As the delta variant continues to drive the latest coronavirus surge, many long-term care providers and advocates are calling for mandatory vaccinations for staff members -- a stark change in tone from earlier in the pandemic.
"I have come full circle," said Michael Wasserman, a member of California's Vaccine Advisory Committee and past president of the California Association of Long-Term Care Medicine. "It is abundantly clear that if all nursing home staff were vaccinated, that we would dramatically impact nursing home deaths from COVID-19."
Nursing homes, once deadly epicenters of the coronavirus pandemic, were among the first to be eligible to receive the vaccine against COVID-19 due to their vulnerable population of older adults, many with underlying conditions. To date, more than 184,000 nursing home residents and staff in the U.S. have lost their lives to the virus.
In the months since nursing homes were prioritized for vaccination, COVID-19 cases and deaths in nursing home facilities have decreased dramatically. Yet nationwide vaccination rates among nursing home staff members are lagging far behind.
The American Association of Retired Persons estimates that about 78% of long-term care facility residents are fully vaccinated -- while staff vaccinations are only at 56.7%.
"Some say they believe it is still too soon for them to get the vaccine," Evan Lubline, CEO of Hooverwood Living in Indiana, said of his staff members. "So they're still evaluating and seeing what works for them. They want to have the choice."
The Centers of Disease Control has said for some time that where nursing home staff vaccinations lag, outbreaks may follow.
In April, the CDC linked a COVID-19 outbreak at a Kentucky nursing home to an unvaccinated health worker at the facility. Authorities identified 46 total COVID-19 cases, resulting in the death of three residents -- one of whom had been vaccinated.
"Unvaccinated staff can still cause outbreaks," Wasserman told ABC News. "These outbreaks will still kill any unvaccinated residents and also put unvaccinated staff at risk. I find it unconscionable that we not mandate vaccines in nursing home staff."
"We don't want a repeat of what we've been through, for anyone -- not for older adults, or the people who care for them," Katie Smith Sloan, the president and CEO of LeadingAge, an elder advocacy group, told ABC News. "If a community is at risk and cases are rising, then older adults and long-term care are at risk."
A new CDC report released on Thursday addressed vaccine hesitancy among long-term care staffers, despite their being prioritized for early COVID-19 vaccination due to their high-risk roles. The report comes as more than 50 major health organizations are calling for mandating staff vaccines.
Earlier this year, LeadingAge and the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) -- which represents more than 14,000 nursing homes -- conducted a joint national campaign to get 75% of all nursing home staffers vaccinated by June 30. The campaign, however, failed to meet its goal. As a result, the organizations are now calling on all nursing home facilities to make staff vaccinations mandatory.
"We can start saving more lives today by ensuring staff are fully vaccinated," Sloan said.
But vaccine mandates can cut both ways. In some long-term care facilities, vaccine hesitation among staff members has been so pronounced that executives are worried that requiring the vaccine will push them out the door.
Kimberly Biegasiewicz, Vice President of Clinical Services at Avante Group, which owns several long-term care facilities across Florida, told ABC News they are not mandating vaccinations for staff after holding conversations with staff. Instead, the group recently initiated a "vaccination push" across facilities, with initiatives including offering prizes to facilities with the highest vaccination rate and holding conferences with health experts to educate staff.
"We have talked to our staff and they have been transparent to share that they want to make their own health care decisions," Biegasiewicz said. "In addition, there is a very real concern that mandating vaccines in the setting will force these staff to leave the profession, and now more than ever we need these hard working staff to provide quality care to our most vulnerable."
"Staffing related issues in long-term care facilities are always a concern," said Lubline. "We don't want them to leave."
As a result, said Lubline, "we just try to educate them. We are always providing them with information on the vaccines, but we also tell them that they should feel comfortable. We don't want to put too much pressure on them to make them feel like they have to do it."
Likewise, the AHCA acknowledges that mandates could hamper staff recruitment efforts and make worker retention more difficult. As a result, the organization -- while fully supporting mandatory vaccines -- is encouraging nursing home facilities to continue providing education about the efficacy and safety of the coronavirus vaccine, in order to encourage staff to get vaccinated voluntarily.
SEIU, the union that represents health care workers, including many who work in nursing homes, is also encouraging employers to make it easier for staffers to get the vaccine.
"[Vaccination] is simply not happening quickly enough in the face of surging Delta variant cases across the United States and the world," SEIU officials said in a statement. "A lack of paid time off for vaccination or vaccine side effects, language barriers, and access to more trusted messengers of the same culture and community are all factors that are making getting the vaccine that much harder for working people. At this critical moment, more corporations and employers must do their part to remove these barriers."
Dr. Sachin Jain, an internal medicine physician and the CEO of SCAN Health Plan, told ABC News that, as a doctor, he believes "it is absolutely critical that we vaccinate everyone who comes in contact with older adults."
"We have known for some time that older adults are at high risk for severe illness due to the coronavirus," said Dr. Jain. "That remains the case. However, we have effective vaccines now that have been proven to reduce the chance of becoming severely ill."
Douglas Adkins, the administrator at DaySpring Senior Living, one of the first nursing homes in the country to mandate vaccinations for staff in March, told ABC News that he stands by his decision.
"The simple truth is that mandatory vaccination is a win-win for everyone," Adkins said. "Keeping residents and staff and our visitors safe is important to us."
Terry Fulmer, president of the John A. Hartford Foundation, which works to improve care for older adults, said it's time for nursing homes to get tough.
"Previously we were in a phase of education and outreach," Fulmer said. "But we now have a set of individuals who are unlikely to change their mind, and mandated vaccines are the only way to protect older adults."