The Biden Adminstration’s latest gambit to combat Covid by increasing vaccination levels among nursing homes’ staffers via coercion shows a lack of appreciation of what is at stake. If this works at all, it will be in the nature of “Burn the village to save it” in too many instances.
As I wrote to or Covid brain trust:
Oh, this is going to work well. All stick no carrot.
94% of facilities already have staff shortages.
Of the 40% not vaccinated, not a hard guesstimate that at least 10% will quit. Can they take another 4% staff loss?
IM Doc replied: “Put simply – no”
Now let’s go through this situation in more detail. First, the Biden policy, according to the Associated Press:
President Joe Biden on Wednesday announced that his administration will require that nursing home staff be vaccinated against COVID-19 as a condition for those facilities to continue receiving federal Medicare and Medicaid funding.
Biden unveiled the new policy Wednesday afternoon in a White House address as the administration continues to look for ways to use mandates to encourage vaccine holdouts to get shots.
“If you visit, live or work in a nursing home, you should not be at a high risk for contracting COVID from unvaccinated employees,” Biden said.
Let us put aside for the moment that Biden is not “following the science” in the framing of this policy. The reason to get vaccinated is to lower the odds of getting a bad case of Covid. It would be perfectly reasonable to push for higher levels of vaccination in any workplace where employees are in close physical proximity with each other and with patients/customers, to keep them from getting sick and overloading hospitals. Covid-jammed hospitals have all sorts of bad knock-on effects, like delays in administering ER care, staff Covid cases, burnout and resignations, postponement of elective surgeries, and higher medical system costs due to all of us indirectly paying for Covid care costs via medical system costs (the piper has to be paid somehow).
The evidence is not as strong as vaccine proponents would like to believe that the current vaccines prevent the transmission of the Delta variant, as a new UK study suggests, confirming the CDC finding in Provincetown of similar levels of Covid virus in the nasal passages of the vaxxed and unvaxxed in Provincetown:
?Fully vaccinated people carry the same amount of Covid as the unvaccinated, scientists have found in a new study.
The study calls into question the effectiveness of vaccine passports https://t.co/GChFtbufm4
— The Telegraph (@Telegraph) August 19, 2021
In other words, “We can’t afford to have you wind up in the hospital and your patients can’t afford to have you in the hospital either” is a more honest sales pitch, and also appeals to self interest. But weirdly the officialdom has been consistently unwilling to go there.
The Associated Press makes clear that this new policy is intended to be coercive:
It comes as the Biden administration seeks to raise the costs for those who have yet to get vaccinated, after months of incentives and giveaways proved to be insufficient to drive tens of millions of Americans to roll up their sleeves.
But the coercion is applied to the wrong party. This use of the Medicare/Medicaid funding stick is what is called an unfunded mandate. Nursing homes are supposed to behave differently, as in find out who is unvaccinated among their workers (and not just nurses and other attendants, but also kitchen staff, cleaners, and clerks) and fire them. As we indicated at the top of the post, just shy of 60% of nursing home personnel are vaccinated, which is just about on par with the overall level of vaccination in the US. That contrasts with the 80% vaccination level of the residents.
Moreover, these nursing homes collectively have only that 60%ish vaccination level despite many having tried hard to get more workers to take the jab. They have extremely strong incentives to do so. Nursing home residency fell during Covid due to the (correct) perception that being around a lot of other people isn’t terribly safe. Being able to say you have a high vaccination rate among residents and staff would reassure some fence-sitters, or sway them to pick your facility over a competitor’s. Nursing home occupancy fell 10% from December 31 to end of May 2020 alone due to deaths and a big drop in new admissions. It continued to fall in 2020 to a national occupancy rate of 69.2% at the end of January, down from the pre-Covid level of 84.6%, and was starting to recover.
And even with shrinking populations, the workforce had also fallen, in no small measure due to Covid concerns. From Skilled Nursing News as of this June:
Of 616 nursing homes surveyed by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), 94% said they are experiencing a staffing shortage.
Nearly three-fourths of respondents indicated that their workforce situation has worsened compared to 2020, largely due to higher turnover associated with the COVID-19 pandemic. Facilities are actively trying to hire across the board, including registered nurses, licensed practical nurses (LPNs), certified nursing assistants (CNAs), dietary staff and housekeeping.
While operators could make headway on these shortages if they offered better pay and benefits as incentives, 81% said that higher reimbursement from payers is necessary to support those actions.
Do not assume these nursing homes are poor mouthing without justification. From another article in Skilled Nursing: “”So the question is: do we get back to our baseline (pre-COVID) operational reality; median operating margin of 0.0%..'”
