With nursing home cases up, officials mull mandates
Less than 30 percent of nursing home staff in Connecticut had received a COVID-19 booster shot as of mid-December, according to state data, and as the number of COVID cases among both residents and staff continues to grow, some providers are wondering whether a booster mandate is needed.
With the omicron variant expected to become dominant, providers are hoping to avoid another wave of infections among nursing home residents, who have already borne the brunt of previous COVID waves.
In a meeting this week, DPH officials told providers that only about 29 percent of long-term care staff have gotten a booster. The percentage of residents who have had a booster is about 80 percent. That number has increased recently because the state made a concerted effort to hold a clinic at every facility by Dec. 15.
Data released Thursday show just how quickly the number of cases is growing. As of Dec. 21, the state had recorded 136 cases among residents and 242 among staff, compared to just a week earlier, when there were 66 cases among residents and 76 among staff.
On Thursday, the state’s positivity rate was 9 percent, and hospitalizations had increased by 16 to 837. In the previous two weeks, there had been 75 deaths, and 13 of them were long term care residents.
The infections have been on the rise since early November, according to DPH data. Staff cases have quadrupled since the end of November and cases among residents have more than doubled.
“Just 120 days ago, the governor mandated vaccines in nursing homes. We went from 70 percent vaccinated to 98 percent in a matter of weeks,” Paul Liistro said.
Some employers are mandating booster shots for staff
Liistro is the CEO of Vernon Manor and Manchester Manor and is one of only a handful of providers that has mandated that his employees get booster shots. Liistro said the clock is ticking because many got their initial two doses more than six months ago – meaning the efficacy of the vaccine is waning just as omicron is about to hit.
“He (Lamont) needs to mandate vaccines in nursing homes now. One can always do something a day too soon but not a day too late,” Liiistro said.
One of the other providers that has mandated vaccine boosters for staff is Masonicare of Wallingford, one of the largest facilities in the state.
“In November 2021, I issued a company-wide mandate for the boosters. I’m once again thrilled by the response from our employees, who are stepping up to receive the booster that will offer continued protection to both employees and the frail and vulnerable patients in their care,” Masonicare CEO Jon-Paul Venoit said Thursday.
The staff there has until the end of January to get the booster shot. About 40 percent have gotten the third shot so far. Masonicare has scheduled at least eight more clinics and two family clinics over the next few weeks.
But Matthew Barrett, President and Chief Executive Officer of the Connecticut Association of Health Care Facilities, said his group would not favor a booster mandate and that there hasn’t been any indication from the state that one is on the horizon. He added that the 29 percent rate of vaccinated staff is a “big concern” but that with a more focused effort, those numbers will improve. “We have to be very careful and cautious about a universal mandate,” Barrett said. “We are in a different place on the staffing issue than we were previously, and it’s not a better place. The fact is, the staffing situation is considerably worse than where we were during the underlying rollout of the initial vaccine a year ago.”
At a news conference earlier this week, when asked about possible mandates for boosters, Lamont stopped short of endorsing the idea but said he was monitoring the spread of omicron closely.
“I can’t afford to lose any nurses in nursing homes or nurses in hospitals, and if there’s a trepidation about getting the third dose, I have to take that into account,” Lamont said. “If our hospitals are overwhelmed, we may have to take a second look at that.”
While the percentage of residents boosted has improved, it is still well below the 90 percent rate achieved when vaccines were first introduced.
Part of the problem is the transitional nature of the nursing home business, where people are coming in for short-term rehabilitation from different hospitals, most of which are not offering booster shots to patients before they are discharged.
Several providers said there is no policy on whether hospitals should give booster shots to patients before they discharge them. All hospitals are required to make sure that any patient transferring to a nursing home has a negative COVID test within 72 hours of discharge, but there is no requirement to give them booster shots.
“We have been told by several hospitals that they don’t do booster shots,” said David Hunter, CEO of the Mary Wade Home in New Haven.
Hartford HealthCare Executive Vice President and Chief Clinical Officer Ajay Kumar said they don’t offer booster shots, mostly because of timing.
“We don’t generally give booster shots in house because they (patients) are still recovering, and there’s a complexity around that,” Kumar said.
“The challenge is that if you give a booster in the hospital, it takes a little bit longer for them to get immunity. So if they go back to a nursing home and then get it, that’s a reasonable approach. There’s no downside to that, and nursing homes are doing a good job, as best I know,” Kumar added.
Nursing homes say it is not feasible to give each patient that transfers in from a hospital a booster shot right away. Each vial contains six boosters, so most wait until they have enough patients to use almost the entire vial before opening it. During some weeks, that could be a day or two, and at other times, it could be a couple of weeks, depending on admissions.
Vaccine requirements for visitors?Hunter said the other issue that concerns providers is visitation. Right now, most nursing homes take visitors’ temperature and ask them to wear a mask before admitting them to the building.
“We have no control over who is visiting and what their vaccination status is, and that’s tough on the staff,” Hunter said.
The rules for visitation at long term care facilities are set by the Centers for Medicare and Medicaid Services, so the state has no say in it.
Barrett said his organization would be in favor of a similar approach that Yale New Haven Hospital has taken – requiring visitors to show proof of vaccination before they can enter the building and visit a patient.
Barrett said no one wants to see visitation cut off completely, like it was at the beginning of the pandemic, but he said some balance may be needed with the omicron variant appearing to spread quickly.
DPH Commissioner Dr. Manisha Juthani said longterm care facilities need to be more vigilant as cases increase.
“I think that, again, masking of visitors — being maybe a little bit more vigilant on those types of interventions in a nursing home itself — is something a home can decide and institute for themselves, in terms of where and how that exactly is implemented,” Juthani said.
She said officials are sensitive to the isolation that many nursing home residents experience.
“Visitation is the one thing that actually can help keep people connected with their families, but that is something that will need to be assessed on a nursing home by nursing home basis, especially if an outbreak occurs,” Juthani said. “It also depends on what the circumstances are in a given community with a given staff and with a given group of residents might be, and so I think that homes are going to have to be on red alert.”