Can Long-Term Care Employers Require Staff Members to Be Vaccinated?

She endorses reimbursing staff members for time and expenses. But, she noted: “There’s good evidence from behavioral economics that offering money signals taking risks. These vaccines really are safe and effective, so we don’t want to solidify people’s fears.”

Although Covid-19 cases and deaths are falling in long-term facilities, even those with high vaccination rates will need to stay on guard. New residents arrive continually, and employees leave; turnover among nursing staffs in nursing homes is extraordinarily high, an annual average of 128 percent, a new study has found. That means that after a year, all the original nursing staff members will have left, and so will 28 percent of their replacements.

Probably the thorniest problem is vaccinating the largest segment of the nation’s direct care workers, the roughly 2.3 million people working in private homes.

“It’s going pretty badly,” said Vicki Hoak, executive director of the Home Care Association of America, which represents 3,200 home care agencies. Although home care workers are given priority for vaccinations in every state, they are struggling to get them, she said.

Like the rest of the direct care work force, home care workers are primarily women of color, many of them immigrants. At an average $12.12 an hour in 2019, they are the lowest-paid group, according to the research and advocacy group PHI. Almost half rely on some form of public assistance, like Medicaid or food programs.

Without a central workplace, they will be harder to reach, educate and vaccinate than aides in nursing homes and assisted living centers. (Some, privately hired by individuals and families through the so-called gray market, don’t work for agencies at all.)

“Vaccine hesitancy is absolutely a factor, but more so is the lack of easily accessible opportunities to get vaccinated,” said April Verrett, president of S.E.I.U. Local 2015, the union representing almost 400,000 home care aides in California.

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