So again, the Biden Administration only thinks it is coercing those refusnik staffers. It’s actually coercing the nursing homes, who are already having trouble attracting and keeping staff. And nowhere do I see any plan to increase Medicare/Medicaid reimbursement rates, which would allow these facilities to pay more and hire more staff, both to fill the gaps they now have plus the ones that will result when they tell employees, “No jab, no job”.
Let’s look at a few of the cohorts that are on the vaccine hesitant to anti-vax spectrum that have good odds of quitting:
Reproductive age women who’ve heard of cases menstrual period disruption post vaccination. The CDC has simply ignored this issue, which doesn’t engender confidence in women who’ve heard about these problems. The lack of interest reeks of gender and class bias. Well off women could store their eggs before getting a shot and then get IVF later. Or they could afford a fertility doctor if they had issues, whether or not due to the vaccination. Lower income women don’t have these fallbacks.
And these changes are frequent enough to not be “rare” (like the roughly one in a million J&J blood clots) even if not common. And they are in many case alarming. From WBRC last month:
Katharine Lee noticed changes in her menstrual cycle not long after getting her COVID-19 vaccine….
“When we were going through ethics approval, Katie and I had a discussion about how many people we anticipated would participate and the number we put in was 500 and that was being optimistic,” said Kate Clancy, PhD, Director of Graduate Studies, Associate Professor of Anthropology, University of Illinois. “We hit 500 I think in the first couple of hours and in fact, were in the thousands within 24 hours.”
Their research survey launched a few weeks ago and has nearly 130,000 replies from women sharing their menstrual experiences after vaccination…
Among those people, just broadly what we can say, is for the most part their experience is that their period is heavier, but we do also see some people with lighter periods, and really the most important finding for us, is not just looking at the experiences of people who are currently menstruating, but looking at people who are not currently menstruating.”
Clancy said women who are on-long active contraceptives or women who are postmenopausal are reporting breakthrough bleeding.
Some experts (of course men!) have tried to depict these results as stress-driven, but stress if anything leads to late and/or light periods, not early and heavy ones. And since when do post menopausal women have heavy breakthrough periods?
Even some of our male readers have heard about this syndrome. From Isotope_C14:
With the quality of data being collected by CDC and VAERS I don’t know how any person could hang a flag to either side…
Anecdotally, all the girls that run the bar that I shouldn’t go to have incredibly whacked long-term symptoms. All of them are under 30. Most of them are having bizzare menstrual problems. One, who is utterly adorable and reminds me of a young Terry Farrell hasn’t had her time of the month in 55 days.
He also mentioned how odd it was to have women who were just a bit over half his age tell him about their periods, which he took as an indicator of how much it was on their minds.
An MD (yes confirmed as an MD), sent his examples via e-mail:
I have 2 young women in my practice – both robustly healthy late 20s. Both were vaccinated in the spring and have not had a period since. Multiple OB GYN evals and hormonal evals. Absolutely nothing showing up wrong. OB GYN is really concerned – never seen this before. Now that it has been 4 missing cycles – both will be having hysteroscopy this next week. Both of these young women really want to be mothers – and are OUT & LOUD with all their friends and coworkers about this issue. And they wonder why there is hesitancy? Most people who want to have kids will gladly tell the boss to take the job and shove it – and they are.
Religious objectors. Even though nearly all national church leaders are urging members to get the shot, there are still congregations and individuals that don’t buy in. Some still believe the debunked idea that the vaccines were made with stem cells. Some particularly hard-core evangelicals see the vaccine requirements such as vaccine passports as the Mark of the Beast, so for them getting a shot would condemn them to hell.
Anti-vaxxers or serious vaccine doubters. Despite the stereotypes, these are not all or even mainly Bubbas. As we’ve described, the ground zero for the anti-vax movement was Northern California, and it has significant funding from individuals in the private equity industry who believe in it. Similarly, I know a top professional, highly paid, better traveled and cultured than I am who is getting out of New York as quickly as possible because there’s nothing for him to do there any more in light of the requirement to be vaccinated to go to museums and restaurants and shows (a mere same day clean test won’t do).
And of our four aides, who are the closest demographically to nursing home workers of all the people I know, only one has been vaccinated, and that’s because we dragged her to Publix. One of the non-vaccinated CNAs is 30, had Covid, and might get a vaccine but is nervous about all of the people she knows who’ve had side effects. Odds are 50/50 she’ll get a shot. One CNA is in her early 40s, very religious, and keeps her views to herself, so I don’t know her reasoning. The third, a 67 year old retired hospital tech, is PMC in her presentation (extremely well spoken and put together, and a vegan). She is highly resistant but I don’t understand exactly why. It seems to boil down to mistrust of the testing and the messaging.
It’s not hard to imagine that these groups could easily account for 10%, if not more, of the vaccine non-takers at nursing homes. It’s not hard to imagine that those those who have or can create other employment or survival options will avail themselves of them.