With many hospitals instituting vaccine requirements for their employees, advocates and industry associations are asking long-term care facilities to consider similar measures.

Nationwide and statewide, while vaccine uptake among residents at long-term care facilities is quite high, rates among staff are variable and, in some facilities, quite low.

This puts both residents and staff at continued risk for outbreaks, albeit much, much less so than before vaccines were introduced. In fact, vaccines have driven down outbreaks in long-term care facilities dramatically in Washington.

In December 2020, as many as 900 COVID-19 cases were confirmed in one week – all associated with long-term care facilities – but once vaccines became available, that number dropped significantly. Now less than 100 cases are confirmed each week in long-term care facilities, according to state data.

Now, with vaccines available to everyone, many residents and the state long-term care ombuds are asking facilities to require vaccines for their care staff in order to keep residents protected.

“Resident vaccination rates have been much, much higher than vaccination rates of staff, and the people who pay the cost are the residents,” Patricia Hunter, Washington state long-term care ombuds, said, adding that it’s the residents who lose the ability to have visitors or have to go into lockdown when transmission rates rose last year.

The delta variant has brought with it new challenges, and the threat of ongoing outbreak – while lower – is still possible, especially with less vaccinated staff. The delta variant is much more transmissible than previous variants and strains, and the Centers for Disease Control and Prevention found that even fully vaccinated people can spread it, triggering a mask recommendation for everyone.

Breakthrough cases, when a fully vaccinated person tests positive, are expected and also very, very rare.

Of the just 4,241 breakthrough cases confirmed in Washington, 8% of those people were hospitalized. There have been 52 deaths due to a breakthrough case of COVID-19 confirmed by the state health department, and half of the breakthrough deaths are associated with outbreaks in a long-term care facility.

The Spokane Veterans Home, which had outbreaks earlier in the pandemic before vaccines were available, had another outbreak recently. While the investigation of how the virus got into the facility is not finished, vaccination rates in the facility show that not even half of the staff there are fully vaccinated, while 89% of residents there are.

The Centers for Medicaid and Medicare Services has collected vaccine rates at nursing homes in each state, and this list shows similar trends in many facilities in Washington, where the vast majority or, in some cases, all residents are vaccinated, while the staff vaccination rate ranges from matching residents to less than half.

For example, Lakeland Village, a state-run facility in Medical Lake, has a 99% vaccination rate among residents, while just 48% of staff have their shots. Similar to the Spokane Veterans Home, since Lakeland Village is run by a state agency, the governor could mandate vaccines for employees there.

Robin Dale, CEO of Washington Health Care Association, which represents 500 nursing homes and long-term care settings, said his association is encouraging facilities to mandate vaccines, but he added that the most effective type of vaccine mandate would come from the top of state government.

“If you’re going to do mandatory vaccination, it has to be all health care providers not just long-term care,” Dale said.

He added that a health care system-wide mandate would prevent workers from just leaving a facility for another one that has no mandate. He also added that ombudsmen, state surveyors and others who regularly go into long-term care settings should also be subject to a mandate if implemented.

Gov. Jay Inslee could mandate vaccines in not only long-term care settings but also across the health care industry broadly. He is considering a mandate for state employees, and there is a press conference scheduled this week that might offer more details on the possibility of a mandate.

Individual facilities are allowed to require vaccines for their employees, but Dale said many facilities are wary of losing staff should they do so, especially if there’s another center down the street that will pay the same and not mandate the vaccine. There was already a staffing shortage in long-term care before the pandemic, so the threat of losing workers is a reality that many facilities deal with regularly.

Dale said an across-the-board mandate, much like the one issued in California, would help facilities mitigate the threat of staff leaving. He added two large companies that run long-term care homes in the state have required vaccines and so far have only lost a small amount of staff, if any at all.

“We do have members who have mandated vaccination for all their employees, and those providers have seen that they’re not losing as many people as they thought they would,” Dale said.

Ensuring long-term care staff have access to the vaccines as well as the assurance that they can get time off should they need to rest after their second dose will be vital to easing access for staff members, Hunter said.

“They most likely can’t afford to miss work and are afraid of symptoms and whether or not they will be paid to get vaccinated,” Hunter said.

The Washington Health Care Association has recommended facilities be flexible in supporting staff members to take time off to get vaccinated as well as to recover if they get sick after their second dose.

Ultimately, with the virus circulating this fall and winter, vaccine rates in facilities could make the difference for long-term care residents’ quality of life.

“If we are really about protecting those who are most vulnerable, we need to truthfully stand back and ask ourselves how can we stop it?” Hunter said. “It’s really not visitors, or family or friends, who are bringing it in, it’s the staff.”

Hunter said her hope is that with high enough vaccination coverage, residents will not be subjected to lockdowns and isolation again later this year.

“Now that we know better, we need to do better,” Hunter said. “I hope we don’t just flip the switch and put everybody in isolation; there should be no reason to do these massive lockdowns.”