On Tuesday, the CDC’s Advisory Committee on Immunization Practices (ACIP) — in an overwhelming majority — voted to recommend that health care workers, among others, get first priority on a COVID-19 vaccine when one is authorized.
In light of this latest development, the question now becomes: Should home health providers mandate vaccinations for employees?
The news of the federal advisory committee’s vote should come as no surprise, given the significant toll COVID-19 has taken on the health care community, including home health workers.
More than 200,000 U.S. health care workers have now contracted the virus. More than 800 have died from COVID-19, according to the CDC’s latest count.
Vaccinating health care personnel — which the CDC defines as those working in home health, hospitals, long-term care facilities, outpatient clinics, pharmacies, emergency medical services and other settings — supports the principle of maximizing benefits and minimizing harms, Dr. Kathleen Dooling, a medical officer at the CDC, said during a recent ACIP meeting.
“Protection of health care personnel leads to preservation of health care capacity — and better health outcomes for all,” she said. “Vaccinating health care workers promotes justice because health care personnel put themselves at risk and will be essential to carry out the vaccination program.”
If home health providers were to mandate vaccinations for employees, the move would not be unprecedented.
Over the years, many providers have mandated flu vaccinations, but when it comes to COVID-19, some companies have expressed concerns.
“There are a number of home care companies that have mandated flu vaccines, but in talking to some of those companies, they’re hesitant to mandate this vaccine,” National Association for Home Care & Hospice (NAHC) President William A. Dombi told Home Health Care News. “And lawyers could come up with a whole series of reasons to go after a health care provider that mandates a vaccine. I’ve even heard some lawyers talking about various Constitutional rights under the First Amendment.”
Indeed, providers could potentially land in legal hot water if employers don’t navigate this action carefully.
“The research that I’ve done on this one leads me to a position of, there’s no real solid advice, in the absence of specific legislation that lawyers can give, other than to tell people, ‘It’s going to create risk for you.’” Dombi said. “It created risk with the flu vaccine, but this one may create even more risk because of the clinical aspects of this vaccine.”
A major factor for providers: Some employees are still likely to be skeptical despite promising results from Pfizer and Moderna on their COVID-19 vaccine trials.
About 79% of health care workers said they haven’t received enough information about the COVID-19 vaccine, in terms of safety, side effects and administration, according to a recent survey conducted by the American Nurses Foundation.
On the flip side, there are many home health providers that are hopeful about the vaccine and applaud ACIP’s recent vote.
“I’m very pleased that home health care workers are in that conversation … and part of the front-line workers,” Cleamon Moorer Jr., president and CEO of American Advantage Home Care Inc., told HHCN. “Oftentimes, hospitals, of course, are the top priority, and then outpatient clinics. But I’m glad that home health care workers are included on the front end.”
Dearborn, Michigan-based American Advantage Home Care Inc. is a provider of home health care and rehab services, plus specialty care and medical social work. The agency operates across nearly a dozen Michigan counties.
Moorer also believes there are a host of reasons why it may be difficult for providers to mandate vaccinations for employees.
“Some of our home health care workers could be pregnant or planning for a family,” he said. “In that event, we’re often concerned about the impact of vaccines on pregnant women. Secondly, there are some individuals who for religious and/or ethnic purposes find themselves averse to vaccines. We definitely want to be sensitive to this.”
For context, Pfizer and Moderna’s vaccine trials haven’t included people who are pregnant.
Still, for people who don’t fall into the previously mentioned categories, strongly encouraging and incentivizing employees to take the vaccine — rather than mandating — might be the best option for providers.
“[Providers could potentially] offer a monetary incentive, for those that take on a high volume of patients, especially for those that continuously see patients who have been diagnosed with COVID-19,” Moorer said.
In cases where an employee may decide to forgo the COVID-19 vaccine, there are administrative actions that providers can take.
“They could take the staff that’s refusing to be vaccinated and only assign them to patients who are low risk and are not in a position to transfer the virus from patient to provider,” Dombi said.
Typically during flu season — October through March — American Advantage Home Care Inc. makes multiple in-services available to employees. This means providing education around the flu vaccine and presenting the option for workers to receive the shot or decline, as well as keeping documentation of this information.
The company plans to approach the COVID-19 vaccine in a similar manner, once it’s available. Moorer urges providers to lean on educating workers in the coming weeks and months.
“I think that education is of the utmost importance for health care workers,” he said. “It tends to be one of those forks in the road where a person considers what is the lesser of the two burdens, perhaps contracting COVID-19 versus experiencing some unknown side effects of the vaccine. I think many who have seen the death toll, as related to the virus, would perhaps look at the vaccine as the less of two burdensome outcomes.”
Ultimately, the COVID-19 vaccine could serve as another safety tool.
“The best thing that I’ve heard from anybody so far, is the vaccine … becomes another tool, but you don’t drop your guard on everything else that you’re doing in infection control,” Dombi said. “It doesn’t mean you stop wearing the mask. It doesn’t mean you start gathering with large numbers of people or start getting reckless.”