Researchers found just 3.7% of unvaccinated workers in a network of continuing care retirement communities departed rather than get COVID shots after their employer adopted a mandate at the height of the pandemic.
The findings, based on employment data from a single CCRC organization with nearly 7,000 employees in multiple states, may represent the first up-close look at the efficacy of a company-wide vaccine mandate for senior care workers.
Many healthcare employers adopted internal vaccine mandates ahead of a federal mandate cleared by the US Supreme Court in January 2022. But many skilled nursing operators balked at the idea, claiming such requirements would chase much-needed employees into the open arms of competitors or other sectors.
In the study published Monday in Health Affairs, researchers from the University of Pennsylvania and Carnegie Mellon University found that 1,208 of the organization’s 6,733 active employees (or 17.9%) were unvaccinated on July 38, the day before the institutional mandate was announced.
The CCRC organization was not disclosed, nor were the states where it operates.
After the policy was adopted and time given for individual compliance, the CCRC network terminated 252 workers, or 3.7% of its overall workforce. The mandate drove compliance from 82.1% to 95.1% on the day before terminations began.
Overall, 56.2% of unvaccinated employees received COVID shots after the announcement, although about 250 of them left for other reasons before being fired.
“Vaccination mandates are authoritative interventions that some long-term care employees may disagree with, but we demonstrate that they can significantly increase vaccination uptake,” the authors wrote. “Employers must weigh this benefit against the costs, including the need to terminate some employees for noncompliance.”
The researchers noted the mandate was more effective than other methods intended to increase COVID vaccine uptake, including a specific educational campaign among nursing homes and an email-based intervention that had been previously studied. Those improved vaccine coverage not at all and by 3% respectively.
But in comments share with McKnight’s Long-Term News Monday, they noted there were likely variations across sites within the CCRC system.
“This was an average rate and that terminations may have been more significant for certain facilities or departments; and … this rate only represents terminations due to noncompliance with the mandate among employees who waited until the compliance deadline to separate,” lead author Aleksandra Golos said. “It is possible that additional employees separated for mandate-related reasons prior to the compliance deadline; per our reported findings, this could amount to up to a maximum additional rate of 3.8% (7.5% total). However, in an analysis that we performed but did not report in the final article, we found no evidence that this additional rate was higher than the ‘background’ employee turnover rate seen prior to the mandate announcement.”
The researchers compared their data to national trends in the CDC’s National Healthcare Safety Network Long-Term Care Facility COVID-19 Module, hoping to understand whether the CCRC findings were simply mimicking secular trends across healthcare.
While overall rates among nursing home employees also climbed during the study period, the studied CCRCs saw a faster acceleration and steeper climb in uptake.
A federal mandate finalized for nursing homes in early 2022 was allowed to sunset Saturday; few if any skilled nursing providers have announced that they will continue to require COVID vaccinations or boosters moving forward.
The Health Affairs study also examined demographic trends among the initially unvaccinated. Researchers noted the organization’s mandate had the greatest impact in states without any existing mandate for long-term care worker vaccines.
Non-Hispanic Black employees also had significantly lower odds of vaccination before the organization announced its mandate; afterward, they were less likely to leave the organization than other unvaccinated workers when the policy went into place.
Golos added Monday that internal mandate policies may still have a place in the LTC landscape.
“Maintaining COVID-19 vaccine requirements in LTC facilities – and in other healthcare settings – would be consistent with other common requirements such as those for flu vaccination,” she said. “Our findings support other studies demonstrating that COVID-19 vaccination requirements had a small, though observable, impact on employee separation. Maintaining these requirements in senior care organizations at a time when we are not in an acute crisis would likely present less blowback (in terms of observed employee separation, as well as in public commentary and sentiment), compared to reinstating requirements when faced with a recurrent or new emergency situation.”
In addition to Golos, study authors are Allison M. Buttenheim and Elizabeth F. Bair of the University of Pennsylvania; Ashley Z. Ritter of senior care organization NewCourtland; and Gretchen B. Chapman of Carnegie Mellon.
