Nate Schema, President and CEO of The Evangelical Lutheran Good Samaritan Society, joined the December 8, 2021 LeadingAge Coronavirus Update Call. He responded to questions from Ruth Katz and from callers. Here is a brief summary of the interview.

Q: Please briefly describe the Good Samaritan Society.

A: We have a broad range of services to older adults including home health, senior living, independent living, assisted living, and skilled nursing. We have a concentration in the Upper Midwest and have locations in 22 states from Washington state to Florida. We serve 15,000 people daily and have over 12,000 employees.

Q: Good Sam was quite bold to mandate vaccines for COVID-19 early on. What all did you consider in making that decision?

A: As I reflect on the fourth quarter of 2020 when we were seeing so many cases of COVID-19 in our locations with such devastating consequences, it was clear that vaccination was the way out of the pandemic. As 2021 progressed, we saw a resurgence of COVID and a plateauing in the number of vaccinations. We decided on July 16 to draw a hard line in the sand and mandated that staff be vaccinated by November 1. We want to be a safe place to live and to work and that comes first.

Q: Many members are concerned that mandates will result in losing staff. How did you think about that?

A: Well, staffing pressures are what keeps me up at night above all else. However, we have had staffing challenges long before the mandate. For me they are separate issues. I don’t see workforce as a vaccine mandate issue – we have reimbursement issues, lack of awareness of jobs in the field, difficult work and lots of other issues. We lost about 2% of our workforce and most were PRN or part-time.

Q: You likely had pushback from employees when you implemented the mandate, didn’t you?

A: We had a handful of communities that quickly reached full vaccination, but for many others it was a slow process – that’s why we gave people a good many months to get vaccinated. About 10% of our staff members received exemptions. We have seen a 96% reduction in COVID since the mandates and that makes it well worth it.

Q: Have you moved unvaccinated individuals out of direct care roles?

A: Not necessarily, we are following CDC/ CMS guidance regarding testing, masking etc.

Q: Please tell us more about your experience with exemptions.

A: Nine out of ten exemptions are for religious reasons. We were not overly narrow in accepting those. We have many locations in very small towns and so losing one RN or LPN to a mandate is huge. But we haven’t seen that – we are more seeing wage wars.

Q: Are you seeing patterns related to the staff that left, or patterns in exemptions? Rural v. urban? Regions of the country? Other variables?

A: We are not seeing geographic or demographic patterns. There is no real difference in rural areas or other sorts of geographic or demographic variables. Facility leadership made a difference in how quickly and smoothly we got through the mandate to vaccination. We have furloughed people and then they decided to get vaccinated and come back. We are also seeing people apply to work with us because they wanted to be with a safe employer.

Q: Did you see vaccinated employees then encouraging their families and friends to get vaccinated?

A: We believe that part of why we were able to get through the mandate pretty smoothly, was that people were encouraging one another, and they did see the focus on safety as a good reason.

Q: What have been the reactions of residents and family members?

A: Residents and family members are pleased with the fact that we are putting safety first and that is helping with census, particularly in independent living and assisted living where more choice is involved in making the decision to move in.

Q: How is the current visitation guidance working out?

A: It is working pretty well. We are trying to navigate visitation protocols and are following guidance. Variations from state to state in this, as in so much, is one of the challenges of operating in so many different states. Keeping families apart was one of the hardest parts of the pandemic, so we are trying to support visits in every way possible.

Q: You see the workforce crisis as separate from the vaccine mandate. How are you addressing the staffing challenges? What are you trying in terms of recruitment?

A: Good Sam is blessed to be part of the larger Sanford Health system with access to their talent recruitment professionals. We are focused on building a pipeline by engaging with prospective talent early and often. Employment issues are not specific to our field and we need to change and be more flexible about employment terms and see what we can learn from other industries.

Q: Are you requiring staff who received an exemption to wear N95s and additional PPE?

A: We considered that but came back to the science and are following CDC/CMS guidelines.

Q: How did you educate staff about vaccines and the mandate on such a broad scale?

A: We have used many different vehicles including weekly town halls and sending senior leaders such as our chief medical officer and chief nursing officer to sites where vaccinations were lagging. In the final two weeks we saw a significant bump in vaccinations. It really was one-on- one conversations that made the greatest difference.

Q: Did you track where people went when they left? Did they go to employers without a mandate?

A: We have tracked that closely. We had a few people leave to other non-mandating employers, but then the places they went required vaccines, so they came back. And, other people have been attracted to our organization because we required vaccines.

Q: Will you mandate boosters and/or future annual vaccinations?

A: We are all-in with our commitment to safety, so we are committed to whatever is recommended.

Q: You mentioned wage wars – are you using hiring bonuses?

A: We have had mixed results with hiring bonuses. In one area we are seeing people jumping from place to place to get the hiring bonuses so it is not a good long-term solution. We are exploring retention bonuses and other incentives to encourage people