New York hospitals and nursing homes are worried that a state COVID-19 vaccine mandate set to take effect Sept. 27 for their employees could cause staffing shortages, leading to an adverse impact on patient care.
Hospital and nursing home officials told Newsday it’s critical that employees get vaccinated to reduce the risk of transmitting the coronavirus to patients. But firing employees who refuse to get the shot could exacerbate existing shortages of nurses and other employees, and that "could negatively impact the ability of some systems to provide care for their communities," a Sept. 12 Healthcare Association of New York State report said.
Employees of hospitals and nursing homes must have received at least one dose of vaccine by Sept. 27, or face possible termination. The deadline for others, including assisted-living and home-health-care employees, is Oct. 7.
"We want the state to make sure they understand that there could be emergencies where you have buildings full of elderly people who need care, without enough workers," said Jim Clyne, CEO of LeadingAge New York, which represents nonprofit nursing homes and other facilities for older adults.
What to know
New York hospitals and nursing homes are concerned about staff shortages once New York’s requirement that all health care workers be at least partially vaccinated by Sept. 27 goes into effect.
Long Island health care officials say they are still trying to persuade unvaccinated employees to get the shot, and they vow that any shortage will not affect care, with one hospital saying any potential cutbacks would be in nonemergency procedures.
Supporters of the mandate said it is necessary to reduce the risk that hospital and nursing home employees infect patients with the coronavirus. Nursing home residents and many hospital patients are particularly vulnerable to severe COVID-19, they say.
The situation is most dire upstate, where vaccination rates are lower, according to Clyne and the Healthcare Association's report. Yet there may be problems elsewhere as well, Clyne said. Nursing home staffing statewide already was tight pre-mandate, so losing a few key employees "could put pressure on them," he said of nursing homes on Long Island and other regions.
Gurwin Jewish Nursing & Rehabilitation Center in Commack is confident it can handle the mandate, but that’s because "we have basically placed a quota on our admissions so that we can safely care for everyone" if a significant number of employees leave, said Stuart Almer, president and CEO of Gurwin Healthcare System.
Gurwin has about 360 residents, 100 below capacity, he said.
Nearly a quarter of Gurwin staff are unvaccinated, Almer said. He expects some to wait until the last minute, in the hope of a court ruling or other delay. A federal judge in Utica on Tuesday temporarily blocked the state from refusing to accept religious exemptions to the mandate, but the overall requirement remains in place.
'We believe there’s an obligation by health care workers to do everything we can to protect the patients who are in our care.'
Dr. Joseph Sellers, president of the Medical Society of the State of New York.
Dr. Joseph Sellers, president of the Westbury-based Medical Society of the State of New York, which represents physicians statewide, said health care workers long have been required to get certain vaccinations.
The COVID-19 vaccine mandate is necessary because "we believe there’s an obligation by health care workers to do everything we can to protect the patients who are in our care," said Sellers, whose office is in upstate Cobleskill. "The vaccines for COVID are a very effective way for us to decrease the risk of our patients acquiring COVID infections from us as health care workers. It’s also to keep our health care workers healthy so they’re there to provide care to patients."
Nursing home residents and many hospital patients are particularly vulnerable to severe COVID-19, and "I can’t think of a worse thing than a health care worker bringing COVID to a patient," he said.
Impact could be felt upstate
Nationwide, more than 96% of doctors were vaccinated as of early June, with about half the rest planning to do so, and 88% of registered nurses were vaccinated or planned to get the shot as of July, separate surveys found. But research published Thursday in JAMA Internal Medicine found that as of mid-July, only 49% of certified nursing assistants in nursing homes, the majority of caregivers there, were vaccinated.
The Healthcare Association report said there could be cuts or elimination of services, particularly upstate.
In four upstate regions, 25% of registered nurse positions already are unfilled, and health care executives surveyed by the association said that number could double after the mandate takes effect.
'There’s a big unknown.'
-Wendy Darwell, president/CEO of Suburban Hospital Alliance of New York State, speaking about hospitals not knowing how many unvaccinated staff will get inoculated by the deadline.
Wendy Darwell, president and CEO of the Hauppauge-based Suburban Hospital Alliance of New York State, which represents hospitals on Long Island and in the Hudson Valley, said no hospitals in her organization have told her they expect to cut services. But, she said, "There’s a big unknown" as to how many unvaccinated people will scramble to get inoculated within the next week.
Long Island hospitals have an advantage because almost all are affiliated with larger health care systems, and that means "you have resources to draw on outside your building" and more flexibility, she said.
Gov. Kathy Hochul said at a news conference on Wednesday that hospitals should have staffing plans to handle shortages. She said state officials are trying "to figure out how we can send support, if necessary."
Darwell said with staffing tight nationwide, "every hospital in the country is competing" for nurses and other health care workers, including hospitals in states with much higher levels of COVID-19 hospitalizations.
At Mount Sinai South Nassau hospital in Oceanside, nearly 90% of employees are vaccinated, and it’s expected that most of the rest will get the shot by Sept. 27, averting the need for any cutbacks, said Dr. Adhi Sharma, the hospital’s president.
If there are unexpected cuts, they would be in elective procedures, so emergency and other critical care is not affected, he said.
"We’re meeting with anyone who has concerns" about the vaccine, individually and in groups, he said.
