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As COVID vaccine mandate approaches, Upper Valley nursing homes worry about staffing

Valley News Staff Writer
Published: 11/13/2021 7:12:13 AM
Modified: 11/13/2021 7:12:12 AM

WEST LEBANON — COVID-19 case counts once again are spiking at nursing homes in the Twin States as cases trend upward in the broader community.

This week, Vermont reported outbreaks at seven long-term care facilities, while New Hampshire, which has more than twice the population of Vermont, had 23.

Outbreaks in nursing homes are causing fewer deaths than those that occurred at this time last year before vaccines were available and most nursing home residents got them, but family members say that nursing home workers ought to do all they can to protect the vulnerable people in their care.

“It never occurred to me that first-line medical workers … would refuse to get vaccinated,” said Liane Horsey-Giunta, whose fully vaccinated 90-year-old mother contracted COVID-19 in a Windsor County nursing home last month. “That makes no sense to me to whatsoever.”

Her mother, a retired registered nurse, lived in Perkinsville before entering the nursing home due to declining health this summer. Her mother has recovered, but Horsey-Giunta, who lives in Flagstaff, Ariz., was appalled to learn that workers at the facility were not yet required to be vaccinated against the virus.

“I don’t want anybody caring for her who is going to put her in danger,” Horsey-Giunta said. “I want this nursing home staff to be fully vaccinated.”

Health officials say that nursing home outbreaks are driven by a variety of factors and have occurred in facilities with low staff vaccination rates and high resident vaccination rates, as well as where the reverse is true. Outbreaks have also taken place in some nursing homes with near-universal vaccination rates among both residents and staff, but public health officials say the vaccines remain key to protecting people from the effects of the virus.

“Booster shots and third doses for those who are immunocompromised are critical to restore high immunity levels among residents and staff,” said Jake Leon, a spokesman for the New Hampshire Department of Health and Human Services. “As transmission levels remain high in many of the communities where facilities are located, it is also critical that people from the community get vaccinated to help protect the residents of long-term care facilities.”

As of Oct. 31, 87% of workers in Vermont nursing homes and 89% of workers in New Hampshire nursing homes had been fully vaccinated. Those numbers are below rates of vaccination among residents: 96% of Vermont nursing home residents and 94% of New Hampshire residents have been vaccinated.

To further boost vaccination rates among nursing home workers, the Centers for Medicare and Medicaid Services issued a mandate last week, requiring workers at facilities that accept Medicare or Medicaid funds to have at least one dose of a COVID-19 vaccine by Dec. 6 and be fully vaccinated by Jan. 4.

The mandate has inspired mixed responses. It has the support of the New Hampshire Health Care Association, which represents nursing homes in the state. But the mandate has raised the ire of some state officials who say the federal mandate is overreach and it will cause nursing homes to lose workers at a time when the workforce already has shrunk, further reducing their capacity. Lost capacity in nursing homes could have the effect of reducing capacity in other areas of the health system such as hospitals, which are already seeing a bed crunch amid this COVID-19 surge and worsening of chronic illnesses due to pandemic-related delays.

New Hampshire this week joined a 10-state coalition suing to stop the mandate.

“We have heard from long-term care facilities that are at risk of shutting down if this mandate goes through,” Republican Gov. Chris Sununu said in a Thursday news release announcing the suit. “This lawsuit can help stop another overreaching mandate in its tracks, avoiding a catastrophic workforce and care crisis for some of our state’s most vulnerable residents.”

Upper Valley nursing home administrators say the federal government’s requirement that health care workers get vaccinated against COVID-19 by early next month may leave them even shorter-staffed than they are now. The American Health Care Association and National Center for Assisted Living recently released a report showing that long-term care facilities nationally have lost 14% of workers, or 221,000 jobs, since the beginning of the pandemic, more than any other health sector.

Both Woodlawn Care Center in Newport and Hanover Terrace Health and Rehabilitation Center stand to lose about 15% of their workers who remain unvaccinated against COVID-19, according to their administrators.

“Staffing is tight,” said Chris Martin, Woodlawn’s administrator. “We can’t afford to lose anyone at this time. We have restricted admissions already.”

Woodlawn, which is currently in outbreak status, had 46 residents on Friday, below its capacity of 53. All residents and 85% of workers have been vaccinated. Martin said he’s a vaccine advocate and that high vaccination rates have saved lives. In total, the ongoing outbreak has included five residents and six workers. Most cases have been mild, but one resident died after testing positive, Martin said.

Though he supports vaccination, Martin is concerned about the mandate’s effect on staffing and operations.

“Continued higher costs, lower census and higher staff costs is a recipe for closure over the long term,” Martin said.

Martha Ilsley, administrator at Hanover Terrace, said she feels torn about the mandate.

“I see both sides of the situation, as a nursing home administrator doing what science tells us is the right thing to do, and the other side, of being an American with personal choice, and New Hampshire, ‘Live Free Or Die,’ ” she said.

The 16% of her employees who have yet to be vaccinated object to vaccination out of concerns for the long-term safety of the vaccines or because they oppose the idea of a mandate.

“They feel the vaccine should be optional, that this is America and no one should have the authority to tell you what you have to put in your body,” Ilsley said.

Ilsley said it seems unfair to fire unvaccinated staff who have worked up until this point, including through Hanover Terrace’s outbreak last year.

“These employees could all have easily left almost a year ago to work in a less risky environment, but they chose to stay because they cared, and now we are telling them they have to go,” Ilsley said. “I am fully vaccinated because I chose to be, and so far all that are vaccinated made that personal choice.”

The mandate won’t have much effect at Menig Nursing Home in Randolph Center, however. There, just one of 70 workers remains unvaccinated, not including two unvaccinated traveling nurses, said Ursula Margazano, vice president of senior services for Gifford Health Care, Menig’s parent organization.

“I’m proud to say we have a pro-vaccine culture at Gifford,” Margazano said. “Employees here are more accepting of mandates, dating back to before the pandemic when Gifford instituted a flu vaccine mandate three years ago.”

The public health benefits of requiring vaccines outweigh the costs, said Brendan Williams, CEO of the New Hampshire Health Care Association.

“To be sure, at a time when most nursing homes here are turning away prospective residents due to a staffing crisis ... losing any vaccine-resistant staff members will bring hardship,” Williams said. “Yet losing residents to COVID-19 is the greater hardship.”

Williams said he believes that “any litigation against the mandate is doomed to fail” because CMS has the authority to issue such a requirement. To that end, he said, nursing homes in the state that have yet to require vaccines are preparing to do so, even as they are already down about 10% from their pre-pandemic capacity.

“We just have to move forward,” he said. “I don’t think providers are putting any stock into this lawsuit.”

In the meantime, the mandate can’t come fast enough for Horsey-Giunta, whose mother is in the nursing home in Windsor County.

“I don’t want my mother getting COVID twice,” she said. “I just want my mother to be safe.”

Nora Doyle-Burr can be reached at or 603-727-3213.

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