The vaccine mandates from the Centers for Medicare & Medicaid Services (CMS) and the Occupational Safety and Health Administration (OSHA) have received mixed reactions from in-home care providers.
But the bottom line is that each will cause at least some employee movement, whether it’s forcing workers out of the health care sector completely or to another provider that’s held to lesser standards.
For instance, the CMS mandate excludes many home- and community-based services (HCBS) providers, though some are still subject to it based on which state they’re operating in. That’s according to National Association for Home Care & Hospice (NAHC) President William A. Dombi, who offered an update on vaccine policies during the organization’s Fall Forum Wednesday.
“Most states do not require home- and community-based services outside of home health and hospice services to be provided through a Medicare provider subject to Conditions of Participation (CoPs),” Dombi said. “So that in itself creates one of the issues that we need to see addressed.”
Specifically, NAHC is concerned that a staff member from a provider subject to CoPs, not wanting to get vaccinated, could have the opportunity to move to a home care company not subject to the CMS mandate.
Encompass Health (NYSE: EHC) CEO Mark Tarr said Monday that his company is fully expecting at least a small portion of its aides to exit its workforce due to the CMS mandate, which will go into effect partially in December and fully at the beginning of 2022.
Tarr also said that the mandate will naturally increase the company’s vaccination rate, urging the final group of workers who are hesitant to get vaccinated to keep their jobs.
Dombi made the same point Wednesday, pointing to testimonies from providers that went through mandates in their own states prior to the nationwide CMS regulation.
“The comforting part is that most employees – by far, into the 90-plus percentile – choose to get vaccinated rather than leave their jobs,” Dombi said. “So we hope a similar result will come from these new actions out of CMS and OSHA, and that they don’t bring too much of a disruption.”
While the CMS mandate has been scoffed at by some, it hasn’t come under real legal scrutiny thus far. On the other hand, the OSHA mandate – which applies to private companies with 100 or more employees – has been challenged legally.
Those legal challenges are underway and are likely to move very quickly.
“There is litigation pending in multiple parts of the country on the OSHA requirements, and one court has already issued a restraining order to keep that from taking effect,” Dombi said. “These things are going to move very, very quickly. What’s going to happen is that the OSHA cases are going to be consolidated into a single court of appeals. That decision will be made by the courts of appeals in a matter of days, and it is highly likely that these matters will find their way to the U.S. Supreme Court.”
The only question that could end up being challenged legally from the CMS mandate is the idea of forcing non-patient-facing workers to get vaccinated.
All workers, including back-end staff, are currently required to get vaccinated under the mandate; only full-time telework employees are exempt.
“We can anticipate that there’s going to be a bit of a bumpy road in the near term relative to these mandates,” Dombi said.
Expanding the pool of workers
While certain home health providers have found success in poaching workers from other health care jobs, that won’t be a panacea to the massive shortage that the industry is facing.
Instead, the entire health care workforce that deals with seniors needs to be expanded greatly, Dombi said.
“We’ve reached a point where the awareness and understanding of health care at home … is such that we are now seeing the demand exceeding the supply of the workforce,” he said.
National training and certification programs would help, as will the $150 billion included in the Biden-Harris “Build Back Better” plan to bolster in-home care services in the U.S.
But the overarching problem that needs to be addressed is the lack of human resources in the home care and home health industries. The pool of talent is still simply too small.
“Nursing schools are insufficient to supply the nurses that we need,” Dombi said. “There are other ways to incentivize people coming into health care – and particularly to home care. [Those include] such things as training programs in high school, college credits for providing services and tuition-free education and certifications of home care aides in community colleges.”
Workers from outside of the country will also be needed, though, which has been tough during the pandemic as borders have been closed or harder to get through.
“Where will we get the individuals to help?” Dombi said. “That opens up conversations about immigration, which are politically and socially sensitive. But it’s something we cannot ignore as a potential source of caregivers.”
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