It’s a question that has plagued senior living and skilled nursing operators since COVID-19 vaccinations first became available in December: Can and should vaccination be required for staff members?

Several experts say it is probably legal for employers to make vaccination a condition of employment. Guidance from the federal Equal Opportunity Employment Commission largely has agreed, as long as employers provide for exceptions based on accommodations for disability or religious objections.

Most long-term care operators have gone the route of more incentive-based vaccination programs, providing paid leave to obtain the vaccine or for employees who experience any side effects after vaccination. But others, including Atria Senior Living, Juniper Communities and Silverado, already have mandated vaccination for employees. And others still, including Asbury Communities, say they plan to mandate staff vaccination once COVID-19 vaccines receive full Food and Drug Administration authorization, not just emergency use authorization. And at least one operator has implemented a vaccination requirement for new hires and residents, expecting to do so for existing employees and residents when they are more comfortable with the prospect.

Those that have implemented staff mandates are finding that they do increase vaccination rates, according to a New York Times analysis published on Friday. As of Feb. 25, 97.7% of Juniper residents had received two vaccine doses, and so had 96% of its staff members. At Atria, 92% of residents have received at least one dose of the vaccines, along with approximately 85% of staff. 

Those numbers are in stark contrast to staff vaccinations in many facilities. The Centers for Disease Control and Prevention has reported that during the first month of vaccine clinics in nursing homes, only 37.55% of staff members received the first shot, along with 77.8% of residents.

For many operators, concerns over already increased staffing shortages have kept them from implementing vaccination mandates.

With long-term care chronically understaffed, “I don’t think we want to do anything right now to push people out of those settings,” David Grabowski, Ph.D., a health policy researcher at Harvard Medical School, told the New York Times. Grabowski has suggested more substantial rewards than the gift cards or free meals some facilities are offering, including paid time off, so that employees can get inoculated and afford to miss a day’s work or two if they have reactions.

Yet Atria CEO John Moore says the mandate has been “nothing but positive” for the Louisville, KY-based senior living operator.

“The number of people we’ll have to replace is going to be pretty small,” he told the McKnight’s Business Daily. “It’s done great things for us from a morale point of view, as well as in terms of occupancy recovery.”