Baker administration orders staff at long-term-care facilities to get COVID-19 vaccine

Infections at nursing homes rising rapidly again

Maplewood at Mayflower Place, an assisted living facility in West Yarmouth, had a COVID-19 outbreak last month.Steve Heaslip/Cape Cod Times

Citing a fivefold increase in COVID-19 infections among staff and residents in Massachusetts nursing homes in the past month, Governor Charlie Baker’s administration on Wednesday ordered most nursing home workers to be fully vaccinated against the coronavirus by Oct. 10.

The emergency vaccination order aims to “strengthen infection control and protect vulnerable residents,” the administration said in a statement, adding that there also has been “an observed increase in COVID-related resident deaths.”

Massachusetts is believed to be the first in the nation to mandate COVID shots for nursing home staff, some of whom have stubbornly resisted getting the shots even though they care for some of the state’s most vulnerable residents. But some nursing homes have been reluctant to order staff to get vaccinated for fear of exacerbating an already serious staff shortage.

“Currently, vaccine hesitancy among some front line health care workers remains a significant barrier, notwithstanding extensive efforts by our members to offer education and multiple incentives,” Tara Gregorio, president of the Massachusetts Senior Care Association, which represents nearly 400 senior care facilities, said in a statement.

“The governor’s new state COVID-19 staff vaccination mandate for nursing home staff will save lives, especially since many workers move between jobs frequently or hold two jobs in different health care settings, and it aligns with public health goals to achieve herd immunity,” Gregario said.

Massachusetts nursing facilities have the sixth highest rate of staff COVID-19 vaccination in the country at 74 percent — substantially higher than the national average of 59 percent, federal data show. But even in Massachusetts, more than a quarter of nursing home workers are unvaccinated.

The governor’s mandate comes as the state is experiencing a rapid increase in new infections and battling outbreaks on Cape Cod, one that involved at least 33 people in a nursing home in West Yarmouth, and another, much bigger one in Provincetown.

Now, the Provincetown cluster, which had infected nearly 900 people last month, is showing signs of coming under control. The percentage of tests coming back positive has plummeted from a peak of 15.1 percent on July 15 to 3.2 percent, Town Manager Alex Morse said Wednesday. While roughly 75 percent of those infected had been vaccinated, few were reported seriously ill, and just eight hospitalizations have been linked to the cluster.

Also, on Wednesday, the World Health Organization pushed back against nations such as Israel and several in Europe that are planning or already starting to administer booster shots for the fully vaccinated, particularly for older citizens. The WHO called for a moratorium on boosters until there are sufficient doses in countries where few people have received shots.

The international health agency has repeatedly urged the United States and wealthy nations to do more to improve access to vaccines in the developing world.

In the United States, the failure of many nursing home staff members to get vaccinated has emerged as one of the most serious gaps in the nation’s defenses against COVID-19. Fully one-quarter of the pandemic deaths in the country had occurred in nursing homes as of June.

Baker’s directive applies to the state’s 378 skilled nursing facilities, as well as the state’s two soldiers’ homes in Chelsea and Holyoke, where 76 veterans died from COVID in a single outbreak last year.

As of Aug. 2, the statement said, 155 of those facilities had fewer than 75 percent of their staff fully vaccinated.

The directive includes “all individuals employed directly or by contract” at nursing homes. Unvaccinated workers must get at least one dose by Sept. 1, and be fully vaccinated by Oct. 10.

The state Department of Public Health will enforce the requirement, which includes exemptions for workers with medical restrictions or “sincerely held” religious beliefs that bar them from getting vaccinated, the statement said.

But enforcement will focus on the nursing home, not the individual employees. Any nursing home that has fewer than 75 percent of personnel vaccinated by Oct. 10 may be ordered to stop accepting new admissions until it has reached that threshold, under the new mandate.

Senior-care company executives have said for months that they were reluctant to mandate the shots, fearing such a requirement would potentially cause employees to leave, exacerbating a labor shortage in the industry.

Instead, administrators in Massachusetts and across the country have largely resorted to dangling gift cards, cash, T-shirts, and more, but such incentives have largely failed at convincing holdouts.

Recently, a small but growing number of senior-care companies had started to mandate the shots, including Hebrew SeniorLife, New England’s largest senior-care provider, with 2,600 employees, which issued the requirement July 26.

“It is truly our moral obligation to do everything we can to protect our residents and our staff,” Lou Woolf, Hebrew SeniorLife’s chief executive, said Wednesday.

Even before the company’s requirement, roughly 85 percent of its workers were vaccinated, leaving about 400 needing shots. Woolf said that since his company’s announcement, only four of those workers have requested an exemption for religious or medical reasons. None have quit. The company’s deadline for full vaccination is Oct. 1.

David Grabowski, a professor of health care policy at Harvard Medical School, said the state’s mandate will likely boost vaccination rates in nursing homes. But he said the Massachusetts mandate, the first that he knows of in the nation, may also lead to resignations of some of the lowest-paid workers, the certified nursing assistants who do much of the hardest work bathing and feeding residents, as well as dietary and housekeeping staff. They could be attracted to jobs in restaurants and retail that pay as much or more, and don’t yet mandate shots.

“We haven’t valued these staff, we underpay them and the work is hard,” Grabowski said. “Now that we are mandating vaccinations, some might say this is the tipping point, and leave, while others hopefully will get vaccinated.”

Dr. Asif Merchant, medical director at four nursing homes in the Metro West area and chief of geriatric medicine at Newton-Wellesley Hospital, said he is more worried about rising infection rates than driving away staff.

“There is a resurgence and if we don’t nip this in the bud right now we will see a full-blown” outbreak, he said.

The Baker administration does not regularly release detailed data on nursing home infections and deaths. But according to the state, the seven-day average of new COVID infections among all ages has increased at least sevenfold in the past month.

Merchant said some workers in his nursing homes who have held out against the shots, expressing fears, have also said they would be more likely to get vaccinated if it was mandated, rather than leave.

“There is a human connection,” Merchant said. “They become like a family member in many instances [to residents], they become emotionally attached and we see it when someone passes away.”

In Massachusetts, vaccine mandates have primarily been rolled out by private sector employers in health care and higher education.

Last week, a trade association representing nearly all the state’s hospitals announced it will require vaccines.

Baker has previously been reluctant to issue state mandates.