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Missouri ranks last in U.S. for vaccinating nursing home staff, as the federal deadline draws near

Regina Murdock, a registered nurse with D&H Drugstore, administers a dose of the Pfizer vaccine to a resident on Aug. 6, 2021, at a clinic at the Neighborhoods by TigerPlace in Columbia, Mo.
Tessa Weinberg
Missouri Independent
Regina Murdock, a registered nurse with D&H Drugstore, administers a dose of the Pfizer vaccine to a resident on Aug. 6, 2021, at a clinic at the Neighborhoods by TigerPlace in Columbia, Mo.

Just 57% of Missouri nursing home staff are vaccinated as of Thursday. Long-term care facility trade groups have warned of an exodus of staff if vaccines are mandated, but some nursing homes that instituted mandates haven’t seen that happen.

Even as nursing homes worked through the summer to get Missouri over the halfway mark in employee vaccinations, the state fell further behind peers, dropping to last in the nation.

And while neighboring Kansas has fared better, both states have large swaths of nursing home staff to get vaccinated before a federal deadline next month.

In August, less than half of Missouri nursing home workers were vaccinated — ahead of only Florida and Louisiana for worst in the nation.

While the vaccination rate rose to 56.9% as of Thursday, Missouri now ranks last in the country.

“It’s really disappointing, because these are the folks that we’re relying on to protect our most vulnerable citizens,” said Marjorie Moore, the executive director of VOYCE, a St. Louis nonprofit that advocates for quality living across long-term care. “And they’re the people that have honestly seen some of the worst of the pandemic.”

About 65% of Kansas nursing home staff are vaccinated, ranking it 37th — a slight drop from its ranking of 35th three months ago, according to data compiled by the Centers for Medicare and Medicaid Services.

Nationwide, the median vaccination rate for nursing home staff is about 73%. Both Kansas and Missouri have higher rates of residents vaccinated than staff at over 86%.

Missouri’s last-in-the-nation ranking comes ahead of a forthcoming rule by President Joe Biden’s administration that sets a Dec. 5 deadline for nursing home staff to receive at least one dose of a COVID vaccine and includes exemptions for those with religious conflicts or underlying medical conditions that prevent them from being vaccinated.

Health care workers in facilities that participate in Medicare and Medicaid programs must be fully vaccinated by Jan. 4 under the emergency regulation, and unlike other workers they do not have the option to test weekly if they choose not to get vaccinated.

Asked about Missouri’s vaccination rate for nursing home staff, Gov. Mike Parson recently told Nexstar's Emily Manley that while that number “is out there, the problem is we’re not having problems in the nursing homes (any) more.”

“We’re not having them,” Parson said. “So that’s just the fact of the situation.”

After several months of low infection rates, COVID-19 cases in Kansas and Missouri nursing homes spiked over the summer because of the Delta variant.

Since August, reported infections in Missouri have been on the decline with 62 resident cases and 62 staff infections reported the week ending Oct. 24, compared to 163 and 232 during one week in August.

In Kansas, COVID cases in nursing homes started rising again in August and remain elevated compared to the spring. During the week ending Oct. 24, the state’s nursing homes reported 71 infections among staff and 57 among residents compared to 90 and 41 in mid August.

“Would we like for more of them to be vaccinated? Yes, we would,” Parson said in his recent TV interview. “But again, it also proves to you that the people in the homes that are getting vaccinated are much safer also, and they took it upon themselves to do that. ... So we know that’s working.”

Vaccine mandates

Heidi Lucas, the state director of the Missouri Nurses Association, said the federal vaccine mandate brought mixed reactions for nurses across the state.

To advocates for nursing home residents, it’s welcome news. But some industry groups have warned that mandating vaccines will force more nursing home staff out of their jobs and worsen an already dire staffing shortage.

Some nursing homes created their own vaccine mandates long before the Biden administration.

Good Samaritan Society, with 11 CMS-licensed homes in Kansas, was among the first major nursing home chains this summer to announce it would mandate vaccines for its workers.

Employees were required to receive their first shot by Nov. 1 or face a 60-day suspension. If they still didn’t get vaccinated after that time, they would be considered to have voluntarily resigned.

The latest CMS data shows that as of the week ending Oct. 24, vaccination rates for staff members had risen since mid summer at all 11 of the chain’s Kansas nursing homes. But eight of them still lingered below 75%, a goal established by the long-term care industry.

