New York hospitals, nursing homes offer vaccine incentives and brace for staff shortages

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• Amna Nawaz:

  Well, New York state has become the first in the nation to require all health care workers to get a COVID-19 vaccine, or face being fired.

  Before last night's midnight deadline, there was a dash for vaccinations. Of the 450,000 hospital nursing home staff and other health care workers, the governor's office said today more than 90 percent have gotten at least one shot.

  But, as John Yang reports, many hospitals are bracing for staff shortages if they have to lay off workers or some leave the profession altogether.

• John Yang:

  Amna, while New York Governor Kathy Hochul says the vaccine requirement is needed to try to curb the spread of COVID, she acknowledges the problems it may create for hospitals already strained by a surge of cases caused by the Delta variant.

  She's declared a disaster emergency, opening the door for health care workers from out of state and even out of country to practice in New York.

• Gov. Kathy Hochul (D-NY):

  It reflects my priority to just stop this virus dead in its tracks. We are over it. We are done. We want to move on.

  And the only way we can do that is to ensure that everyone is vaccinated, but particularly individuals who are taking care of the people who are sick.

• John Yang:

  To see the effect on one health care operation in New York, we're joined by Tom Quatroche. He's president and CEO of the Erie County Medical Center, which operates a hospital and a nursing home in Buffalo, New York.

  Mr. Quatroche, thank you very much for joining us.

  What's been the compliance with your staff so far on this vaccine requirement?

  Tom Quatroche, President and CEO, Erie County Medical Center: Well, thank you, John, for having me.

  We're down to about 5 percent in the hospital of folks that had to go on unpaid leave as a result of the vaccine mandate. In our nursing home, it's a little different situation. About 20 percent of our work force is on unpaid leave.

  And that's kind of a common theme among nursing homes, because some of the workers are on — lower on the wage scale. They're able to make other choices, and get out of health care if they choose to be unvaccinated. So, for us, it's a challenge, because, obviously, patients need to be discharged from the hospital to nursing homes.

  So, it's kind of clogged up a lot of hospitals with patients who really belong in nursing homes, but are stuck in hospitals.

• John Yang:

  And what are those numbers doing to your operations, in terms of elective surgery and that sort of thing?

• Tom Quatroche:

  So, about a week ago, we started seeing this effect that I discussed about nursing homes kind of not accepting our patients.

  So, we had the highest census we ever had in history, with 56 people waiting in the E.R. So we took some mitigating steps. We stopped elective — inpatient elective surgeries. We stopped many of our outpatient visits. We stopped medical ICU transfers to rural hospitals and lower levels of care.

  So, we took some mitigating steps. It did have an effect on lowering the volume. Right now, we have a lot of people that remain taking extra shifts for us, and we incentivize them to do that. And that's working very, very well.

  But this is a longer-term problem. In the short run, we're managing the situation, but we're very concerned long-term because we had some of these staffing issues prior to the decision to do a vaccine mandate.

• John Yang:

  And you say, at least in the hospital, a lot of the unvaccinated workers are so far being put on unpaid leave. You're not severing them altogether from employment.

  Are you hopeful that they will come around, that they will eventually become vaccinated? Or what's the situation?

• Tom Quatroche:

  Yes, we weren't certain what the actions of the state would be around the date, so we wanted a little bit of flexibility with those workers.

  They do have 30 days before their employment will be terminated. And there's some question around exemptions, and religious exemptions, and those types of things. For us, as a public institution, it's very hard to sever somebody from employment, and then bring them back. So, we have a unique challenge in that regard. That's why we decided to do the unpaid leave.

• John Yang:

  Are you talking to them at all?

• Tom Quatroche:

  We are.

  Many people, actually, as a result of the incentive to work extra shifts, which is obviously extra money, some of them came back and received vaccinations because of that. So, you never know what's going to work in getting somebody motivated to be vaccinated.

  But as we continue to educate, and I hope colleagues continue to talk to them about the importance of vaccination, we will get some folks back. But the reality is, there are some people that just believe in either choice or they don't want to be vaccinated for whatever reason, and they're leaving — leaving health care.

• John Yang:

  And you said there's a difference between the hospital workers and the nursing home workers.

  The nursing home workers, you say, tend to be lower on the pay scale, is that right, and so more likely to go elsewhere?

• Tom Quatroche:

  Yes, the way the reimbursement models work for nursing homes is, it really doesn't support as much nursing care as it maybe probably should.

  We actually have a higher nursing ratio than many other nursing homes, but it's supported by a lot of aides. And those aides are in the range of anywhere from about $18 to $20, somewhere around there. And, as you know, many, many organizations are offering that kind of wage for workers, including fast food restaurants.

  So they can't get the benefits maybe that they can have in a place like ours, but they can get the same wage.

• John Yang:

  If the governor had not placed this mandate or placed this requirement on health care workers, had you been considering doing it on your own?

• Tom Quatroche:

  We hadn't. We had not considered that. We were continuing to educate our staff, and we were also worried about the fact, if we did it, then those workers could go to another hospital somewhere else. So, it was a competitive issue for us.

  So, the government's doing the right thing for all the right reasons. There's just a reaction and an effect that it has on the health care industry. So we're trying to work with the state government, and we're supportive of the vaccine mandate, but we just need some help with the reality on the ground.

• John Yang:

  And, as we said, the governor has opened the door to not only out-of-state, but out-of-country health care workers. Is that something you think you might avail yourself of?

• Tom Quatroche:

  We will have to see if that can be helpful.

  We're just grateful that the governor is trying everything that she can do in her power to help us. It's a challenge. Agencies across the United States are charging crazy amounts of money for agency nurses. We're talking $150 to $200 an hour.

  But, normally, it's about $65 an hour for an agency nurse. So, the demand that's been created nationally for agency nurses is a real challenge for everybody in health care.

• John Yang:

  What — as you look forward, you look ahead, what are your concerns?

• Tom Quatroche:

  I worry about burnout of our staff. They have been through a lot during COVID.

  And I think it was a shocker for them to think they're going to have even less people in the institution. So, I — we worry about the long-term sustainability of these types of staffing levels and making sure that we can take care of many of the patients that come into our care.

• John Yang:

  Tom Quatroche, the CEO of Erie County Medical Center in Buffalo, New York, thank you very much.

• Tom Quatroche:

  Thank you very much, John.

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