‘We Are Losing Excellent Direct Care Staff’: Home-Based Care Providers Report Vaccine-Mandate Blowback

Hundreds of in-home care workers in Rhode Island have resigned from their posts due to the state’s mandatory vaccine policies, the Rhode Island Partnership for Home Care announced Tuesday.

That, in turn, has jeopardized patient care in the state.

An emergency declaration was made Aug. 17, requiring all licensed health care workers in Rhode Island to be vaccinated against COVID-19 by Oct. 1. A limited number of exemptions are being given, but home care providers are nonetheless seeing nurses, social workers, rehab therapists, office staff and others walk out the door.


For now, the exodus is unique to Rhode Island, Home Health Care News follow-up reporting determined.

But similar scenarios in other states across the country could arise quickly.

“While home care administrators are supportive of patients, clients and employees getting vaccinated, it should remain a decision between an individual patient and their physician,” Michael Bigney, the president of the board of directors for the Rhode Island Partnership for Home Care, said in a statement. “We are losing excellent direct care staff that have been on the front line throughout this pandemic.”


The sudden influx of resignations means more than 1,000 in-home care patients and clients may lose the services they depend on by Sept. 30, the partnership projects.

“I hope that every displaced patient and client calls Governor [Daniel] McKee to tell him that this mandate is wrong,” Bigney continued. “Discharging vulnerable homebound patients and clients without continuity of home care may contribute to more hospitalizations than any COVID-19 breakthrough variant.”

Rhode Island is not alone in enacting emergency vaccination requirements. New York, California, Washington, Illinois and Colorado and other states have either partial or full vaccine mandates for health care workers, with more likely looming.

Nationwide mandate struggles

Vaccine mandates for health care workers, while generally popular due to the severity and highly contagious nature of the Delta variant, are particularly tough on home-based care agencies already dealing with staffing complications.

Even if a small percentage of workers are unwilling to comply, that can mean a loss of business for agencies. As the Rhode Island Partnership for Home Care projected, it can also mean home-based care deserts for seniors.

In the next few months, momentum is likely to pick up for more mandates across the country.

“Several states have or are considering mandating vaccines for health care workers,” a spokesperson from the National Association of Home Care & Hospice (NAHC) told HHCN in an email. “In some instances, the mandates apply to health care workers in facilities and do not apply directly to health care at home. However, even those mandates affect home care where patients are seen in assisted living facilities or nursing homes.”

Outside of Rhode Island, where concrete numbers seem to be surfacing, it is tough to quantify the exact impact of mandates at this point on providers.

“Home care providers have expressed that the mandates will trigger the risk of losing staff with staff shortages already occurring due to inadequate supply and increased demand for home care,” the spokesperson said. “With existing staff shortages, it is predictable that continued patient service is at risk if additional staff leave their jobs. That is particularly the case if the mandates do not include sufficient time to implement or do not provide for reasonable, temporary exemptions.”

While the long-term effects of mandates are still difficult to assess, there is a major concern among providers and associations alike that losing workers now may mean losing workers forever.

That loss comes at a time when more workers are desperately needed in both home health and home care.

“Especially on the non-medical side, once an employee leaves home care, it is going to be very difficult to get him/her/them back,” Sarah Ratcliffe, the executive director of the Illinois HomeCare & Hospice Council (IHHC), told HHCN in an email. “Retention strategies, including building career ladders and offering innovative benefit packages, are so important in maintaining the current workforce and building capacity to continue to safely care for individuals in their homes.”

In Illinois, a mandate has been issued for health care workers in facility-based settings, but home-based care workers have not yet been required. There are still some agencies, however, that have required them for all staff — especially the ones that have employees working in patients’ homes and facilities.

“Thus far, we have not heard of mass resignations of home health or home care staff,” Ratcliffe said. “But workforce challenges have always been [an issue] for our agencies and the COVID-19 public health emergency and its downstream effects have definitely exacerbated this issue.”

A recent survey conducted by IHHC found that 66% of agencies in Illinois were currently experiencing difficulty hiring aides, while 83% and 61% were having difficulty hiring nurses and therapists, respectively.

“Due to staffing shortages in general, there have already been agencies that have had to turn down referrals because they don’t have the staff available to care for the patient,” Ratcliffe added.

The Home Care Association of New York State (HCA-NYS) documented similar staffing struggles in a letter to the state’s public health department, also expressing its reservations over mandates.

“If the council moves to mandate vaccination in home care, it must consider the impact on this already decimated workforce and the unsustainability of a worsened situation,” Al Cardillo, the president and CEO of HCA-NYS, wrote in the letter. “Because of the in-home, one-on-one nature of home care — combined with all of the clinical, cultural and scheduling considerations necessary to appropriately match workers with patients — the loss of worker access in home care and hospice essentially can equate to the loss of care.”

In California, statewide mandates for home-based care workers are not in place. But they are in L.A. County, where the government specifically made sure that home care workers were not exempt from the mandate.

For the Los Angeles-based 24 Hour Home Care, which has over 10,000 caregivers in California, it has forced them to scramble to make sure its workers aren’t set to leave if forced to get vaccinated.

“We’re in this testing phase right now,” Ryan Iwamoto, the president and co-founder of 24 Hour Home Care, told HHCN. “We’re probably at about 50% vaccinated, in terms of caregivers who’ve told us they’ve gotten the shot. With the other 50%, we’re wondering, ‘Are they on the fence? Or are they just going to leave the industry?’ It’s all a bit unknown. We hope most will get [the vaccine], but you never know. And I think that’s what we’re sort of facing right now.”

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