Minnesota long-term care COVID-19 cases rise as federal vaccine mandate for workers approaches

COVID-19 infections in Minnesota's nursing homes are on the upswing as facility officials await more details about a federal mandate that workers get the COVID-19 vaccine.

President Joe Biden announced Wednesday that nursing homes will be at risk of losing Medicare and Medicaid dollars if their workers are not fully vaccinated. But many crucial details about how the mandate will be implemented have yet to be revealed.

About 34% of nursing home health care workers in Minnesota are not fully vaccinated, and in 55 of the state's 364 nursing homes, the staff vaccination rates are below 50%, according to the Centers for Disease Control and Prevention.

The resident vaccination rate stands at 91%, the seventh highest in the country.

As a result, there were twice as many new staff COVID-19 cases compared with resident infections last week.

When assisted-living facilities are included, Minnesota had 86 new staff cases, an increase of 110% from two weeks earlier. The number of facilities that recently had at least one case jumped from 29 to 45.

"We are starting to see activity in our long-term care settings," state infectious disease director Kris Ehresmann said. "The good news is we are not seeing as many cases or the rapid spread we had before vaccine coverage."

Deaths of long-term care residents have not increased as much and vary week to week. Last week saw six deaths; the prior week had 14.

Staff vaccination rates are slowly increasing as long-term care operators continue COVID-19 vaccine education and as some long-term care facilities have already implemented their own vaccine mandates as they watched COVID-19 infections return.

"It is not the raw number at this point; it is the trend line," said Randy Bury, chief executive of the Evangelical Lutheran Good Samaritan Society, which operates more than 200 long-term care facilities in 24 states, including Minnesota.

"We are not going to go through this again, and we have a tool in the toolbox, and it works," he said.

Good Samaritan implemented a vaccine mandate in late July. Staff vaccinations have increased somewhat but still remain at 60% systemwide. Employees have until Nov. 1 to complete the series.

Some in the industry fear employees will quit rather than get the shot.

"Everybody always jumps to the staff issue. It is true, it is real," Bury said. "We still did a mandate knowing all of that."

Worker shortages in long-term care have been an ongoing problem, so much so that facilities are turning away prospective residents.

"If we do see workers leave instead of being vaccinated, there won't be enough workers to fill that gap," said Gayle Kvenvold, chief executive of LeadingAge Minnesota, an industry trade group.

Federal health officials are expected to craft regulations for the vaccination mandate in the coming weeks. One unknown is how much of a financial hit nursing homes will take if they don't achieve complete vaccination.

"We don't know what the financial penalties will look like," Kvenvold said. "There are some rural care centers that are worried about keeping their doors open."

Industry leaders also are concerned that the mandate does not apply to other providers, such as hospitals and home health care, which receive Medicare and Medicaid money.

"We are concerned that there could be flight from our settings to others where it isn't required," Kvenvold said.

There is some confusion about whether the mandate will apply to assisted-living facilities. A White House fact sheet did not mention assisted living but did say the regulations would apply to the 15,000 nursing homes nationwide. There are nearly 29,000 assisted-living facilities.

Minnesota health officials report that 95% of assisted-living residents and 66% of staff were fully vaccinated, based on a survey of 945 of the 2,000 facilities.

While the Biden vaccine mandate will protect the most vulnerable residents who tend to live in nursing homes, it still will leave many others in assisted living exposed to unvaccinated workers, said Jean Peters, president of Elder Voice Family Advocates.

"I'm thrilled that Biden has made this his policy, and we'll see what happens," she said. "What is most concerning is that unvaccinated individuals are taking care of vulnerable individuals who often don't have a choice of who cares for them."

Eilon Caspi, a gerontologist and assistant research professor at the University of Connecticut, said the vaccine mandate alone is not sufficient to improve conditions for residents and staff.

"The Biden administration can take a wiser approach, which is to make sure that the requirement comes with a very appropriate level of support systems to the staff," he said. That includes better wages, health insurance, sick and family leave, and child-care support.

"A lot of these individuals are women with low income, and many of them are poor, living from paycheck to paycheck. While some will leave, many may not be able to leave because of necessity of life," he said. "That is not a strategy, you don't want to exploit that."

The Biden administration said it was taking action partly because research has shown a "significant" decline in vaccine effectiveness in nursing homes.

The Pfizer and Moderna vaccines were 74.7% effective against COVID-19 infection in nursing home residents in March through May. But by June and July, effectiveness had slipped to 53.1%, according to a CDC study.

In Minnesota, new infections have been spread out throughout the facilities, with most having just one or two new cases each week.

Jones-Harrison Senior Living in Minneapolis had one staff member test positive Thursday morning. That sparked a round of testing of all staff in the afternoon, as well as shutting down visitations for a week.

"It is frustrating for all of us as the delta variant continues to rise in the community," said chief executive Annette Greely. "Every time it peaks in the community, we are affected."

Even with 90% of its workers fully vaccinated, masks and personal protective equipment are still required for infection control.

Greely said the facility will continue to talk with unvaccinated workers to close the gap.

"We have been successful with love and compassion instead of being punitive," she said. "People see their peers getting vaccinated, and I think that helps, and we all talk to each other to get vaccinated."