NAHC President: Providers Navigate Vaccine Mandate Uncertainties

Hospices have mounting concerns that their employee ranks may thin as staff weigh vaccinations during ongoing workforce shortages, even as they strategize to keep workers, patients and families safe. In addition, some are seeing potential complexities in ensuring compliance with the new requirements.

Eligible staff at health care organizations that participate in Medicare or Medicaid will be required to be fully vaccinated prior to providing care, treatment or services by Jan. 4, according to recently issued emergency regulations from the U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Occupational Safety & Health Administration (OSHA). The CMS rule applies to all organizations, regardless of size, requiring them to implement a vaccine policy by Dec. 5.

Though most health care employees have chosen to get vaccinated rather than leave their jobs, providers can expect turbulence in an already shallow workforce pool, according to William Dombi, president of the National Association for Home Care & Hospice (NAHC).

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“We can anticipate that there’s going to be a bit of a bumpy road in the near term relative to these mandates in terms of workforce,” said Dombi during NAHC’s recent Fall Forum. “You’re scrambling to figure out where this goes. You’re continuing to face staff reluctance, particularly among home care aides.”

Roughly 30% of the nation’s health care personnel were unvaccinated for COVID-19 as of Sep. 15, according to a recent report from the American Journal of Infection Control, which analyzed data from the U.S. Department of Health and Human Services.

The potential loss of staff due to a vaccine mandate comes at a time when workforce shortages abound across the nation’s health care system. While hospice providers worry about the potential for losing employees, some stakeholders contend that the mandate would “level the playing field.” Staff would be less likely to leave for a health care position at a company with no vaccine rule if all organizations are held to the same standard.

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The mandate does, however, come with a few loopholes. Dombi said that states that implemented mandates received “no shortage” of health-related or religious exemption requests, indicating that similar push back will likely be coming with the federal mandate. This leaves a lot of the decision-making at the providers’ discretion, according to Dombi.

“What we’ve seen in states where they have already mandated vaccinations for health care providers is that there is no shortage of both health care and religious belief exemption requests that will be coming,” Dombi said. “There are questions about how far CMS could go and mandating vaccinations for staff that do not have contact with patients.”

Employees can be exempt based on recognized medical conditions or religious objections. CMS has not issued a list of specific conditions, indicating that employers should look to standards from the Equal Employment Opportunity Commission..

The CMS mandate excludes many community- and home-based providers, though some are still subject to it based on which state they’re operating in, Hospice News sister publication Home Health Care News reported. This has created an issue that providers will need to keep their eyes on, according to Dombi.

Enforcement of the vaccine mandate will come through a hospice’s survey and Medicare certification process. Providers may receive publicly reported citations of noncompliance, which ultimately could lead to termination of the provider agreement and intermediate sanctions in severe instances.

“We hope that we can get some degree of finality on the myriad of existing and pending vaccine rules. The current situation of uncertainty is an untenable environment for the home care community,” said Dombi in a statement shared with Hospice News.

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