Home Health & Hospice Week

Are Medicare-mandated shots for staff in the cards?

As the Delta variant continues to surge, vaccination of home health and hospice staff is becoming an even higher priority.

Like the rest of the nation, agencies have been fighting an uphill battle for worker vaccinations since the vaccines were approved. COVID vaccine hesitancy is putting a serious damper on vaccination rates, providers report.

For example: AfterCare Nursing Services in Cheektowaga, New York has a vaccination rate of 55 percent, reports President Tom Boyd. “I don’t understand why [vaccinehesitant employees] are so unwilling to get vaccinated,” Boyd tells AAPC.

The issue may become even more critical for HHAs and hospices if the Centers for Medicare & Medicaid Services enlarges its newly announced COVID vaccination mandate from nursing home staff to home health and hospice staff.

On Aug. 18, CMS announced that it, “in collaboration with the Centers for Disease Control and Prevention (CDC), is developing an emergency regulation requiring staff vaccinations within the nation’s more than 15,000 Medicare and Medicaid-participating nursing homes,” according to a CMS release.

“The data are clear that higher levels of staff vaccination are linked to fewer outbreaks among residents, many of whom are at an increased risk of infection, hospitalization, or death,”

CMS Administrator Chiquita Brooks-LaSure says in the release. “We will continue to work closely with our partners at the CDC, long-term care associations, unions, and other stakeholders to advance policies that keep residents and staff safe. As we advance these new requirements, we’ll work with nursing homes to address staff and resident concerns with compassion and by following the science.”

About 62 percent of nursing home staff are currently vaccinated, CMS says. (CMS requires nursing homes to report that data.) “Vaccination among staff at the state level ranges from a high of 88 percent to a low of 44 percent,” the agency reports. Many recent COVID outbreaks have been “occurring in facilities located in areas of the United States with the lowest staff vaccination rates,” CMS adds in the release.

While CMS doesn’t expect to issue the requirement until September, “CMS strongly encourages nursing home residents and staff members to get vaccinated as the Agency undergoes the necessary steps in the rule-making process over the course of the next several weeks,” it says. “CMS expects nursing home operators to act in the best interest of residents and their staff by complying with these new rules.”

Don’t be surprised to see the same requirement hit home health and hospice agencies, observers say. A precursor to that may be requiring agencies to submit staff vaccination data, like long-term care facilities do — but not necessarily.

A big problem with implementing such a requirement is its exacerbation of the already critical staffing shortage. In a new survey of 1,630 executives and human resources officials nationwide, the top three concerns about implementing vaccination mandates are “resistance from employees … who refuse to get the COVID-19 vaccine or oppose vaccination generally” (79 percent), “impact of implementing a mandate on company culture/employee morale” (67 percent), an “loss of staff and difficulty operating due to termination or resignation of employees (without … exemptions) who are unwilling to be vaccinated” (60 percent), reports law firm Littler in a new report on the survey. Amongst healthcare employers, loss of staff concerned a higher 85 percent of respondents, Littler adds.

“These considerations are even more important now given labor shortages in some sectors,” the Littler report emphasizes.

That includes home health and hospice. “Shortages of healthcare workers have created intense competition between employers, which has led to further shortages in some communities and healthcare settings,” says the National Hospice and Palliative Care Organization. “At the same time, employer vaccine requirements have frustrated some health workers.” New vaccination requirements “may cause further frustration in the short term, and we are concerned about that,” NHPCO says.

Before CMS slaps a vaccination mandate on home health and hospice agencies, the industry is stepping up to try to address the problem. Organizations and agencies are pursuing a range of solutions varying in intensity.

At one end is NHPCO. “All health workers and volunteers in all settings — including home health, home hospice, and home palliative care workers — should be required to be vaccinated against and regularly tested for COVID-19, with exemptions for medical and religious reasons,” the trade group says in a release issued after the FDA gave full approval to the Pfizer COVID vaccine Aug. 23. “The requirement should include a clear timeline and implementation should be supported with financial resources, including but not limited to additional support under the Provider Relief Fund and sufficient home-based rapid testing supplies,” NHPCO says.

The move would actually improve staffing crunches, the trade group argues. “In addition to optimizing public health and safety, uniform, mandatory vaccinations for health workers would help improve public confidence in the healthcare system and help to address staffing challenges,” NHPCO maintains. “Taking the long view, it’s clear that consistent requirements will strengthen public trust in the healthcare system and help stabilize staffing.“

Some companies are jumping on this bandwagon. “Empath Health has announced a policy that requires colleagues, volunteers and vendors to be fully vaccinated against COVID-19,” says the parent company of Suncoast Hospice and Tidewell Hospice in Florida.

“As a community health organization, Empath Health’s highest priority is to protect the health and safety of our clients, colleagues, volunteers and communities,” Tidewell Hospice Chief Medical Officer Nevile Sarkari says in a release. “Vaccines play a vital role in public health and safety, and the COVID-19 vaccine continues to demonstrate efficacy in protecting individual health and limiting the spread of COVID-19.”

Workers and volunteers, including vendors, must obtain full vaccination by Nov. 1, Empath says. Those who qualify for exemptions “may be subject to additional masking requirements and ongoing COVID-19 testing,” according to the release.

A less drastic move taken by some home health and hospice employers is to require vaccination of new hires only.

The vast majority of home health and hospice agencies, however, appear to be sticking with the carrot rather than the stick approach, offering benefits like paid time off or bonuses for getting vaccinated, and perhaps requiring testing if staff aren’t.

The National Association for Home Care & Hospice aims to give agencies assistance in this area with a new partnership with the National Minority Health Association and the Flex for Checks program, it says in a release.

“We need to be honest and recognize our shortfall in vaccinations as an industry,” says NAHC President Bill Dombi in the release. “But as an industry, we need to come together to solve it.”

Dallas-based chain AccentCare is using the Flex for Checks program to try to reach 5,000 shots. “We recognize that the industry has a problem when it comes to vaccinations,” AccentCare CEO Stephan Rodgers says in the release. “Vaccination is the first line of defense against COVID-19 and we want to be part of the solution, and that’s why we are aggressively encouraging our team members to get vaccinated.” AccentCare operates across 31 states.

“We are thrilled to partner with NAHC and AccentCare as we seek to get as many home care workers and people in underserved areas vaccinated as possible,” NMHA’s Burgess Harrison says in the release. The Flex for Checks program runs with grant funding from the federal Health Resources and Services Administration.

“Home care workers and community members need to be vaccinated,” the website at flexforchecks.org says. “This program offers an opportunity to reward the people who get vaccinated, along with your workers and your agency for motivating them to get vaccinated. For each reward given to the community member, we also give a reward to the worker and to your agency.”

How it works: Community members receive $50 per shot ($100 for 2-shots); home care workers receive $25 for each shot a community member gets under their registration number; and home care agencies receive $25 for each shot a community member gets under their registration number. Flexforchecks.org provides “free, online training and support for you and your staff,” it says. “You’ll be prepared to answer tough questions with unbiased information from reputable sources and so you can speak with confidence.” The site also has numerous video testimonials from industry workers who have gotten vaccinated.