Edie Starr, of South Windsor, right, talks to her brother Burt Deane through the window at Manchester Manor Health Care Center. When Deane was fighting with coronavirus a few months ago, Starr and her older brother Phil Deane would communicate with Deane through thumbs up and thumbs down through the closed window. Burt recovered from the coronavirus. Yehyun Kim / ctmirror.org
Residents at Beechwood, a nursing home in New London, have lunch together in a dining room while social distancing. Yehyun Kim / ctmirror.org

A few weeks ago, most nursing home operators in Connecticut weren’t ready to require workers to get vaccinated against COVID-19. Many pointed to a staffing crisis that has left facilities struggling to fill vacant jobs and tapping temp agencies to cover shifts. They feared a vaccine mandate would worsen the problem.

But with the Delta variant driving up the number of cases and hospitalizations statewide, pressure is mounting on nursing homes to ensure all employees are vaccinated. State officials and leaders of national and local nursing home organizations are now urging managers at those facilities to impose vaccine mandates.

“Even in the face of severe staffing shortages, which are real and have their own harm, still many nursing homes in Connecticut are seriously considering the mandate,” and some are moving ahead with it, said Matthew Barrett, president and CEO of the Connecticut Association of Health Care Facilities, which represents 145 of the state’s 211 nursing homes.

Earlier this week, the association released a statement in support of long-term care facilities that are adopting a vaccine requirement and encouraged all employees to get immunized.

Paul Liistro, who owns nursing homes in Manchester and Vernon, recently decided he would require his workers to be vaccinated. About 78% of his 350-member staff has been inoculated, but Liistro wants to close the remaining gap.

“We have to do our part to encourage everybody to get vaccinated because the Delta variant is getting out of control,” he said. “I know I’m risking [the health of] other staff members, because someone is going to come, be infected and start spreading it. And then we’ll lose staff and be closed to admissions.”

Liistro has set a deadline of Sept. 30 for employees to get vaccinated. But instead of threatening to fire workers who don’t comply — as some other health providers have done — he is requiring any unvaccinated staff to submit to COVID testing on a weekly basis. Employees also must wear a face shield over their mask while working.

“If they don’t show up for the weekly testing, we’re going to write them up,” Liistro said. “We’re also going to be telling them that we think this is a bridge to mandatory, governmental required vaccinations. I do believe that’s going to happen.”

So far, Gov. Ned Lamont has not imposed mandates for any workers, including state employees.

Asked recently whether he believes nursing homes should require staff to be immunized, Lamont said: “I do. I mean, these are mainly private enterprises. So I haven’t gotten into mandating to a private enterprise … But if I see this ramping up, maybe we step in.”

“If I ran a nursing home, I’d probably like to know if somebody coming in was vaccinated,” he added. “That’s just me. And I think that probably is the best way to go for the near term.”

Dr. Manisha Luthani, a Yale physician who was nominated to take over as the state’s public health commissioner in September, said that as the Delta variant spreads, she is concerned about the elderly in long-term care facilities.

“They are our most vulnerable,” she said. “I do feel that staff in nursing homes should be vaccinated, because, in my opinion, if we are going to see a signal of this virus breaking through vaccines, our most vulnerable … are likely to be the first ones to experience that.”

At the height of the pandemic last spring, nursing home deaths accounted for more than 60% of Connecticut’s overall COVID-19 fatalities. In May 2020, a third of the state’s nursing homes with coronavirus cases recorded infection rates of 50% or higher among their residents. As of July 20, the most recent data available, 14,128 residents had been infected and 3,881 have died.

Eighty-seven percent of Connecticut’s nursing home population has been vaccinated, while 70% percent of the workforce has been immunized, according to data from the Centers for Medicare and Medicaid Services.

Athena Health Care Systems, which owns 24 nursing homes in Connecticut, is developing a policy that requires new workers to be fully vaccinated as a condition of employment. Tim Brown, a spokesman for the company, said a date has not yet been set for when the new mandate would go into effect.

Athena is also weighing a requirement for current workers. About 70% of the company’s more than 6,000 employees in Connecticut are vaccinated, Brown said.

In the meantime, Athena is trying to incentivize those workers with prizes, including cash rewards for some who get the shot.

