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Not enough staff members in skilled nursing facilities here vaccinated against COVID-19

STORY BY MICHELLE GENZ (Week of July 29, 2021)

One year ago, when Sea Breeze nursing home had nearly 60 cases of COVID-19, Laura Graves was desperate to transfer her chronically ill mother out of there. But before she could, her mom too tested positive. Unlike eight others at Sea Breeze who died, Graves’ mom had few symptoms and recovered.

Today, Graves gets to visit her mom – masked and in a special visiting room – at Consulate Healthcare, where her mother moved last April. She is happier, Graves said, and getting good care. As for COVID-19, Graves is convinced that her mom’s infection gave her lasting immunity.

That would be fortunate for her. But it doesn’t help the rest of Consulate’s unvaccinated residents – a number that is nearly half its current census. According to federal data from mid-July, at Consulate, only 56 percent of residents have been fully vaccinated and only two out of every 15 staff members.

The data comes from a federal CMS database that began publishing biweekly nursing home COVID data last month.

That new federal report is a much-needed source of information. Just as the delta variant whips the still widely unvaccinated Indian River County into a fearful frenzy again, the state of Florida has stopped publishing counts of COVID-19 in long-term care facilities, schools and prisons – three potential hotbeds of contagion.

Unfortunately, the federal report does not include data about cases in assisted living facilities, making the gap in COVID information even larger.

Consulate’s local and corporate management did not respond to multiple requests for information. 

If the federal figures are correct, Consulate, where 27 people died out of the 180 people infected with the coronavirus over the course of the pandemic, has by far the lowest staff vaccination rate in the county.

Three other facilities have staff rates in the 60-percent range – Florida Baptist, Willowbrooke Court at Indian River Estates, and  Palm Garden, according to the report. A Willowbrooke spokesperson said vaccinations there now are over 70 percent.

Staff vaccination rates at two other nursing homes – Sea Breeze and Orchid Cove, formerly Grace Rehab – were only around 28 percent, though Orchid Cove has a high percentage of vaccinated patients – 98 percent, the same as Willowbrooke. Florida Baptist reported 100 percent vaccination of its residents.

And the one skilled nursing facility within a hospital – Steward Sebastian River Medical Center’s transitional care unit – showed a staff vaccination rate of 44 percent.

Those numbers combined brought the average staff vaccination rate among Indian River County’s seven skilled nursing facilities to 42 percent, the same abysmal rate as the Florida average. That mid-July statewide rate, publicized last week by AARP, was nudging out Louisiana and Mississippi for worst in the nation.

Skilled nursing centers share in part the same labor pool as clinics and hospitals. That pool of workers has been drying up since the pandemic. As a result, one of the biggest concerns surrounding the notion of a vaccine mandate is the fear of workers leaving.

“There is no doubt that unvaccinated staff at assisted living, nursing home, and medical facilities pose a risk to residents and patients,” said Dr. Gerald Pierone, founder of Whole Family Health Clinics and an infectious disease specialist. “The dilemma of many facilities is that staffing will likely suffer if vaccines are mandated.”

And inadequate staffing poses its own risks, he continued. “I don’t know which is worse, inadequately staffed facilities or unvaccinated staff.”

Graves, like her mother in Consulate, is not vaccinated. Neither are her seven children, the two youngest of whom regularly visit their grandmother – they all put on masks and meet in a designated visitation room.

Graves believes it is her mother’s choice whether to be vaccinated and boost whatever immunity her infection imparted last summer, as the CDC recommends.

She also believes it should be the choice of staff whether to get vaccinated. She understands that other residents may be at risk, but she believes imposing a vaccine mandate, even if only on new hires, would invalidate an employee’s right to a choice.

There is hardly time to debate, it seems. Things are changing rapidly. Cleveland Clinic Indian River Hospital had just begun allowing its handful of COVID-19 patients to have visitors July 1, as COVID-related hospitalizations were in decline. Two weeks later, on July 16, that policy was rescinded. COVID-positive patients can no longer have visitors, and visitors to other patients are now limited to two people.

A week ago, Treasure Coast Community Health’s low-cost clinics began requiring masks again after dropping the rule in mid-May. Masks are required of patients, visitors and staff regardless of vaccination status at all eight of the system’s clinics.

