COVID-19 vaccine mandates in two states are giving home care agencies massive headaches. 

New York State’s mandate for home care workers took effect Thursday, despite a court injunction that temporarily allows for a religious exemption. Millie Ferriter, executive director of Community Health Center of St. Mary Healthcare & Nathan Littauer Hospital in rural Johnstown, New York, told McKnight’s Home Care Daily Pulse Thursday that two of her 18 staff members have quit over the mandate. Three others have taken unpaid leaves of absence until New York courts weigh in on the exemption.

A panel of three judges could decide next week if the state must grant religious exemptions. Glenn Lane, CEO of Westchester Family Care, told McKnight’s Home Care Daily Pulse he has already developed a process for considering exemptions for workers who don’t want the shots for religious reasons.

“We’re not just punting waiting for the court cases to be heard,” Lane explained.

Meanwhile, California home care agencies are bracing for a COVID-19 vaccine mandate that will go into effect for them at the end of November. However, that mandate exempts home care and hospice workers who provide services to a single home. It also exempts workers for religious or medical reasons, but requires them to get tested for COVID-19 weekly.

Home care agencies will be required to maintain records of workers’ vaccination or exemption status. They will also be required to keep all testing records of exempt employees.

Jacquelyn Kung, CEO of senior services employee engagement firm Activated Insights, told McKnight’s Home Care Pulse the vaccine mandate is likely to be burdensome to many home care firms.

“The labor shortage has been exacerbated in home care agencies,” Kung said. “The California mandate is the right thing to do for public health. That said, it is quite challenging, as it doesn’t provide home care agencies with help recruiting, tracking, or paying higher wages.”

California had a separate vaccine mandate for healthcare workers that went into effect at the end of September. It was later expanded to include home care workers as well.

This article originally appeared on McKnights Home Care