What Senior Care Operators Should Know About COVID-19 Vaccination Programs

A cornerstone of nationwide vaccination efforts against COVID-19 is vaccinating first those who are most vulnerable.

That includes residents and staff at the nation’s senior care facilities, a group that accounted for 5% of all coronavirus cases but 34% of virus-related deaths as of February 2.¹ Yet despite those grim statistics, at least half of employees at senior care facilities are reluctant to get vaccinated, according to estimates.²

Employer vaccination programs can help reduce staff reluctance in receiving a COVID-19 vaccine. However, implementing such programs can be complicated, in part due to guaranteeing workplace employee protections — protections on which regulators have provided little guidance on their application.

Here’s guidance on how to get vaccination programs at senior care facilities on track.

The biggest roadblock: employee buy-in

Why is there so much employee mistrust about coronavirus vaccines? One reason is staff concerns stemming from past medical abuses against people of color,³ as well as distrust over the efficacy and safety of vaccinations developed in a matter of months. There’s also fears of possible allergic reactions to the vaccines.

Such concerns must be addressed — not summarily dismissed — with factual information from credible sources. Providing employees with FAQs containing this information will help them get acclimated. Some key points:

• Explain what can be expected with the Pfizer and Moderna two-dose vaccines. People can still get the virus after the first shot. They are less likely to test positive but will have the coronavirus antibodies. Those who have gotten the virus after the first dose have had less severe symptoms than those who haven’t had any vaccination.
• An allergic reaction usually stems from preexisting allergies to the ingredients in the vaccines. Reviewing a checklist of allergies before each shot can help minimize the likelihood of a reaction.
• Show the science behind the vaccine, which doesn’t contain an active virus and doesn’t alter one’s DNA. Tell employees the vaccine poses no threat to pregnant women nor the child they are carrying. Explain how the vaccines instruct cells to make a harmless “spike protein” that builds an immune response and makes antibodies.

To mandate or not to mandate – that is one question

Senior care facilities apparently can mandate COVID vaccinations.⁴ But should they mandate? The U.S. Centers for Disease Control (CDC) provides information about high-risk environments that may be relevant. Employers also need to decide if a mandate would be right for their cultures and businesses.

Mandated or not, organizations must establish guardrails to address employee concerns without violating the Americans with Disability Act (ADA) or Title VII of the Civil Rights Act.

If employees are concerned about receiving the vaccine, the employer must find out if an underlying health condition or religious prohibitions are the reason:

• Health issues will trigger the Americans With Disability Act (ADA), which requires following a specific process to determine accommodations. For example, the employee might be assigned to a secluded, non-patient contact role, but it’s not necessary to create a new job or displace another employee.
• A religious-based declination involves Title VII, requiring a conversation with the employee to determine its legitimacy. Ask for documentation. In Equal Employment Opportunity Commission (EEOC) matters, the CDC leans toward employees, making incumbent upon the employer to resolve the conflict. Resolution typically involves moving the individual into a non-patient contact role.

Any employee concerns are considered private medical information to be kept secure.

Carrots and sticks must be handled with care

A voluntary, incentive-based vaccination program’s success depends upon its structure. For starters, it’s best not to connect it to a health and wellness program. Regulatory and legal rulings have created uncertainty if incentives can be built into health and wellness programs, so it’s best to avoid the connection altogether.

It’s also better to offer collective incentives instead of individual ones. For example, consider having contests to reach a 100% vaccination rate, which avoid being connected to health insurance and health and wellness prohibitions.

As senior care operators push to keep their doors open and patients and staff safe, they face difficult decisions on vaccinations. The legal, regulatory and human resource challenges in a vaccination program makes it essential to have the right broker partnership with comprehensive capabilities and a holistic approach to risk management.

HUB International’s team is ready to help your organization respond to the opportunities and risks in today’s changing senior care environment.

¹ New York Times, “More Than One-Third of U.S. Coronavirus Deaths Are Linked to Nursing Homes,” February 2, 2021.

² NBC News.com, “Nursing homes make big push to change minds of workers who refused vaccination,” January 17, 2021.

³ Healthline, “Why Some Black and Latinx People Are Reluctant to Get the COVID-19 Vaccine,” December 18, 2020.

⁴ JDSUPRA.com, “The COVID-19 Vaccine Is Here — Can Employers Mandate Immunization?,” December 22, 2020.