CT hospitals are requiring staff to get vaccinated against COVID. Will other health providers follow?

Connecticut’s 27 acute care hospitals are moving to adopt a policy requiring staff members to be vaccinated against COVID-19, following dozens of other hospitals and health systems nationwide that have implemented the mandate.

The edict gained momentum last month after a federal judge dismissed a lawsuit against Houston Methodist that challenged the hospital’s vaccine requirement for workers. Houston Methodist was one of the first hospitals in the U.S. to mandate that staff be inoculated against the coronavirus. One hundred and seventeen unvaccinated employees brought the suit, saying it was illegal for management to demand that workers get the shot.

The dismissal cleared the way for many others to implement the requirement. Hospitals in New York, Massachusetts, Maryland, Indiana, New Jersey, Pennsylvania and other states have imposed the rule. And it has raised questions about whether other health care facilities, such as nursing homes, federally qualified health centers, private practice physicians and community clinics, will be compelled to join them.

In Connecticut, discussion around the policy began two months ago and culminated recently in an announcement by the state’s hospital association that all of the facilities would soon require COVID-19 vaccinations for their staff. The move was agreed upon by hospital leaders.

“There are some patients now who are asking, ‘Is everyone coming in and out of my room vaccinated? Are the clinical staff vaccinated?’ Certainly it’s a concern for patients,” said Paul Kidwell, senior vice president of policy for the Connecticut Hospital Association, which is helping to develop the mandate. “We want to be able to tell our patients that we’ve done everything we can to make sure they are protected from COVID.”

The effort comes as the highly contagious Delta variant gains a stronger foothold in Connecticut and elsewhere. Researchers at Yale estimate that 10% to 20% of the state’s cases now are the Delta variant.

While the rate of new coronavirus cases and deaths has slowed Connecticut, health officials are watching the variants closely.

“Our transmission rate is very low, and our hospitalization rate is very low, but we do need to keep our guard up against the variants,” Kidwell said. “The best way to protect all of us and keep our patients safe is to get as many people vaccinated as possible.”

Hospital administrators and the association have not yet revealed when the policy will take effect and what the deadline will be for workers to get vaccinated. The precise requirements may vary slightly among hospitals, but all will mandate that workers be vaccinated, Kidwell said.

Details, concerns
While details of the policy are still being firmed up by hospitals, the edict will likely apply not only to clinical staff, but to everyone who works in a hospital or related health system, officials said, even if workers are not interacting with patients.

Still under discussion is whether the requirement will extend to contractors who work with the hospitals.

At Bristol Health, which is finalizing its policy, managers say they will require some contractors to be vaccinated.

“For those that are predominantly in our locations on a frequent basis – either on a daily basis or multiple times on a weekly basis – they will be required to be vaccinated as well,” said Christine Laprise, vice president of human resources and administrative services for Bristol Health.

The company will offer medical and religious exemptions to employees, though workers who select an exemption will be required to continue wearing a mask. Bristol Health has a similar policy for staff who claim an exemption to the flu shot.

About 75% of the health system’s 1,700 workers are currently vaccinated, and Laprise said all staff members have been put on notice about the upcoming policy. An online system already in place allows workers to upload their vaccination cards into their employee profiles.

The company is working with staff who are reluctant to get vaccinated.

“Some people are still concerned about long-term effects. We see a much smaller population than originally, but some women of childbearing age are still concerned about getting the vaccine,” Laprise said. “Education in general has really helped dispel some of the concerns.”

The Yale New Haven Health system is considering what type of exemptions it may offer for staff, but managers say they will be more discerning over exemptions for medical workers.

“For the flu vaccine, there was one [exception] if you were allergic to eggs or if you had Guillain-Barré [syndrome]. But neither of those plays into this because the same materials weren’t used to make this vaccine,” said Marna Borgstom, the health system’s CEO. “As far as personal or religious objections, we have not yet decided what that process will look like or how we will handle them. But I do think it’s safe to say it will be hard to have people who are exempt from the vaccine in direct patient care.”

Tom Balcezak, the chief clinical officer, said patients and their families have occasionally been asking whether employees there are vaccinated. About 81% of the 28,589-member staff have been inoculated against COVID-19.

The health system still has a universal masking policy and testing available.

“We have a number of different safety measures in place,” Balcezak said. The vaccine mandate “is one more step we are going to take in the next week or two to make sure we are protecting our staff, our patients and our visitors to the greatest extent possible.”

“I would hope that individuals working in health care would want to do everything they can to protect their colleagues, themselves, and most importantly, the patients and families that we care for,” he said.

For now, hospital administrators say they are not worried about staff departures when the vaccine requirement goes into effect. After Houston Methodist’s policy was adopted, 153 workers resigned or were fired from the health system for non-compliance.

Although 24,947 employees there did get vaccinated by earlier deadlines, Houston Methodist suspended 178 workers who failed to do so on June 7, giving them an additional two weeks to prove they had been immunized, the Washington Post reported. Twenty-five of those staff members got vaccinated.

