Member Solutions for COVID Vaccinations

Workforce | December 23, 2020 | by Dee Pekruhn

As COVID vaccination becomes a reality for the employees and residents of nursing homes, assisted living, and (in some states) other forms of congregate independent living, members are finding solutions to pragmatic challenges in delivering the vaccine. Chief among these challenges is promoting vaccine acceptance with employees. Below, we discuss what members are doing to educate and incentivize employees to be immunized.

In a recent “straw poll” by one LeadingAge state partner, members attending the weekly state call were asked to what degree the organizations planned to require COVID immunization, and how agreeable residents, staff and leadership were to taking the vaccine. The informal poll results proved to be consistent with what members around the country have shared: more than half were “not sure” to what degree to require the vaccine of staff, with only a very small percent planning to make it a condition of employment, and the rest using various methods of encouragement to entice employees to get the vaccine. None of the three stakeholder groups - residents, staff or leadership – reported high levels of “eagerness” to get the vaccine, with residents and leadership evenly split between being “uneasy with” or “mostly comfortable” with vaccination, and the majority of staff reportedly “uneasy with” getting the shot.

Since the Pfizer vaccine received its Emergency Use Authorization (EUA) from the FDA a little more than two weeks ago, members have been struggling with whether and how to motivate – or even incentivize – their employees and residents to get vaccinated. Finding ways to assist, educate and manage all community members, including families, in their decision-making and receipt of the vaccine has been paramount on the minds of LeadingAge providers.


Require, Incentivize, Motivate: Staff Approaches

The Requirement Approach: Unless the state does not allow employers to mandate that staff be vaccinated, providers may issue such a requirement, but few say they plan to. A small number have considered or plan to make the vaccine a condition of hire for new employees, which is subject to less stringent EEOC requirements. One member did share that her organization plans to make the vaccine mandatory once it’s no longer only authorized under an EUA. Read more about the complex considerations around mandating vaccination for employees in the LeadingAge FAQs, Page 8.

The Incentive Approach: This member approach includes offering staff additional compensation in the form of cash bonuses, extra paid time off, promotional raffles for participants, and group incentives for reaching a certain overall participation percentage. One member was planning to give staff a one-time $30 bonus for taking the vaccine; another planned a raffle with a grand prize of $2500 to the winning employee. In Pennsylvania, one county is using federal CARES act monies to fund direct $750 cash payments to the employees of its county-owned nursing home who receive the vaccine. This approach has also been questioned by other members, who worry that offering direct payments or compensation will cause employees to question ‘whether there’s something wrong with the vaccine.’ Members have discussed consulting with their legal counsels first to determine whether payments for vaccination will increase their exposure to liability, should the vaccine cause serious side effects for some.

The Motivational Approach: Transforming the vaccination process into a milestone celebration is an approach that some members are taking. Senior leaders and executive directors are scheduled to ‘publicly’ take the shot to encourage employees by some members; others are planning (COVID-safe) group parties, refreshments and give-aways with prizes. The fact that key public figures, like the former and future U.S. Presidents, are taking the vaccine publicly is being used to assure residents and staff of the vaccine’s safety. Using her leadership example and cache with staff, one member said that she plans to tell her employees that, while the vaccine is not required, like her, she expects them to take the vaccine to protect the residents in their care.


Pragmatic Considerations

Worker’s Compensation: In advance of offering the vaccine to employees, several members have discussed coverage, in advance, of any time lost for vaccine side effects with their worker’s compensation agencies. Members who have done so have reported that their worker’s compensation agencies generally plan to cover time and lost wages if an employee takes the vaccine and must be out of work. Some members are considering having employees sign an Assumption of Risk Agreement prior to giving them the vaccine.

Staff Call Outs for Side Effects: Following the data presented by FDA, CDC and others, some members have reported that they plan to allow staff members to have up to 24 hours’ paid time off if they struggle with the known and common side effects of the vaccine: fever, headache and body aches. Others are considering additional measures, such as testing those staff with side-effect complaints that are similar to COVID symptoms, just to be sure the staff member hasn’t also contracted COVID 19 during the vaccine efficacy gaps between and following the two doses. The vast majority of side effects reported during vaccine trials were related to redness or soreness at the site of injection. These can be addressed with acetaminophen.

Vaccination Administration Record (VAR) Forms: To facilitate the collection and transmission of medical insurance and personal information, some members have created their own processes. Collecting and copying the insurance cards in advance is one example of solutions to expedite the on-site vaccination and consent process. And, because some second-round (or, even first-round) vaccination clinics will be held in the new year, these members have informed their stakeholders that new copies of their insurance will be required if their medical coverage has changed.

Post-Vaccination Monitoring: Following the reports of (rare) severe allergic reactions by those vaccinated, members were planning to adhere to the CDC’s recommended 30 minutes of post-vaccine monitoring of vulnerable individuals. Working together with their pharmacy partners to notify them of individuals with severe allergies and to ensure that the appropriate interventions such as epinephrine ‘pens’ are available in the observation spaces is an approach being taken by members. CDC is promoting its V Safe Vaccination Tracking App as yet another way that those receiving the vaccine can track and report their side effects.


Education, Tools and Resources

Communication Channels for Educational Materials: Members have shared a variety of methods through which they plan to promote vaccination information from trusted, vetted sources. These include: emails, flyers, website postings, webinars, handouts, YouTube or Facebook Live broadcasts, Town Hall meetings with the CEO and Medical Director, Call Alerts/ Texts. Using a variety of approaches to reach different audiences has been a technique recommended by many members.

CDC Tools and Resources: Many members have begun to use the educational tools that CDC has issued for residents, families and staff. You can find a compilation of them on the LeadingAge Vaccination Website, or on the CDC Vaccination Website. CDC announced during its weekly stakeholder call with CMS that a toolkit on Strategies for COVID Vaccination in LTC will be issued soon; you will be able to find it here with the other CDC Vaccination Toolkits.

As the information, resources and processes for promoting COVID 19 vaccination represent an ever-changing landscape, LeadingAge members are strongly urged to check regularly with the LeadingAge Vaccination Website, among other resources, to get the latest on changes, new recommendations and guidelines.