Now that the initial phase of a federal program offering on-site clinics in long-term and congregate care facilities has closed, staff members must use community sources for vaccination. That adds a layer of complexity for facilities that want to ensure all staff — full-time caregivers, dining and custodial staff, contractors such as physical therapists, and others — are as protected as possible from COVID-19.

Early data suggest Massachusetts still has work to do to vaccinate its health workforce against COVID-19. Fewer than one-third of nursing homes in the state have reported to the U.S. Centers for Medicare & Medicaid Services (CMS) that 75% or more of staff members are fully vaccinated.

A new CMS interim rule requires nursing homes to report vaccination status for all people who work at least one day per week in their facilities. The deadline for first reports was June 13, 2021, and the first public release of data occurred on June 11. Facilities that missed the June 13 deadline face the prospect of monetary fines.

Similar to vaccination coverage in the general population, rates at nursing homes and other long-term and congregate care settings vary widely. For the most part, vaccination rates among staff members at these facilities are lower than among the residents they serve and often align with vaccination rates in their communities.

Worker bonuses tied to vaccination

New Horizons at Marlborough, one of two assisted-living facilities owned and run by the Cummings Foundation, has used education, one-on-one conversations, logistical support and financial incentives to help drive up staff vaccination rates.

As with other pandemic-related challenges, New Horizons Executive Director Betsy Connolly said the organization tried to be as pro-active as possible. For example, earlier this year when vaccination appointments were difficult to obtain, she wrote a letter asserting the “essential” nature of workers’ jobs, which staff members could use for added persuasion at vaccination sites, with good results. And when some staff were denied shots at the federally sponsored onsite clinics because they had a history of allergic reactions, Connolly worked with Marlborough Hospital to make sure they could be vaccinated in a setting equipped to provide care if needed.

In addition, the Cummings Foundation offered 20% bonuses to staff during two different time periods to incentivize regular attendance at work and, later, to also get vaccinated. New Horizons — home to more than 400 residents across independent and assisted living and memory care, with 200+ employed and contracted staff — currently estimates its worker vaccination rate at 78%. “Most of our staff members were as eager to be vaccinated as our residents were,” said Connolly. “Marlborough was at the top of the Commonwealth’s high-risk category for months, so mostly everyone knew someone who had contracted COVID.”

Connolly also described the challenge of keeping accurate records. Now that staff are getting shots in the community or at other facilities where they also work, good recordkeeping requires persistent reminders to bring in vaccination cards.

Mandate follows intensive education and support efforts

Benchmark Senior Living, the largest provider of residential senior living services in New England, also initially relied on encouraging voluntary vaccination for staff. After five months of outreach, however, Benchmark decided to mandate COVID-19 vaccination for all staff without documented religious or medical contraindications beginning at the end of July.

The company made that decision because the vaccine has proven safe and the most effective tool — when coupled with ongoing infectious disease mitigation — for protecting Benchmark communities from the spread of COVID-19, says John Hartmayer, Chief Operations Officer.

While Benchmark ultimately chose to mandate the vaccine, its leadership says it remains committed to ongoing education and support of staff members that began back in December. Benchmark offered FAQs in multiple languages, a daily “Myth Buster” email that corrected misinformation about the vaccine, a video series called “Because … ” in which executives, staff members and residents explain why they chose to be vaccinated, printed handouts, and Town Hall-style meetings with employees, and residents and their families.

Founder, Chairman and CEO Tom Grape, other Benchmark leadership, and members of the Benchmark Coronavirus Advisory Council hosted a live, online meeting on December 21 to answer any questions and help encourage staff members to get vaccinated. “We understood that this was not a one-way conversation. We listened to our associates, carefully considered and responded to their questions and concerns, and approached immunization as we have with all pivotal moments in Benchmark’s history — together,” said Grape.

Benchmark also tailored its approach to the needs of its 63 facilities across seven states. Staff vaccination rates vary, often reflecting rates in the local community. The quality of the relationship each executive director has with his or her staff also makes a difference. Benchmark has worked with individual directors to learn how best to approach one-on-one conversations about vaccination, said Hartmayer.

Many organizations shy away from mandates both for annual flu shots and COVID-19 vaccines for fear of losing valued staff members, especially in a difficult labor market.

But Jewish Senior Services, a provider of skilled nursing and senior care services in Connecticut, reported losing only about 1% of staff members when it imposed a vaccination mandate earlier this year.

President and CEO Andrew Banoff explained that the staff vaccination rate was only 55% after increased education, coaching and three on-site vaccination clinics. “Our message was simple,” Banoff says of the mandate. “We have to do everything in our power to protect the people we serve.”