Home-Based Care Providers Face Major Losses Ahead of Vaccine Mandates

Home-based care agencies all across the country are racing toward – or already moved past – effective dates of vaccine mandates in their respective areas.

And as they continue staff-education efforts internally while following outside legal challenges to mandates, providers are struggling to keep workers who refuse to get vaccinated against the COVID-19 virus.

“We are still plateaued at about a 63% vaccination rate,” Kevin Smith, president and CEO of Best of Care, told Home Health Care News. “Of the remaining, we are in pretty much daily communication to find out what these aides are planning to do, given that there is an Oct. 31 vaccine deadline here in Massachusetts.”

Boston-based Best of Care is a privately owned non-medical home care and care management company that serves roughly 1,200 clients weekly. It has around 350 aides, about 130 of which are not vaccinated, despite continued and aggressive vaccine education throughout this year.

In Massachusetts, all home care workers need to have received their second dose – or just one if they opt for the Johnson & Johnson (NYSE: JNJ) shot – by the end of the month. While the state has allowed for caregivers to seek religious or medical exemptions, that presents a whole new set of problems, Smith said.

For one, even if those unvaccinated aides are allowed to keep working, clients may not want unvaccinated workers coming into their homes. Secondly, if testing allows the unvaccinated to continue working, it will create another burden for providers for the foreseeable future.

“The issue for providers is the undue burden associated with a weekly testing program for home care aides who are transient in nature,” Smith said. “How is that going to work for large companies, and who’s going to pay for that? Is that coming at the expense of the aide who chose not to get vaccinated or is exempt? Or is it coming at the expense of the employer? And if it’s coming at the expense of the employer, what type of costs mitigation or reimbursement will we be getting? That is the major concern right now.”

As a part of President Joe Biden’s COVID-19 strategy announced in September, most home health workers are required to get vaccinated. In addition, private businesses with over 100 employees are subject to vaccination requirements, unless a worker is willing to subject themselves to weekly testing.

Currently, local or state mandates are mostly concentrated in the Northeastern part of the U.S. and the West, with a few exceptions.

“This is a big problem,” Smith said. “And I can’t tell you on Nov. 1, whether or not our aides can simply go to work, if they’re unvaccinated and exempt, simply wearing a mask, which is honestly what they’re doing today. So, there’s still a lot of uncertainty about them.”

Most home-based care providers have still not opted into mandating the vaccine themselves, fearing an exacerbation of an already poor staffing environment.

LHC Group Inc. (Nasdaq: LHCG) is in that camp. And while its vaccination rate among its tens of thousands of employees is only around 60%, it varies greatly by geography. For instance, in states more inclined to have mandates in the Northeast, vaccination rates tend to be around 75% for the company, CEO and Chairman Keith Myers said at the Home Health Care News FUTURE conference last week.

“We thought a mandate would further exacerbate our staffing issues,” Myers said. “But that being said, … we will likely go to mandatory testing for those that aren’t vaccinated. I see us going to that place.”

Meanwhile, LHC Group says that its quarantine rate for employees is at its best since the pandemic began. Where 4.4% of employees were quarantined at a high point, that rate is now below 2%.

“We’re happy about that,” Myers said. “And with regard to the disparity, regionally, it’s just all about the vaccination rate. … There are states that are along the Gulf, in the Southeast, where we’re seeing a 40% vaccination rate.”

Where infections occur

Dorothy Davis, the president and CEO of the Atlanta-based Visiting Nurse Health System (VNHS), also does not believe in organizational mandates. But her company is in a better place, with an 83% vaccination rate overall.

“We’re waiting to see what the policy and legal teams do with the mandate from the Biden plan,” Davis said at FUTURE. “There are a lot of reasons why our board and myself feel that mandating is not the right direction.”

VNHS is a home-based care organization with about 6,500 patients on its census.

What Davis is more concerned about is how her organization’s workers end up being infected with the virus, however. Most often, exposure to COVID-19 happens not at work when clinicians are treating patients, but rather when they’re off the block.

“What we have found is that infections have happened outside of the workplace,” Davis said. “If we were seeing risk in the workplace, I think we would take a different approach. We’re self-insured, so there’s a lot of factors to consider. But what we find is pretty much all of our infection rates or quarantines have happened from what people do in their personal lives, not what happens in the home.”

That has forced VNHS to continue education efforts not just on the vaccine front, but also on protocols that were laid out in the early days of the COVID-19 crisis.

“That [issue] has also really helped from an education standpoint,” Davis said. “It’s helped to really focus on protocol, and continue to reinforce what we do each and every day when we leave our homes and go into individual homes. It’s really about awareness and following protocol across all our settings.”

The $50 million question

Non-medical home care agencies tend to be struggling more with mandates than medical home health ones, Angelo Spinola, the co-chair of the home health and home care industry group at the law firm Polsinelli, also said at FUTURE.

“It’s a mess, particularly in personal care,” Spinola said. “When you get into your clinicians in the skilled care [space], it’s a little better as far as what the percentages are. But it’s very jurisdictional and very personal. And what we found is that when a caregiver doesn’t want to get vaccinated, you can incentivize them, you can educate, you can make it as easy as possible, and they still may not get vaccinated.”

Thus, even when the government looks to enforce a mandate, it may not sway the unvaccinated worker.

If workers are unaffected by advocacy and education, providers are faced with a dilemma: a fully vaccinated workforce and much less business, or a business plan not in compliance with law.

“We’re just working on this today with the Philadelphia mandate,” Spinola said. “And this provider, it’s got about $100 million of service in Philadelphia, and they’re going to lose half of that because half of their workforce is not vaccinated. They’re thinking, ‘What do we do? Are we going to ignore it? What can we do?’ The question is whether it’s more advocacy or some sort of lawsuit.”

The Philadelphia mandate was announced in Mid-August and goes into effect on Oct.15. Still, the city has struggled to get home-based care workers, in particular, vaccinated.