How a Vaccine Mandate Could Worsen a Shortage of Home Care Aides

JASA, an organization serving older adults in New York City, said that its staff members had rushed to be vaccinated this week after an all-out push by the agency. Among its 660 home health aides, some 94 percent are now vaccinated, up from 20 percent who had submitted proof by August, said Kathryn Haslanger, the organization’s director. Five people resigned over the mandate.

This week’s vaccine deadline, set in an Aug. 26 emergency regulation by the Department of Health, covers certified home health agencies, long-term home health care programs, hospices and adult care facilities.

What to Know About Covid-19 Booster Shots

The F.D.A. has authorized booster shots for millions of recipients of the Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines. Pfizer and Moderna recipients who are eligible for a booster include people 65 and older, and younger adults at high risk of severe Covid-19 because of medical conditions or where they work. Eligible Pfizer and Moderna recipients can get a booster at least six months after their second dose. All Johnson & Johnson recipients will be eligible for a second shot at least two months after the first.

Yes. The F.D.A. has updated its authorizations to allow medical providers to boost people with a different vaccine than the one they initially received, a strategy known as “mix and match.” Whether you received Moderna, Johnson & Johnson or Pfizer-BioNTech, you may receive a booster of any other vaccine. Regulators have not recommended any one vaccine over another as a booster. They have also remained silent on whether it is preferable to stick with the same vaccine when possible.

The C.D.C. has said the conditions that qualify a person for a booster shot include: hypertension and heart disease; diabetes or obesity; cancer or blood disorders; weakened immune system; chronic lung, kidney or liver disease; dementia and certain disabilities. Pregnant women and current and former smokers are also eligible.

The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people. The C.D.C. says that group includes: emergency medical workers; education workers; food and agriculture workers; manufacturing workers; corrections workers; U.S. Postal Service workers; public transit workers; grocery store workers.

Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.

As with the hospital mandate, limited medical exemptions are permitted. The regulation does not allow religious exemptions, but workers whose employers have approved their religious exemptions may be permitted to work for now while the issue is challenged in court.

The state’s hundreds of thousands of home health care workers have been largely out of the spotlight during the pandemic, despite the work they have done to care for high-risk patients. Home health workers were not initially included in New York’s highest priority category for vaccination, for example, though after lobbying efforts, they were added.

Most home health aides — the bulk of the home health work force — make close to the state minimum wage of $15 an hour. The home health care system, largely funded by Medicare and Medicaid, also relies on a smaller number of nurses, who help oversee care of homebound patients. Agencies also employ therapists and social workers.

Already facing an industrywide staffing crunch, agencies have begun to implement emergency staffing plans, which include limiting new admissions, asking family members of home care recipients to shoulder more of the burden, and authorizing overtime. The Visiting Nurse Service is asking to have until the end of the year to comply with the mandate.

Assemblyman Richard Gottfried, who chairs the health committee, said in an interview that “a short delay might well make sense,” given the ongoing staffing crisis in home care. He also suggested that the state use federal money to offer enhanced salaries and overtime incentives to help hire and retain home health aides.

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