More Senior Living Providers Impose Staff Mandates As Covid-19 Vaccination Lags

When the first doses of the Covid-19 vaccine arrived in senior living communities late last year, residents rolled up their sleeves with gusto. But the same was not true for the industry’s workers.

And that has not changed in the roughly two months since then, according to a recent National Investment Center for Seniors Housing & Care (NIC) survey of 84 senior housing and skilled nursing operators across the U.S. While an average of about 80% of the surveyed operators’ residents have received at least their first dose of the Covid-19 vaccine, just 50% of staff had done the same.

That wide gap between resident and staff vaccination rates has prompted some senior living providers to make getting the vaccine a condition of employment, barring some exemptions. These include Bloomfield, New Jersey-based Juniper Communities and Louisville, Kentucky-based Atria Senior Living, which were among the very first large operators to do so.

Today, that list now includes Silverado Senior Living. And there are other providers that plan to set their own mandates in the future, including Hickory, North Carolina-based ALG Senior and Aegis Living, which is headquartered in Bellevue, Washington. Additionally, there are some companies that have not set mandates, but also have not ruled out making vaccines mandatory for workers at a later date. These include Winter Park, Florida-based Holiday Retirement and Forth Worth, Texas-based Civitas Senior Living.

This is not to say that mandates are the only way to achieve high rates of staff vaccination. For example, about 80% of the Belmont Village workforce has been vaccinated, without a mandate in place, CEO Patricia Will said recently on an SHN+ TALKS appearance. Aegis also has a high staff vaccination rate on a company-wide basis, but President Kris Engskov noted that some communities have higher rates while others have lower rates.

Whether to implement a mandate is a tricky decision, and there clearly is no industry consensus on the right approach. Other sectors — including airlines and retail — also are debating whether to impose mandates or offer certain incentives for workers to get vaccinated.

But time is of the essence.

For Silverado CEO Loren Shook, boosting vaccination rates sooner rather than later is important — doubly so when taking into account Covid-19’s new genetic variants, some of which are spreading rapidly across the globe.

“We know there will be more variants coming, and we don’t know what those will look like,” Shook told Senior Housing News. “So, it is incumbent upon us as leaders in the company to make the hard decision that … you have to be vaccinated to work here.”

‘We don’t have a choice’

Although the senior living industry is seeing lower vaccination rates among its workers, it’s also not unique in this regard.

A new study of 11,460 skilled nursing facilities from the Centers for Disease Control and Prevention (CDC) found that while a median of 77.8% of residents had received their first Covid-19 dose as of Jan. 17, a median of just 37.5% of staff members had done so.

Some of that has to do with the sheer amount of misinformation regarding the vaccine, what it’s made of and its effects. Other times, it’s a matter of senior living workers simply not wanting to go first.

For Silverado, education efforts and leading by example have led to a mixed bag of results, and vaccination rates for staff generally run between 50% to 80% at the company’s more than 20 communities.

“That’s not good enough,” Shook said.

So, starting March 1, getting a Covid-19 vaccine will be a condition of employment, barring exemptions for medical or religious reasons. And this isn’t the first time the company has made a vaccine mandatory. Silverado also made the most recent flu vaccine a condition of employment for workers, and now those vaccination rates are nearing 95%.

“We don’t have a choice,” Shook said. “It’s one tool we have that can help people stay alive.”

While setting a vaccine mandate might cause some Silverado staff to leave, Shook also believes prospective hires will be more discerning about places of employment that can guarantee high levels of vaccination.

Other senior living providers have committed to making the vaccine mandatory, but not right away. For instance, Aegis President Kris Engskov said the provider plans to make the vaccine a condition of employment, but only when more doses are available.

“When you can take a letter right from Aegis and walk into a CVS and say, ‘Hey, I need to get the vaccine,’ and it’ll be available, that is I think when we can mandate it,” Engskov told SHN.

That’s not to say Aegis has seen low rates of vaccinations among workers. In fact, Engskov said an average of about 85% of the company’s staff have received their first dose so far, with some variation from one community to another. The company’s educational efforts are a driving force behind that high vaccination rate.

“We’re working with the handful of folks that are still concerned for whatever reason,” Engskov said. “We’re dispatching an expert to go meet with that team and help them understand how the vaccine works and … really leaning in to make sure they get all the information they need.”

But while Aegis’ education efforts are paying off now, Engskov also believes having a mandate in place will help the provider stay current with vaccinations as new and potentially unvaccinated workers come aboard.

“A really important part of what we offer is protection,” Engskov said. “If we don’t have all of our team vaccinated, that feels like we’re not doing everything we can to protect [residents].”

ALG Senior is also planning to issue a vaccine mandate in the future similar to what it has already done with flu clinics in the past.

“We are currently working to address logistical concerns with vaccine availability, such as when and how new hires will be able to receive their vaccine after our scheduled clinics are completed,” an ALG spokesperson told SHN. “As vaccine availability increases in time, we will determine when and how the mandate is issued.”

Wait and see

While providers are encountering challenges in educating and motivating staff to get vaccinated, the majority of providers still have not made the vaccine mandatory, according to NIC.

But there are some who are considering it. For example, while Holiday Retirement has not required Covid-19 vaccines among workers as it’s built its own distribution network, the provider has also not ruled out doing so in the future.

Holiday’s decision hinges partly on the availability of vaccine supplies, according to Holiday’s chief people officer, Karen Sheean.

“We can’t even answer that question until I can rest assured that every one of our communities and our associates have a place to get the vaccine,” Sheean told SHN.

The company’s current vaccination rate among associates is around 45%, and that rate will likely trend closer to 50% by the time most employees have gotten their second doses.

“What we would look toward are CDC recommendations on mandating [the vaccine], and what happens within the broader senior living industry,” Sheean told SHN.

Civitas is another provider that has not mandated vaccines for workers, but is open to doing so in the future. Though it varies by community, about half of the community’s associates on average have already received their first Covid-19 vaccine dose.

“The hesitancy is more just the unknown,” Civitas COO Misty Miller told SHN. “They want to get it, they’re just not sure they want to get it right now.”

In the meantime, the company is incentivizing workers to roll up their sleeves by offering them two days of paid time off and entering them into a money raffle once they’ve completed their second doses.

Silervado’s Shook says he has so far only heard of a small number of providers that are also setting vaccine mandates. But, he believes that vaccine mandates will at some point hit critical mass and have widespread adoption within the industry.

“I think it’s important for the industry to see there’s one more operator doing this,” Shook said. “I think most will at the end of the day.”

Chuck Sudo contributed reporting to this story.