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People In Nursing Homes, Day Centers Are Vulnerable To The Delta Variant

Marcio Jose Sanchez
AP Photo

This story has been updated to provide more clarity on the state's new health facility visitation policy

All California workers in health care facilities such as nursing homes, hospitals, dialysis centers and adult day care programs will need to be vaccinated against COVID-19 by the end of September under Gov. Gavin Newsom’s latest public health orders.

Newsom announced last week that these workers can get vaccinated or be tested for COVID-19 at least once a week. But with rising cases of the highly contagious delta variant, the state is moving toward stronger measures to protect the most vulnerable people.

Advocates for seniors, people with disabilities and others who live in congregate settings said this is a necessary step.

“We worked hard in the beginning of this pandemic and learned a lot of early lessons,” said Alexandria Smith-Davis, a public policy director with LeadingAge California. “We want to continue the positive direction we are in, and we think having a fully vaccinated staff is the best way to protect the residents.”

Nursing homes and other congregate settings were hit hard early in the pandemic, when the virus spread rapidly among seniors and people with pre-existing conditions. Nursing home residents account for 4% of the state’s coronavirus cases, but 20% of its deaths, according to a Los Angeles Times analysis of state data.

After a frightening winter surge, case rates in nursing homes began to decrease this spring as vaccines became available for residents and staff. There were only 22 new cases per day in California’s skilled living facilities as of this week, compared to 728 new cases per day in mid-December. 

But cases have been rising gradually since May and are at their highest since February.

Currently, 80% of skilled nursing facility workers and 82% of residents are fully vaccinated, according to the California Association of Health Facilities, a trade group representing centers for seniors and people with disabilities and mental health conditions.  

Deborah Pacyna with the association said many facilities have already established mandates for staff, and there’s been only a small amount of pushback.

“What you see is a lot of nurses saying ‘hey, we worked through the COVID pandemic without a vaccine and we’re fine,’” she said. “You do have this small group of people out there who are afraid to be vaccinated.”

Some health care unions, like the SEIU Local 2015 representing long-term care workers, have created education campaigns to try to get their members on board with the vaccine.

Unions have been pushing employers to make it easier for workers to get immunized, by providing geographically convenient vaccine clinics and accommodations for people who have adverse reactions. 

“We also have to make sure the vaccine continues to be available and accessible to people who work lots of double shifts,” said April Verrett, president of SEIU Local 2015. “They should be able to get the vaccine on paid time.”

The state said employees may have “options for compensated time off to get vaccinated,” including COVID-19 paid sick leave.

The union also called for exceptions to the mandate for medical or religious reasons, which are permitted under the new health order. And they want the state to take into account any staffing shortages that might occur once the mandate takes effect. 

Pacyna, with the California Association of Health Facilities, said that’s a real concern.

“Our workforce shortage is critical,” she said. “A lot of people may decide they’re just going to quit their jobs, and that will then trigger into a problem of access to services in skilled nursing.”

In addition to mandating that staff be fully vaccinated, Newsom’s latest order says visitors to these facilities must have proof of vaccination or a negative COVID-19 test from the past 72 hours. 

During the worst of the pandemic, most nursing facilities banned visitors or only let loved ones and residents speak through protective glass. Pacyna said it’s highly unlikely that will happen again. 

“There was so much psychological, psychosocial damage to residents, that we need to find a different way if we face these kinds of circumstances again,” she said.

The state says if someone refuses to get vaccinated or give proof of a negative test, they can still visit a loved one who is imminently dying as long as they wear a mask and remain at a safe physical distance.