“We’re still evaluating and having ongoing discussions to determine whether a vaccine mandate will be a condition of employment down the road” for current staff, he said. “Right now, we’re not taking that approach.”

But even as more nursing homes implement a vaccine edict, some are still worried the approach will cost them staff that they can’t afford to lose.

At a recent meeting of nursing home leaders, several of the managers decided they would hold off and see if the state imposes a mandate. A statewide order would help, they reasoned, because workers wouldn’t be able to move from one facility to another – all homes would have identical policies.

“I think every single one of us would mandate vaccines except for the fear of not having enough staff,” said Bill White, whose family owns the Beachwood Post-Acute & Transitional Care center in New London.

White said about 80% of his staff are vaccinated, but if the remaining people left, he wouldn’t be able to fill shifts.

“If I mandate it now, the math just won’t add up for me,” he said. “It can’t be done unless everyone is going to do it together. Otherwise, people will just quit and go work at the nursing homes where they don’t have to be vaccinated.”

The iCare Health Network, which includes 11 nursing facilities in and around Hartford, has not yet imposed a vaccine requirement, though its supervisors are keeping an eye on other companies that have taken the leap, such as CareOne, a New Jersey-based long-term care chain that is the largest private owner of nursing homes and assisted living centers in that state.

“There’s this dual pressure going on. A mandate is something that makes a lot of sense. It’s actually, in our environment, probably the most important,” said Dave Skoczulek, vice president of business development for iCare. “But we’re also in a fairly significant staffing crunch across the industry.”

“We’re on a non-stop recruiting drive. We could fill dozens and dozens of positions that are necessary,” he said. “We’re staffing to what we are required to do, but there’s a lot of overtime, there’s a lot of pool use [hiring temporary workers], and a lot of flexing around different things.”

A study by the American Health Care Association and National Center for Assisted Living in June found that 94% of nursing homes and 81% of assisted living facilities surveyed had a staff shortage in the last month.

The group surveyed 616 nursing homes and 122 assisted living facilities across the country. More than half of the facilities were actively trying to fill vacant positions for certified nursing assistants, licensed practical nurses, registered nurses, dietary staff and housekeeping.

Still, some nursing homes in Connecticut have implemented vaccine edicts without losing a substantial number of staff.

Jewish Senior Services in Bridgeport mandated vaccinations of all employees in February; only 15 workers, or about 2% of the staff, chose to quit rather than get the shot.

“You have to do everything you can to protect the people you’re here to serve,” said Andrew Banoff, the facility’s executive director. “And I think to me, that was the vaccine. That was a tool we had. And we need to make sure we use it to the extent that we can. … We’re hopeful that more and more people will make it a requirement.”

Masonicare, which owns a nursing home in Wallingford and three assisted living facilities in Connecticut, imposed the rule in December, shortly after the first shipments of coronavirus vaccine arrived in the state. President and CEO J.P. Venoit gave workers six months to get the shot; the deadline was June 30.

Venoit estimated that he has lost fewer than 30 employees out of a 1,700-person workforce, which also includes home care staff.

Masonicare recently had a COVID-19 outbreak at its nursing home. Sixteen residents and six staff members have tested positive, and a hospice patient died.

Venoit said the outbreak reinforced his decision to require that all workers be immunized. All of the people who tested positive had been inoculated, he said.

“We’re in better shape thanks to everybody being vaccinated,” he said. “If they weren’t all vaccinated, I think we would be in a different situation than we are in now.”

Jenna is CT Mirror’s Health Reporter, focusing on health access, affordability, quality, equity and disparities, social determinants of health, health system planning, infrastructure, processes, information systems, and other health policy. Before joining CT Mirror Jenna was a reporter at The Hartford Courant for 10 years, where she consistently won statewide and regional awards. Jenna has a Master of Science degree in Interactive Media from Quinnipiac University and a Bachelor or Arts degree in Journalism from Grand Valley State University.

Dave does in-depth investigative reporting for CT Mirror. His work focuses on government accountability including financial oversight, abuse of power, corruption, safety monitoring, and compliance with law. Before joining CT Mirror Altimari spent 23 years at the Hartford Courant breaking some of the state’s biggest, most impactful investigative stories.