TCCH offers the vaccine to employees, but there is no vaccine mandate, said Vicki Soule, the system’s CEO.

“The new variants are more contagious than the original strain and none of the vaccines is 100 percent,” said Soule. “OSHA (the federal Occupational Safety and Health Administration) has new temporary emergency requirements to protect employees – which we had already done, and then some.”

Pierone said his clinics have not mandated vaccination, either, though staff members continue to be vaccinated. The rate is up from the 60 percent in March, he said; another 20 percent of staffers have recovered from COVID-19 infections, imparting some degree of immunity.

“One of our highest priorities is to achieve 100 percent staff vaccination and/or immunity rates,” Pierone said. “It remains a work in progress. I do believe that when the vaccines receive full FDA approval – soon, hopefully – that more medical facilities will phase in mandatory staff vaccination requirements.”

That approval, when it comes, will trigger mandatory vaccination policies in dozens of hospital systems that have already committed to a mandate once a COVID-19 vaccine wins approval.

Others have already put in place such a policy. Last week, the American Hospital Association came out strongly in support of health systems mandating vaccination, as the list of hospitals with mandates grew to 50, including Mass General Brigham with 80,000 employees, and Banner Health, with 52,000. Also on the list are prestigious academic hospital systems including Yale, Wake Forest, Duke, UNC and University of Chicago.

Cleveland Clinic has not yet imposed a mandate.

As for assisted living facilities, at least one large community, the Isles of Vero, is requiring vaccination of all new employees as well as new residents, according to Wayne Chapman, director of nursing. “We’re at 100 percent vaccination of our residents,” he said. The rate of staff vaccinations was not available, he said.

At the end of May, the state released its last published reports of COVID deaths in long-term care. As if tying a black ribbon of mourning around the pandemic, it showed a seemingly final tally of 81 deaths in the county’s nursing homes due to COVID-19.

Three of those deaths were among staff members.

Another 39 died in assisted living facilities, including 10 at The Brennity, and seven each at Rosewood and Harbor Chase.

Last month, Florida became the first state in the nation to abandon daily COVID reporting.

State-run testing and vaccination sites have also been closed. Those services are now left to individual counties, along with private physicians and pharmacies. Last week, the only vaccination site listed on the Indian River County website is July 29 at the Salvation Army center.

“Sadly, we haven’t seen an increase in demand for the covid shots, with one exception – a grassroots effort is beginning again in Gifford,” said Soule. Treasure Coast Community Health runs the Gifford Health Center. 

Soule said that lately the TCCH branch at the United Against Poverty center has been vaccinating 10 to 20 people a week. CVS, Walgreens and Publix continue to offer the COVID vaccine. And the health department holds walk-in clinics twice a week.

One vaccination success story marks a change of direction for a care center that suffered high COVID-19 losses last year. Palm Garden, where 120 people suffered through COVID-19, sees the campaign to get everybody vaccinated who can be vaccinated as a matter of positive change. “We’re excited about it,” said director of guest services Lilliana Meadow.

“We’d like to open up as a community vaccination center,” said Robert Reed, director of nursing at Palm Garden and an ardent backer of vaccination.

Last November, Reed went through a bad case of COVID-19 that landed him in the ER three times, caused him to develop diabetes and left him with a lung condition.

As soon as the vaccine became available, he got in line. “If I could get vaccinated again, I would,” he said.

“Do we want sick staff? Do we want sick residents? No, we do not. If you’re the state with the highest rate of new cases in the country, if we have an explosion in this county, you have to stay on top of it.”

Reed said the facility’s campaign involves regular rounding with residents, and that the education of staff is constant. “We have morning meetings, evening meetings, town halls.

“We are constantly handing out information to families. We want everyone in the community to know about [the importance of being vaccinated].”

Reed, who puts his staff’s vaccination rate closer to 80 percent than the 59 percent reported by CMS, said the motivation to raise the vaccination rate “comes down from a positive corporate leadership and CEO.”

“When you’re constantly encouraged, not hounded and forced to, it becomes a very positive thing,” Reed said. “It’s almost become like a fun challenge to get that accomplished. It’s not a heavy weight that you’re bearing.”