Home Health & Hospice Week

Did your staff lose their spot in line?

In areas where home health and hospice workers have relatively good access to COVID-19 vaccination, another roadblock is making trouble — vaccine hesitancy.

The World Health Organization defines vaccine hesitancy as “the delay in acceptance or refusal of vaccines despite availability of vaccination services.” Vaccine hesitancy seems to be subsiding somewhat since COVID-19 vaccinations began. At pediatric home health agency Consolidated Home Health in Houston, Director of Operations Jonathan Willman saw initial staff refusal rates of about 50 percent, he estimates. As the weeks of vaccinations have worn on, that has dropped to about 20 percent, he believes.

But the phenomenon is still a significant barrier to securing widespread vaccination status for home health and hospice workers.

In a recent poll of Home Care Association of New York State members, 55 percent of agencies saw up to 10 percent of their staff refusing the vaccine, says spokesperson Roger Noyes. The other 45 percent saw even higher refusal rates, ranging up to over half of staff.

The Ohio Council for Home Care & Hospice estimates that around 30 percent of home care and hospice staff are declining vaccination there. “The decline percentage is not as high as SNFs, but still higher than we expected,” says OCHC’s Joe Russell. Some reports have put certain long-term care facility worker refusal rates at over 70 percent.

AT Home Care Staffing in Richmond, Virginia has seen about 15 percent of its staff vaccinated so far, relates co-owner and president Ed Kassab. The agency, which serves private pay, Medicaid, and veteran clients as well as furnishing facility staff, has been educating staff about COVID-19 and the vaccine, including holding a Zoom education and question-and-answer session with AT Home Care Staffing’s medical director.

Kassab expects to see that figure go up as workers see their peers and others receiving vaccinations with little to no ill effects, he says.

Careline Health Group in Jackson, Michigan has seen about 60 to 75 percent of its Careline Hospice staff vaccinated, Chief Clinical Officer Crissy King tells AAPC. Since the pandemic began, Careline has been holding three-times-per-week calls going over COVID issues ranging from vaccine education to PPE status. “We’ve just pummeled them with information,” King says.

Plus: Careline secured a position with the state as a COVID-19 vaccine provider. That means every staff member who wants to get vaccinated has been able to, King relates. Careline has also begun holding vaccine clinics at assisted living facilities with which it partners. Many ALF residents and staff have found it difficult to access vaccinations, she notes.

Hesitant Workers Now At The Back Of The Line In Some Places

Many factors go into workers’ decisions to decline vaccinations, says Kassab, who is also Virginia Association for Home Care and Hospice president. Some workers are dead set against vaccinations and never get any of them, he notes. Others just want to give it a little more time to see how things go, due to the COVID-19 vaccine’s quicker-than-usual development and approval process.

Problem: In Ohio, “being part of group 1A, any agency that contacted their board of health early to get the vaccine have been able to do so until recently,” Russell says. “Once the state began group 1B, anyone not already slated to get vaccinated as part of 1A now has to wait in line until 1B is finished.”

According to a survey conducted by public health software company Surgo Ventures, top reasons health care workers refuse vaccines include a lack of evidence of the vaccines’ effectiveness and safety (31 percent cited this as the primary reason); personal safety concerns (24 percent); and worrying that the vaccine approval process thus far has been rushed (16 percent).

There are also practical considerations like taking off work, Noyes points out.

“Among all healthcare workers, women, Republicans, and Black healthcare workers were the most hesitant; and Black healthcare workers so far have refused available vaccines at significantly higher rates than the average (35 percent),” Surgo notes in its survey results summary.

Multiple home health and hospice providers report that their older workers, who are more at risk for serious COVID repercussions, have been most eager to get vaccinated.

However, many executives also note that vaccine refusal doesn’t necessarily break down along demographic lines such as age, race, political affiliation, or other attributes.

Note: See Surgo’s survey results at https://surgoventures.org/resource-library/survey-healthcare-workers-and-vaccine-hesitancy.