An employee mandate led to a “significant” increase in COVID-19 vaccine uptake with little effect on staffing in a multi-state network of continuing care retirement communities studied by researchers, who published their findings Monday in Health Affairs.
“Vaccination mandates are authoritative interventions that some long-term care employees may disagree with, but we demonstrate that they can significantly increase vaccination uptake,” said the University of Pennsylvania researchers. “Employers must weigh this benefit against the costs, including the need to terminate some employees for noncompliance.”
The CCRC network announced a vaccination requirement in July 2021, with a compliance deadline of Oct. 31, 2021, for clinical employees and a Nov. 30, 2021, deadline for nonclinical employees. Employees were told that their employment would be terminated if they did not comply with the mandate. The researchers found that only 3.7% of active employees within the studied network were fired for noncompliance.
Lead study author Aleksandra M. Golos, MD, clinical research coordinator at the Penn School of Nursing, told McKnight’s that prior studies have shown modest staffing shortages in healthcare institutions that enacted COVID-19 vaccine mandates, so the research team wasn’t surprised by the 3.7% employment termination rate.
But she cautioned that the 3.7% employment termination rate due to noncompliance is an average rate and only represents those employees who waited until the compliance deadline to leave. Some communities or departments could have experienced higher employment termination rates, she said.
“It is possible that additional employees separated for mandate-related reasons prior to the compliance deadline,” Golos said, adding that the employment termination rate could be up to a maximum additional 3.8%, for a 7.5% termination rate for noncompliance. “We found no evidence that this additional rate was higher than the ‘background’ employee turnover rate seen prior to the mandate announcement,” she said.
Before the vaccination deadline, 17.9% of the CCRC networks’ 6,733 employees were unvaccinated. Of the 1,208 unvaccinated employees, however, 56.2% were vaccinated by the deadline. In addition, 44.9% of the unvaccinated employees and 11.3% of vaccinated employees left the organization by the final mandate compliance deadline.
The researchers reported that after the mandate announcement, vaccination rates significantly increased compared with pre-announcement trends, and the effects were greatest in states that did not have mandates for long-term care employees.
The study also showed that in states with COVID-19 vaccine mandates for all long-term care employees, the vaccination rate in the CCRC network increased from 82.1% in July 2021 to 95.1% by the October 2021 vaccination deadline.
The authors found that the 13-percentage-point increase in the employee vaccination rate that occurred between the time of the mandate announcement and the initial compliance deadline compared favorably with “lighter-touch” interventions, including behavioral education campaigns and email-based efforts.
Recurrent or seasonal COVID-19 surges are expected, Golos said, and maintaining vaccine requirements in long-term care facilities and other healthcare settings would be consistent with flu vaccination requirements.
“Maintaining these requirements in senior care organizations at a time when we are not in an acute crisis would likely present less blowback — in terms of observed employee separation, as well as in public commentary and sentiment — compared to reinstating requirements when faced with a recurrent or new emergency situation,” she said. Employers must weigh the pros and cons, the authors said.
The study was supported by a grant from the National Institute on Aging of the National Institutes of Health.
Vaccine mandates in senior living
The Biden administration lifted most federal COVID-19 vaccine mandates, including those for healthcare workers, with the end of the public health emergency on May 11. Mandates from the Centers for Medicare & Medicaid Services weren’t applicable to independent living or assisted living communities but did affect skilled nursing facilities that receive reimbursement from CMS.
Senior living communities predominantly were affected by the mandate put forth by the Occupational Safety and Health Administration, which OSHA withdrew in January 2022.
The COVID-19 vaccination-and-testing emergency temporary standard originally was announced in November 2021 but was withdrawn following a US Supreme Court decision to temporarily halt the mandate while challenges played out in the 6th Circuit Court of Appeals. At the time, OSHA announced that it would focus on finalizing a permanent COVID-19 healthcare standard for employers.
The OSHA standard applied to all companies with 100 or more workers, including assisted living communities and other healthcare settings. The workplace safety rules required communities to conduct hazard assessments, have written plans in place to mitigate the spread of the coronavirus, as well as provide some employees with N95 respirators and other personal protective equipment, and implement social distancing, employee screening, and cleaning and disinfecting protocols.
