing that the accelerated development timeline has not yielded a safe, effective option. An education effort that validates their concerns and sets their expectations is an important backdrop to a successful vaccination program:

  • Explain what can be expected with all of today’s vaccine options. Even after the first shot in a two-shot regimen, the virus can be contracted. Positive tests are less likely, but people will have the coronavirus antibodies. Those who do contract the virus after the first dose typically have milder symptoms.
  • Allergic reactions usually stem from pre-existing allergies to ingredients in the vaccines. Employees should complete a medical checklist before vaccination so administrators are aware of any potential for an allergic reaction.
  • Explain the science behind the vaccines. The vaccine instructs cells to make a harmless “spike protein” that fools the body into thinking “COVID was here,” so an immune response is built and protective antibodies are made.

The press has shared various examples of the types of incentives some employers have offered their workers to encourage them to get vaccinated. Some have offered cash. Others, paid time-off. These incentives have, in fact, encouraged participation. The issue is whether they are legal when the vaccination effort is tied to a workplace wellness program.

A big issue is the limits placed on incentives. The concern of the Equal Employment Opportunity Commission is the potential they pose, especially when they are high-value, to coerce participation and inadvertently lead participants to disclose protected medical information in the process. Proposed rules clarifying incentive limits in wellness programs were proposed in January, then frozen, awaiting review by the new administration.

In the interim, incentives should be considered with a “less is more” philosophy. Modest incentives create less pressure to participate.

Offering all employees a set amount of paid time off to get vaccinated is a one way to go, but it’s important that participants not be tracked, and no one is penalized for not getting vaccinated.

Another option for vaccination drives not connected to health and wellness programs is to offer collective, versus individual, incentives — such as department contests to reach 100% vaccination, for example. Those who have opted out would be excluded from the headcount.

3. Mandated vaccinations – you can, but should you?

Employers have mandated vaccinations for other types of diseases — Hepatitis C, for example, and other forms of flu. From a pure employment law perspective, it is legal. And it takes vaccines to achieve herd immunity – important given the need to protect the vulnerable populations in senior living and care.

The question is the affect a mandate for COVID vaccination would have on a business culture. Further, mandating vaccinations would remove the initiative from the mantle of a voluntary wellness program, another consideration.

Either way, it’s absolutely essential to involve the human resources team in the process to guard against violations of the Americans with Disability Act or Title VII of the Civil Rights Act. It’s important for the employer to find out, if employees decline vaccination, whether an underlying health condition or religious prohibitions are the reason.

  • If a health issue is cited, then the Americans with Disability Act comes into play.  It requires an interactive process to determine what accommodation would be available. This process could call for the employee’s assignment to a more secluded, non-resident contact role. It does not mean that a new job must be created or another employee displaced.
  • A religious-based declination involves Title VII. The matter must be discussed with the employee, who must provide documentation to prove its legitimacy. In Equal Employment Opportunity Commission matters, the CDC leans toward the employee, so the employer must resolve any conflicts. Resolution, again, typically involves moving the individual into a non-resident contact role.
  • In the event of such concerns, employers must remember that they are tied to private medical information, which is not protected under HIPAA but still is to be kept secure.

Protecting their workers’ health and well-being when COVID remains a high risk is a challenge on every front. Circumstances have blurred the boundaries between human resources and employee benefits regulations that must be navigated and the risks that have only been elevated with the times. A COVID vaccination program is one way to protect everyone’s interests, but careful footwork is required.

Gigi Acevedo-Parker is national practice leader – critical risk management for global insurance brokerage Hub International. She is a nurse executive with more than 30 years as a healthcare clinician, nursing leader, healthcare consultant and educator with a focus on healthcare risk mitigation and patient safety.

Wendy King is the director of health and performance for Hub International. She manages HUB’s team of health and performance experts, who provide clients the strategic insight, multi-year plans and provider resources required to create healthy, high-performing organizations.

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