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PROVIDENCE — Rhode Island will allow health care workers who aren’t vaccinated against COVID-19 to work even after Oct. 1 if there’s a risk to quality of care in their absence, the state Department of Health announced Tuesday.

The state had previously given workers an Oct. 1 deadline to get vaccinated, unless they have an approved medical exemption, or they would not be allowed to work. The announcement Tuesday provided some leeway to that edict in the most dire situations, and comes after leaders of some facilities — notably nursing homes — said they worried the deadline would worsen staffing shortages.

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The reprieve comes with a number of caveats: Health care facilities would have to demonstrate that unvaccinated health care workers are critical to patient needs. Anyone who’s not complying is subject to enforcement on Oct. 1. And if an unvaccinated worker has to work beyond Oct. 1 to address that risk to quality of care, their employer would have 30 days to ensure the role is filled by a fully vaccinated health care worker, the state said. They’ll also have to ensure that new hires are vaccinated against COVID-19.

“This is all about staying oriented on health outcomes, and ultimately what’s best for the patient,” said Tom McCarthy, the executive director of the state Department of Health’s COVID response.

According to the latest state Department of Health survey, 87 percent of health care workers are vaccinated, an increase of 10 percentage points since early September.

Asked about what would happen beyond those 30 days, McCarthy said the state had learned during the COVID pandemic to be responsive to the changing environment.

“But given what we know today about our hospital capacity, and the Delta variant, the expectation is 30 days is when we begin to escalate the enforcement,” McCarthy said.

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Facilities will have to file action plans. Those plans will have to address getting unvaccinated health care workers their shots within 30 days; demonstrating that unvaccinated staff are only doing so to mitigate a risk to quality of patient care; and specifying temporary infection prevention measures.

McCarthy added in an interview there would be some degree of transparency about what facilities and providers have been vaccinated.

“Those Rhode Islanders who are fortunate enough to make decisions will know who is compliant and leverage that in their decision making,” McCarthy said. He added: “We want to make sure everyone has access to a facility that’s safe from COVID.”

The enforcement applies to workers in state-licensed health care facilities, as well as health care providers — such as primary care doctors — outside those facilities. That includes private and public institutions and includes everything from hospitals to nursing homes.

Dr. James E. Fanale, president and CEO of Care New England Health System, which is the state’s second largest health system, released a statement to the Globe Tuesday night that said CNE will be “fully compliant” with the state’s vaccination mandate.

“We are holding firm to this mandate, which is in the best interest of patients and staff. If any CNE healthcare worker is not fully vaccinated by Oct. 1, they will not be allowed to work,” said Fanale in a statement.

Across the system, 93.6 percent of workers have been fully vaccinated, according to spokeswoman Raina Smith. And that includes 93.2 percent of all CNE nurses.

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But Fanale then said, “We are, however, developing contingency plans to make sure that all the patients are cared for safely, on and after the Oct. 1 deadline.”

Kathleen Hart, a spokeswoman for Lifespan, released a statement saying the state’s largest hospital system was reviewing the enforcement strategy, and how it was applicable to Lifespan. She added: “Lifespan leadership did not request the modification to the (Rhode Island Department of Health) deadline.”

Earlier on Tuesday, Gov. Dan McKee had said at his weekly news conference that hospital leaders supported the Oct. 1 deadline.

“They are really encouraging us to hold the line, as we are, on the Oct. 1 date,” McKee said. “So we will.”

Later in the day, though, the Department of Health added a caveat. The state doesn’t have any projections on how many people might need to work without being vaccinated, and state officials continued to emphasize that they did not view the new strategy as an extension of the deadline or a new exemption.

“On October 1, anyone that is non-compliant is subject to enforcement,” Dr. Nicole Alexander-Scott, the director of the Department of Health, said in a written statement. “If there is a risk to quality of care and an unvaccinated worker must continue to work beyond October 1 to mitigate that risk, the employer has 30 days to ensure that role is fulfilled by a fully vaccinated healthcare worker.”

The nursing home industry, meanwhile, had raised concerns that the mandate on Oct. 1 would present significant challenges for a workforce that is already stretched thin. About 700 of the 10,000 workers in the nursing home industry are unvaccinated, according to industry leaders, citing state data.

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“Something’s got to give,” said John Gage, the president and CEO of the Rhode Island Health Care Association, which represents mostly for-profit homes in the state. “We can’t lose 7 percent of our workforce on Oct. 1.”

Gage said after the news of the state’s regulatory shift that it might not make much of a difference: He feared there could be regulatory implications if a facility allowed an unvaccinated person to work and an outbreak occurred.

And, citing the 30-day timeframe to find a vaccinated worker to replace unvaccinated ones, Gage said: “The 30 days will be here and gone in no time.”

People in the nursing home industry did, however, see progress in the last few weeks: The vaccination rate was now above 90 percent, when it was about 80 percent earlier in September. James Nyberg of LeadingAge RI, which represents nonprofit providers of aging services, said that could be partly attributed to the vaccine mandate. Nyberg also cited that the state Department of Labor and Training has indicated if people lose their jobs for failing to follow reasonable COVID-19 vaccine requirements, they won’t be eligible for unemployment.

“If people were still waiting to see what happened, that might have nudged them,” Nyberg said.

Still, hundreds remained unvaccinated, leading to concerns.

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“Any loss of staff would just exacerbate the problem,” Nyberg said.

Rhode Island’s COVID-19 vaccine requirement for health care workers is just one of a patchwork of regulations that employees will have to navigate. The Biden administration is also in the process of rolling out rules in health care settings. Those are expected to be issued in October, though they may not go into effect right away. The Biden administration is also developing rules to require employers of more than 100 people to ensure their workers are vaccinated or face weekly testing.



Alexa Gagosz can be reached at alexa.gagosz@globe.com. Follow her on Twitter @alexagagosz. Brian Amaral can be reached at brian.amaral@globe.com. Follow him on Twitter @bamaral44.