“Houston Methodist has over 20,000 employees, so the rate of individuals who decided to leave the organization or were let go is extremely small. The vast majority of individuals in that network decided to become vaccinated,” Kidwell said. “That’s what I think we will see in Connecticut. Once the requirement is laid out in additional detail, I think we’ll see that our employees respond to it and will get vaccinated.”

As hospitals prepare to impose the order, health officials say the move may put pressure on other providers to adopt similar policies. Some nursing homes, federally qualified health centers and other facilities already require coronavirus vaccinations.

“It clearly sends a message that health care organizations believe the right thing to do is to get vaccinated and to protect yourselves and others,” said Rob Rioux, chief operating officer of the Community Health Center Association of Connecticut. “What individual organizations elect to do, I don’t know. But it wouldn’t surprise me if they moved in that direction.”

A ripple effect?
In June, Mark Masselli, president and founder of Community Health Center Inc., the state’s largest network of federally qualified health centers, decided his organization would require the COVID-19 vaccine for workers.

The group is one of few FQHCs in Connecticut to impose the mandate, but Masselli said he felt it was the right thing to do. Workers have until the end of August to be fully vaccinated.

Community Health Center is offering medical and religious exemptions to employees, and allowing others, such as mental health staff who conduct telehealth appointments, to work from home.

Last week, Masselli extended the policy to any contractor who works with CHC. About 80% of the organization’s 1,500 employees are fully vaccinated, and another 10% are partially immunized or have their first appointment scheduled.

“We’re trying not to say it’s our way or the highway, but it is an important public health statement for us to make,” Masselli said. “It’s important for organizations to do it, but also to be sensitive. There are people we work with who have questions and we should acknowledge them and respect them and try to figure out ways that we can work through this.”

Whether the state’s 16 other FQHCs will follow suit remains to be seen, though some facilities have taken steps to explore imposing the mandate.

“A lot of them verbalized to us that they are adopting a wait-and-see approach,” Rioux said. “Some of them have also engaged legal counsel and HR staff to navigate those waters before a decision was made. I don’t know if any of them have arrived at a decision at this point.

“I think every health center in all parts of the country are wrestling with this issue.”

News of hospitals requiring the vaccine has turned a spotlight back on nursing homes, where 3,881 residents have died of coronavirus and 14,121 have been infected since the pandemic began.

Industry leaders say that while a few nursing homes have adopted a vaccine requirement, many others haven’t because of staff shortages. For months, the facilities have had difficulty recruiting and retaining workers. Amid the pandemic, nursing homes have lost candidates to jobs in less risky or better paying professions.

A study by the American Health Care Association and National Center for Assisted Living in June found that 94% of nursing homes and 81% of assisted living facilities surveyed had a staff shortage in the last month. The organization defines staff shortage as meaning that on more than one occasion a facility could not fill all shifts without asking employees to work overtime or extra shifts, or without resorting to a temporary staffing agency.

The group surveyed 616 nursing homes and 122 assisted living facilities across the country. More than half of the facilities are actively trying to fill vacant positions for certified nursing assistants, licensed practical nurses, registered nurses, dietary staff, and housekeeping, the study noted.

Industry officials in Connecticut worry that adopting a vaccine mandate would make the staffing problem worse.

“There remains vaccination hesitancy among nursing home staff. And so there is a concern that a number of nursing home employees will refuse the vaccination, and under a mandatory program they would have to be terminated, or prospective employees won’t take the job if it has vaccination requirements,” said Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, which represents more than 140 of the state’s 211 nursing homes.

He estimated that about 65% of Connecticut’s 26,000-nursing home employee workforce has been fully vaccinated.

Volatility in this job market is the reason Barrett said his organization is holding off on endorsing a policy to require the immunizations. He pointed out that more than 90% of nursing home residents have been inoculated against COVID-19.

“I am aware that some nursing homes are adopting a mandatory vaccination policy, but it’s not the position of the Connecticut Association of Health Care Facilities at this time,” Barrett said. “The main reason is there’s a concern over the vaccine and its impact on staffing.”

At least one nursing home has adopted the mandate with little impact to staffing so far. Masonicare, which owns a nursing home in Wallingford and three assisted living facilities in Connecticut, imposed the rule in December, shortly after the first shipments of coronavirus vaccine arrived in the state.

President and CEO J.P. Venoit gave workers six months to get the shot; the deadline to be vaccinated was June 30. For those who have received a first dose but not a second, he is giving them an additional two weeks to complete the vaccination. He estimated that fewer than 10 of his workers have left because of the edict, and he expects fewer than 10 more to leave soon because they missed the June 30 deadline. Masonicare has about 1,700 employees across its system, which also includes independent living communities and home care.

“The hard decision was stepping out there. The easy decision was, it was the right thing to do,” Venoit said. “In my heart and among our executive team, nobody wavered.”

Administrators at three other nursing homes have contacted him to inquire about Masonicare’s policy, and Venoit has walked them through it. He believes other companies will begin to adopt similar requirements, especially after the hospitals’ announcement.

“We may have been one of the first, but I think more and more are jumping on,” Venoit said. “We’re getting calls from other nursing homes and other health care organizations that are going to start doing it. I think there’s a snowball effect. You’re going to see more organizations require this as a condition of employment.”