COVID stalks Iowa nursing homes again, traced to unvaccinated workers; will a vaccine mandate drive them away?

Tony Leys
Des Moines Register

DALLAS CENTER — John Thomas agreed to get a booster shot of COVID-19 vaccine as soon as it was offered at the Spurgeon Manor nursing home.

He can’t understand why many other Americans continue to decline the shots.

“I think they’re crazy, because it’s a way to remedy this thing,” the retired farmer said, shortly after receiving his booster dose Oct. 1.

Thomas, 85, had hoped the coronavirus pandemic would pass quickly after it surfaced in spring 2020. But like thousands of other Iowa nursing home residents, he had to live through months of isolation due to strict visitor limits designed to keep the virus at bay.

Despite such safeguards, the virus snuck into hundreds of Iowa nursing homes, killing about 2,500 residents. 

The threat to Iowa's nursing homes seemed to be vanquished last spring, after more than 90% of residents were fully vaccinated and cases plummeted. But as a more contagious strain of virus plowed through the U.S. this summer and fall, dozens of Iowanursing homes have reported outbreaks.

More:COVID surge drains morale at packed Des Moines hospital: 'We could have prevented this,' ER doctor says

The new wave of nursing home cases is due largely to the fact that a third of Iowa's nursing home workers aren't vaccinated, said Brad Anderson, president of AARP Iowa. The unvaccinated staffers are carrying the virus in from the community, he said, leading to more "breakthrough" infections among elderly residents who are vaccinated but have weaker immune systems. 

“It’s been like watching a tornado form in a cornfield,” he said.

To try to snuff out the renewed threat, the federal government is moving to mandate vaccination of all nursing home workers. Nursing home leaders say they want more workers to accept the shots. But they also fear that when the vaccine requirement takes effect later this fall, they'll see critically needed employees leave rather than comply, creating a whole new crisis. 

Mass vaccination of residents couldn't halt outbreaks

The current situation in nursing homes is nowhere near as dire as the crisis last fall. Back then, up to 139 of Iowa's 444 nursing homes were simultaneously reporting outbreaks, defined as infecting at least three residents but often involving waves of deathly ill patients.

In March of this year, after more than 90% of nursing home residents were vaccinated, state officials announced that not a single Iowa nursing home had an outbreak. But the delta variant dashed hopes, rekindling the spread of COVID-19 throughout Iowa and eventually inside care facilities. As of Friday, the number of nursing home outbreaks had climbed back up to 31, according to the Iowa Department of Public Health.

Spurgeon Manor hasn’t had any COVID-19 outbreaks, although it’s seen a few residents test positive since the pandemic began. 

More:Official count of coronavirus toll in nursing homes likely missed 16,000 deaths; 68,000 cases

Administrator Maureen Cahill said everyone was optimistic last spring that the danger was receding.

“It’s pretty sad now,” Cahill said. “You wonder, ‘Will it ever end? What’s the next variant going to be?’”

Spurgeon Manor employee Dani Conway gets a COVID-19 booster shot from Carol Hillebrand of Right Dose Pharmacy  at the Spurgeon Manor retirement community in Dallas Center, Friday, Oct. 1, 2021.

Cahill described the situation on a recent morning as she walked the halls of Spurgeon Manor, a modern facility that includes a nursing home, assisted living center and independent living apartments and town homes. The facility has about 140 employees, 75% of whom are vaccinated. That’s well above the state average of 68%, but she’s trying to push it higher.

Cahill is an enthusiastic booster of COVID-shots, but she has mixed feelings about the looming government mandate. She could face a daunting task in replacing any staffers who leave rather than comply.

“This is the worst time we’ve ever had recruiting people,” said Cahill, who has worked in the industry 23 years.

Iowa Poll on vaccine mandates:Feds shouldn't order employers to require COVID shots, 52% say

Spurgeon Manor has repeatedly increased its staff pay, trying to attract more applications for its open jobs. For example, Cahill said, her facility’s dietary aides now start at $12 per hour, up from $8 just two years ago. But she’s seen convenience stores advertising jobs starting at $18 per hour.

The care facility can't match such wages, especially without the temporary federal aid that buoyed the industry during the pandemic’s height, she said.

The new government vaccine requirement could induce some of her unvaccinated staff to leave, she said.

"I can't really afford to lose any of them," she said. "I don't know what I'm going to do." 

'I believe in science,' nurse says as she gets her booster shot

As Cahill worried about a worker shortage,a local pharmacy team was visiting Spurgeon Manor to offer booster COVID-19 shots to residents and staffers who had received the Pfizer vaccine last winter. Julie Messerli, a veteran nurse, didn’t hesitate to get in line for her third shot.

“I believe in science,” she said. “And they’ve been making vaccines for a lot of years now.”

Some co-workers, including those with allergies to vaccines, have legitimate concerns about the COVID-19 shots, she said. But others are citing ridiculous theories, such as that the shots include secret microchips being used to track people.

Spurgeon Manor Administrator Maureen Cahill stands for a photo at the retirement community in Dallas Center, Friday, Oct. 1, 2021.

A blue-and-yellow flier posted on a hallway wall at Spurgeon Manor addresses another persistent rumor. 

“Can the COVID-19 vaccines impact fertility?” the flier says. “Answer: No.”