'There are a handful that no matter what I say are adamant they won't take it.'
- Dr. Anthony Boutin, of Nassau University Medical Center in East Meadow, talks about speaking with the hospital's staff about getting vaccinated.
At Nassau University Medical Center in East Meadow, Dr. Anthony Boutin, who leads the hospital, said that "when I walk the halls and I see somebody, one of my first questions is, ‘Are you vaccinated?' If they say no, I ask why, and I talk to them."
"There are a handful that no matter what I say are adamant they won't take it," but others are persuaded either by medical facts, or by the realization they would no longer be allowed in the building if they're unvaccinated, said Boutin, president, CEO and chief medical officer of NuHealth, the public-benefit corporation that runs the hospital and A. Holly Patterson Extended Care Facility in Uniondale.
Boutin said town halls and one-on-one conversations have helped push vaccination rates to about 90% at both facilities, and he expects more employees to get vaccinated within the next week, with plans in place to avoid any disruption in care.
Hospital officials will talk with employee unions to decide how to handle unvaccinated employees, Boutin said. They will not be allowed in the hospital or nursing home, but they will not be terminated, he said.
'If someone is telling us, ‘Absolutely not, I’m not getting vaccinated,’ we know we’ve got to start recruiting for a potential replacement.'
-Maxine Carrington, Northwell’s chief human resources officer.
At Northwell Health, the state’s largest health care system, there are on-one-one conversations with each unvaccinated employee, who is then placed into a category based on their likelihood of getting vaccinated, said Maxine Carrington, Northwell’s chief human resources officer.
All those employees are educated about the vaccine, but "if someone is telling us, ‘Absolutely not, I’m not getting vaccinated,’ we know we’ve got to start recruiting for a potential replacement for that team member," she said.
More than 1,000 employees had vaccination appointments within the past week alone, indicating success in persuading some employees, she said.
Nurse: 'I’m not getting it no matter what'
Jillian Kulesh, an emergency department nurse at Huntington Hospital, is one Northwell employee who would lose her job rather than get vaccinated.
"I’m not getting it no matter what," said Kulesh, who said she is blind in one eye because of a past stroke. "I’m not willing to risk going completely blind over an experimental vaccine."
With vaccines so new, there’s no way to know what the long-term effects will be, including on fertility, said Kulesh, 33, who has a 1-year-old daughter and wants to have more children.
Kulesh predicted that care at the hospital will "go completely downhill" once the mandate takes effect, because a number of other nurses, lab workers, phlebotomists and other employees she’s talked with also don’t plan on getting vaccinated.
Northwell has plans in place — if necessary — to redeploy some employees to different positions and is working with its own staffing agency and outside ones to fill vacancies, Cunningham said.
'I’m confident we’re going to be able to handle this without an impact on patient safety or the quality of care.'
- Dr. John D’Angelo, Northwell’s chief of integrated operations.
"I’m confident we’re going to be able to handle this without an impact on patient safety or the quality of care we’re delivering," said Dr. John D’Angelo, Northwell’s chief of integrated operations.
NYU Langone Hospital–Long Island also has detailed contingency plans in place to avoid an effect on patient care, NYU Langone Health said in an email.
The other Long Island hospitals and systems — Catholic Health, Long Island Community Hospital and Stony Brook Medicine — did not respond to questions about potential staff shortages or declined to comment.
Kulesh’s concerns about long-term effects and fertility are common, surveys show. Yet the U.S. Centers for Disease Control and Prevention said negative long-term effects from the vaccine are "extremely unlikely," and there’s no evidence it affects fertility.
On the other hand, Sellers said, COVID-19 can be deadly, and even when it’s not, many people struggle with symptoms many months after infection, and their long-term prognosis is unknown.
Group urges flexibility with deadline
Clyne, of the nursing home association, urged the state to be more flexible about the mandate deadline by, for example, extending it for a month for some nursing homes, with unvaccinated employees required to pay for COVID-19 tests twice a week. That also allows more time to recruit and train new employees, he said.
At Oceanside Care Center, a nursing home, only about 5% of employees remain unvaccinated, said Carrol Dela Rosa, director of nursing. If needed, the center would seek help from staffing agencies, she said.
At New York Health, which has outpatient offices on Long Island and in New York City, "I don’t see any interruption in services," said Dr. Razia Jayman-Aristide, the company’s chief medical officer.
New York Health is a division of Port Jefferson Station-based New York Cancer & Blood Specialists and, if need be, employees could be shifted among the approximately 45 combined locations "to make sure we provide coverage in offices that need coverage," she said.
Clyne said the upcoming federal vaccination mandate for health care workers at places that accept Medicaid or Medicare — which is the large majority — helped New York facilities, because employees can no longer avoid vaccination by working out of state. The effective date of the federal mandate has not been determined.
The Healthcare Association, which represents almost all the state’s hospitals, as well as other health care organizations, "stands firm in our support of the vaccine mandate," group president Bea Grause said in a statement. But, she said, hospitals "need flexibility in workforce regulations."
Recommendations in the Healthcare Association's report include making it easier to hire workers from out of state and Canada and expediting state review of professional license applications. Hochul announced Wednesday the implementation of another Healthcare Association recommendation — allowing basic EMTs to administer vaccines — and the state Health Department said in a statement that it is "reviewing the recommendations in the report."