The chain said Thursday that 100% of their employees were in compliance with the mandate, meaning they had either received at least one dose of a COVID vaccine or had an approved medical or religious exemption. The chain said the CMS numbers were out of date but did not provide up-to-date vaccination rates for its Kansas homes or the number of employees who were out of compliance with the mandate before the Nov. 1 deadline.

Aimee Middleton, executive director for Good Samaritan Society’s Kansas locations, said the chain had used its vaccine mandate to recruit more workers and that the rule sent a signal to loved ones that the chain was working diligently for the seniors in its care.

“It has really made our team members feel like they’re coming to work in a safe environment,” Middelton said. “We’ve seen people want to transfer to some of our locations to work for us because they know that they’re going to a safe environment.”

The chain announced Monday that it would close one of its Kansas locations. It reported to CMS in October it was experiencing a staffing shortage. But none of the others reported a nursing staff shortage to CMS as of Oct. 24.

Cardinal Ritter Senior Services, an agency of Catholic Charities and the Archdiocese of St. Louis, which serves seniors in a variety of residential settings, including assisted living, skilled nursing, memory care and independent living, decided in mid-August to make vaccination a condition of employment for all agency staff.

At the time, about 67% of staff were vaccinated. Now, they stand at 95%, the agency’s CEO Chris Baechle said.

Cardinal Ritter Senior Services set a Sept. 30 deadline for employees to get at least one shot. Leading up to that date, the agency's leaders held town halls and small group meetings, as well as one-on-one sessions with employees.

Ultimately, the agency only lost a handful of employees who chose not to get vaccinated out of nearly 400, Baechle said. The most positive feedback came from families of residents, he said, who knew that higher vaccination rates would help ensure visits with their loved ones could occur more regularly.

“Last year we had no control,” Baechle said. “And that's really what we keep focusing on is the safety and preventing the isolation that the residents went through last year.”

Lenny Jones, the director of SEIU Healthcare Missouri and Kansas, which represents unionized workers in nursing homes and supports the federal mandate, said that when facilities collaborated with workers to achieve vaccination mandates, rates of compliance were high.

“They were allowed to take time during the day, while being paid, to go talk to workers who were vaccine hesitant and to share their story,” Jones said of union representatives who acted as vaccine stewards in the workplace.

For nursing home staff, many of whom may work multiple part-time jobs to make ends meet, it's important employers offer paid time off for workers to get vaccinated and recover from any side effects, Jones said.

“It's being respectful,” Jones said. “It's understanding that workers have concerns.”

Staffing shortages

But while Good Samaritan Society and Cardinal Ritter Senior Services consider their vaccine mandates a success, other nursing home industry groups are adamant Biden’s rule will make things worse.

In Missouri, more than 143 of the state’s 516 nursing homes that submitted data to CMS in October reported they were short-staffed.

In Kansas, 132 out of 323 homes reported the same.

While nursing homes struggled with short staffing long before the pandemic, the number of facilities reporting shortages dipped this summer in the wake of the initial vaccine rollout.

Nikki Strong, the executive director of the Missouri Health Care Association, a trade group that represents long term care facilities, said in a statement Thursday that the organization believes vaccination is the best way to keep residents and staff safe. However, the federal mandate will only worsen access to long term care, Strong said, when workforce challenges are already exacerbated by the pandemic.

“We are afraid that the direct consequence of this mandate will be the inability of our frail, elderly and disabled residents to access the long term care services they require,” Strong said.

Kansas’ solicitor general, Brant Laue, told the Legislature’s Special Committee on Government Overreach and the Impact of COVID-19 Mandates last week that “there may be constitutional issues” with the mandate, including potential “limits on the federal government's ability to attach strings to federal spending.”

Camille Russell, Kansas' long-term care ombudsman, said staffing shortages had become untenable for some Kansas nursing homes. It's a worry Moore says is also facing facilities in Missouri, especially those in rural areas.

“They’re pretty critical across the state,” Russell said. “Nursing homes have been insufficiently staffed for a long time.”

Russell said she believed nursing home staff needed to get vaccinated. Residents who call the facilities home have been vaccinated for a long time, she said, and the workers who enter their homes should do the same.

“All (the) things we hope for,” Russell said, “are that between mandated vaccination rates and boosters for the residents and no new surprises with any other variants that we can have things look differently by spring.”

This story was originally published on the Missouri Independent.

Allison Kite is a data reporter for The Missouri Independent and Kansas Reflector, with a focus on the environment and agriculture.
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