The flier, produced by a national nursing home association, shows a photo of a pregnant woman, wearing a face mask and resting her right hand on her belly. The text disputes claims that the shots cause miscarriages.

“This myth started as a rumor on social media,” the flier says. “…Experts in reproductive science have repeatedly said there are no credible theories or scientific mechanisms for these vaccinations to impact fertility." 

More:Who should get a COVID-19 booster shot in Iowa? Here are the details and where to find them.

Messerli said she’s hearing fewer vaccine discussions among co-workers lately. People’s opinions have solidified.

“We’re a close-knit group," she said. "We all know where each other stands."

Nursing home staffers and other health care workers are slated to be among the first professionals to be required by the federal government to be vaccinated against COVID-19. Details of those requirements are expected soon. 

President Joe Biden also announced in September that the government intends to require large employers to get all their employees vaccinated or regularly tested. But that broader mandate has not yet been implemented.

Spurgeon Manor employee Kyle Ballenger gets a COVID-19 booster shot from Carol Hillebrand of Right Dose Pharmacy at the Spurgeon Manor retirement community in Dallas Center, Friday, Oct. 1, 2021.

Messerli worries that by narrowly focusing mandates on health care workers, the government will worsen staff shortages because vaccine skeptics could easily choose to work in other industries.

Nursing home residents’ health could be endangered if it means fewer front-line workers to help prevent falls, pressure sores and other everyday problems, she said. Care facilities also could be forced to stop accepting new residents because of staff shortages, she said. That could limit families’ choices for care.

Nursing home workforce in Iowa shrinks

Even in normal times, nursing homes struggle to recruit and retain workers. The problem has worsened, due to the stress of working amid the COVID threat and the increased competition from other types of employers, said Brent Willett, president of the Iowa Health Care Association.

His group estimates 33,400 people now work in Iowa nursing homes, down from 35,300 in July. Each one of those workers is essential, he said. Losing a cook or a housekeeper is nearly as damaging as losing a nurse or nurse aide, he said.  

"We're dancing on a knife's edge when it comes to staff availability," he said. 

Willett's organization has promoted vaccinations to workers in nursing homes and assisted living centers. But he said his group and others like it nationally are asking the federal government to allow unvaccinated workers to remain on the job, at least for a while, if they wear safety equipment and submit to regular coronavirus testing. 

Spurgeon Manor employee Diane Watts gets a COVID-19 booster shot from Carol Hillebrand of Right Dose Pharmacy at the Spurgeon Manor retirement community in Dallas Center, Friday, Oct. 1, 2021.

Anderson, the AARP Iowa president, said he understands nursing home administrators' concerns about losing staffers over the vaccine mandates. But, he said, "the No. 1 responsibility of nursing homes is to keep residents and staff safe," and vaccinations offer a powerful way to do that. 

Anderson said society must better support people who work in direct care fields, both inside and outside nursing homes.

More:'How long can the health care system hold up?' Iowa sets new 2021 high for COVID hospitalizations

"It's a grueling but incredibly important job, and we need to find a way to treat them better," he said. Government programs, such as Medicaid, should be willing to increase reimbursement rates to facilities and care agencies, but only if they ensure such money will go to raise front-line workers' pay, he said. 

A few Iowa nursing home companies have already ordered staffers to be vaccinated against COVID-19. The Western Home Communities chain, based in Cedar Falls, is one of them. Chief Executive Officer Kris Hansen said his company will require all employees to be fully vaccinated by Nov. 1.

The company owns or manages 10 care facilities. It normally employs up to 1,600 people, but has been down below 1,300 lately. It may lose a few more workers over the vaccine mandate, Hansen said, but resident safety has to be the top priority. 

"We respect that everybody has a choice — but we have a choice as an organization as well," he said. 

Spurgeon Manor employee Jayne Tenhulzen gets a COVID-19 booster shot from Carol Hillebrand of Right Dose Pharmacy at the Spurgeon Manor retirement community in Dallas Center, Friday, Oct. 1, 2021.

Di Findley, executive director of the Iowa Caregivers Association, said she's been surprised to hear how many direct care workers have hesitated to take the vaccine. Her group was among many that successfully pushed in 2020 to include direct care workers in the first group of Americans to be eligible for the shots.

"I was optimistic that more would jump at the chance," she said. 

However, Findley said people who predict an exodus of health care workers due to the impending vaccine mandate may be viewing only part of the picture. They're not taking into account other people who left health care jobs because they feared exposure to the coronavirus. If everyone working and living in a care facility is vaccinated, that could be a selling point in recruiting staffers who take the virus seriously, she said. 

Back at Spurgeon Manor, resident Darlene Devine said she has been mystified by why many younger adults don't want the vaccine. Devine, 89, said her generation remembers how vaccinations erased the specter of polio and other awful diseases. She sees the new vaccines as being just as important. 

"There are some things to be afraid of and some not," she said. "Sometimes, you've just got to take the bull by the horns and take care of things." 

Besides being a resident of the facility, Devine is mother to its administrator, Cahill. Devine said she has faith in health care leaders when they promote the COVID-19 vaccines as safe and effective. 

"They don't go around just sticking needles in people for fun," she said. 

Tony Leys covers health care for the Register. Reach him at tleys@registermedia.com or 515-284-8449.