Colorado’s long-term care facility administrators are concerned about the alarming number of their staff who are refusing the coronavirus vaccine, reigniting a debate over whether workers can be required to get the shot.  

There are no official statistics kept by federal or state agencies, but anecdotal numbers from the state’s largest health care trade organization, the Colorado Health Care Association, indicate that only 50% to 60% of Colorado’s nursing home and assisted living staff have received the COVID vaccine, while all but 10% of nursing home residents have. 

Last week, the group launched a campaign to fight vaccination hesitancy among geriatric health care workers with a series of educational Zoom calls to answer questions from state nursing home leaders.

“Half of the people in my assisted living facility are refusing to get the vaccine. What now?” a Zoom listener only identified as “Maggie” typed in a chat line. “I have bombarded them with vaccine info.... We are even offering incentive days off.”

Travis Neill, a Geriatric Physician Assistant with Forte’ Health and Wellness consulting on the Zoom, advised Maggie that educating non-vaccinated staff is the best way to get her workers to change their minds. 

“We are afraid of things we don’t understand. But that doesn’t solve the problem of half your staff refusing it,” he advised.

The next day, Maggie reported a drastic attitude shift among her employees after showing them the information she gathered from the Zoom education: support for the new vaccine increased among her staff from 50% to 95%.

“Those low vaccination rates among nursing home staff are certainly something we want to see improve,” said Doug Farmer, CHCA President and CEO. Part of the challenge, Farmer says, is that workers are not quarantined inside the facility. “After work, they go home. They go to the grocery store or to doctor’s appointments or to the gas station. If there are people infected in their community, the likelihood that staff gets exposed to it or brings it back to a nursing home or assisted living goes up.”

Neill has little patience for anyone who works in an elder care facility and refuses a vaccine, other than for medical reasons. “It is alarming. Those of us who work around the frail and very vulnerable population have a duty to do whatever we can to protect them,” he said. “It’s less a personal decision of what we want than it is a decision to protect those who we work for.” 

Still, nursing home leaders point to the fact that employees must be tested once and sometimes twice a week for the virus. They wear PPE at all times and social distance when they can. Still, despite those safety precautions, Neill said it’s not enough. “I’ve seen COVID enter a building and spread across the entire population with resident after resident coming up positive,” he said.

More infectious strain in homes

The issue has attracted more urgency since all three CDPHE-confirmed cases of the UK variant strain B.1.1.7 were found in Colorado among people who were working in nursing homes: two National Guard members called in to help at The Good Samaritan Society in Simla and a third, plus a possible fourth, in staff who worked at the Colorado State Veterans Home Fitzsimons. 

A fifth case was confirmed Wednesday by CDPHE out of a Boulder private lab; it is not yet known how this person contracted the virus or if they have a connection to healthcare facilities. 

The variant is now in at least nine states, but it was found first in Colorado. Dwayne Smith, Public Health Director for Elbert County, where the first variant was discovered, told Colorado Politics that CDPHE has not identified the more contagious strain among staff or residents at the Simla facility where it was first detected. 

The Centers for Disease Control reports that eight of 10 COVID-19 deaths in America are among those 65 years and older. The higher the age group, the numbers get more dire. Americans over 85 years old are 630 times more likely to lose their lives to the virus than those who are age 18-29. 

Less than 1% of America’s population lives in long-term care facilities, but according to The Atlantic’s Long Term Care COVID Tracker, 37% of that number accounts for all of the country’s deaths from the virus.

In October, the Pharmacy Partnership for Long-Term Care Program with CVS and Walgreens, which would vaccinate facilities residents and staff at no cost, was announced by the Trump administration. The first vaccinations were administered in Colorado on Dec. 28.  

A Walgreens spokesperson said it will complete giving their first doses to nursing homes by Jan. 25. 

When asked how many Colorado LTCF staff members opted not to receive the vaccine, CVS Director of Corporate Communication Joe Goode, wrote Colorado Politics in an email that they don’t have access to that kind of information. 

“We do not have visibility to how many staff members at a facility decline to be vaccinated,” Goode said. “While we aren’t provided with full staff rosters, based on feedback from our teams in the field, we’re seeing more vaccine hesitancy among staff when compared with residents.”

No COVID vaccine mandate

Medical staff in hospitals and those who work in long-term care facilities can refuse the vaccine for any reason, but so far in Colorado, hospital personnel are more willing to receive it than people who work in care facilities. A CDPHE spokesperson emailed Colorado Politics that they have only received one official report of vaccine refusal in Colorado from a hospital employee. “Currently, approximately 85% of Phase 1A healthcare workers have been vaccinated.”  

This is compared to the 40% to 50% of long-term care staff who are reportedly refusing to get the vaccine. University of Colorado bioethicist Matthew Wynia says he has done a breakdown to learn more about the people who are refusing the vaccination.

“It tends to not be the clinicians,” he said. “It’s not the doctors and nurses. It’s the MAs and front desk and folks. And maybe, more importantly, these are people who have less control over their schedule, who may not be able to take time off, or are able to get child care.” 

Currently, health care workers can refuse the COVID vaccine without having a reason because it falls under federal law governing Emergency Use Authorization status; however, there may be consequences to doing so and the law does not specify what those consequences are. 

The Equal Employment Opportunity Commission unfolded new pandemic guidelines on Dec. 16, saying that employers can mandate vaccines, but added a number of caveats for that refusal, including medical disabilities and religious beliefs.

Theresa Wrangham, executive director of the National Vaccine Information Center, which advocates against vaccination mandates, says the public often share stories with NVIC about feeling coerced and pressured to be vaccinated. 

“Whether it is the COVID vaccine or the flu shot, the decision to vaccinate should always be voluntary.” she said. “Health care workers and other employees shouldn’t be punished for their vaccination decisions. The decision to vaccinate must be voluntary and free from coercion and sanction.”

Wynia told Colorado Politics that one of the most common reasons health care workers have given about receiving the new vaccine is that it has been an emergency rollout, and they feel it hasn’t been tested enough. 

Further, nursing home leaders say some staff are getting misinformation from the internet and from state and national authorities whom they said have political agendas.

Wynia said he believes that although there’s no mandate for healthcare personnel to get the vaccine now, there is a good chance it will be required once it evolves from the experimental stage. 

“Once the vaccine has full approval you will start to see not just nursing homes but probably other businesses start to require people to have the vaccine to do business,” he said.

Neill said he wants to see the day that all healthcare workers who are not medically at-risk inoculated against the virus, but he does not think a mandate will work. Instead, he would prescribe a softer approach involving educating workers and walking in their shoes. 

“COVID has turned this into a nightmare. The stress and strain that nursing home staff are under to not only protect residents while they fear for their own health and lives, but also the work it takes to get tested every week and constantly wear PPE … it’s overwhelming. I’d like to see the more compassionate approach to their problems. We need to recognize that we’re in this together.”

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