Monday is the deadline for staff at hospitals and nursing homes across New York to get at least one COVID-19 shot if they want to keep their jobs, and health care industry groups have raised concerns that it could lead to staffing shortages at some facilities.
In New York City, 83% of hospital workers and 84% of nursing home staff were fully vaccinated as of September 22nd, according to state data. Many more have at least started the process of getting vaccinated, although exact figures are unavailable.
“We can get the number higher, I’m confident of that,” Gov. Kathy Hochul said at a press conference in her Midtown office Thursday morning. “It can be a perfect situation if we can get the holdouts to understand the power they have to help us to get back to normal, and I’m pleading with them to see it [from] that perspective.”
Ever since requirements became more common this summer, major health care unions in New York have opposed vaccine mandates, and some workers have rallied against them or quietly declined to comply. But despite drawing protests, a vaccine mandate that already took effect across the New York-Presbyterian health system was overwhelmingly successful.
The hospital network was the first in New York State to establish such a policy. Fewer than 250 of the health system’s 48,000 employees and affiliated doctors declined to get vaccinated, according to data provided by a spokesperson. That’s more than a 99% compliance rate. At Weill Cornell Medicine, which is affiliated with NewYork-Presbyterian, acceptance reached 98.6% as of September 23rd, with only about 120 of 8,500 faculty and staff still unvaccinated.
“We will continue to provide exceptional care at all of our hospitals, without interruption,” NewYork-Presbyterian said in a statement.
Still, holdouts remain. NewYork-Presbyterian pushed back the deadline for its mandate from September 1st to the 15th to give employees more time. It then took unvaccinated staff off duty, granting them another seven days to show proof of vaccination before losing their jobs permanently. Weill Cornell placed unvaccinated employees on unpaid leave promptly on September 1st but offered until September 30th to get a shot and save their jobs.
It’s possible that in response to the state mandate, some unvaccinated health care workers will lose their jobs on Monday without receiving the same grace period. It’s up to individual employers to determine how to implement the policy, a spokesperson for the state health department said.
Mount Sinai Health System, whose own mandate took effect September 13th, said it anticipates losing less than 1% of its 43,000-plus employees over the policy, though it would not provide a concrete number or indicate whether anyone has been fired so far.
The experience of these hospitals could bode well for the statewide mandate. But state data show that vaccination rates at individual hospitals and nursing homes vary widely, and some may face a more debilitating number of layoffs and resignations. Many facilities are still scrambling to get their vaccination rates up and develop contingency plans for staff that leave as the deadline looms.
Preparing for the Worst
Nursing homes, which already face challenges with recruitment and retention, might be particularly vulnerable to staffing shortages. Michael Balboni, the executive director of the Greater New York Health Care Facilities Association, a trade organization for nursing home operators, had been pressuring New York State to set up a mutual-aid system between nursing home operators, so if one facility struggled with understaffing, they could request backup from other nursing homes.
“There are folks who believe they’re going to be fine. They have high vaccination rates for their staff,” Balboni said. “Then there are other facilities that frankly have been struggling with staffing to begin with and have issues with vaccination rates.”
Certain regions outside New York City are facing greater resistance to the mandate, said James Clyne, president of LeadingAge New York, which represents nonprofit nursing homes. But Balboni said there are individual facilities that will be impacted statewide.
He said facilities with low vaccination rates had begun to develop emergency plans that included halting new admissions to the facility in some cases or restricting some operations that require additional staff.
Hochul said Thursday she was working with state and federal regulators and unions to see if certified health care workers from other states or countries could help fill the void. On Saturday, the governor's office said it was prepared if necessary to declare a state of emergency that would permit out-of-state health care professionals, recent graduates, as well as retired and formerly practicing workers to practice medicine in New York State. Medically-trained National Guard members might also be called into action.
"The Department of Labor has issued guidance to clarify that workers who are terminated because of refusal to be vaccinated are not eligible for unemployment insurance absent a valid doctor-approved request for medical accommodation," read the governor's statement. In the near term, Hochul is also focused on imploring reluctant health care workers to roll up their sleeves.
Balboni said he didn’t think the few extra days before the mandate took effect would make a difference.
“This is not vaccine hesitancy,” he said. “This is vaccine rejection. They just simply do not want to participate in this effort.”
Hospital operations could feel the fallout on individual campuses or even on individual units. One upstate hospital made news earlier this month when it said it would temporarily stop delivering babies because of understaffing due to resignations over its vaccine mandate.
A spokesperson for Northwell Health, the state’s largest private health care provider with more than 77,000 employees, said that about 10 percent of its staff had not yet been fully vaccinated. It’s unclear how many have gotten at least one shot in compliance with the state mandate. Several hundred have requested religious exemptions.
Starting Monday, Northwell plans to begin warning and even laying off employees who have not received shots and didn’t request a religious exemption, beginning with upper-level management and working down.
The vaccine mandate had originally attempted to remove any religious exemptions, but this stipulation is tied up in a federal court. While that matter is pending, nursing home and hospital workers can still apply for religious exemptions if their employer allows them, and no one who claims a religious exemption can be reprimanded for not being vaccinated.
A previously scheduled court date set for Tuesday, September 28th was called off by a federal judge. Instead, both parties will present their case in written responses. The temporary restraining order regarding religious exemptions will stay in effect until a federal judge makes a ruling based on those documents, which is slated to occur by October 12th at the latest, according to federal court filings.
“Northwell wants to reassure the public that patient care will not be affected by New York State’s 9/27 vaccine mandate,” the spokesperson said, adding they were working on contingency plans to address potential understaffing across all their 23 hospitals and 830 outpatient facilities.
Across the city’s public hospital system, only 85% of staff are fully vaccinated, despite a previous mandate requiring city workers to get their shots or submit to weekly testing. A spokesperson for NYC Health + Hospitals would not say how many employees have at least started the vaccination process.
At NYU Langone Health, a spokesperson said Thursday that 96% of the hospital system’s employees have either gotten at least one shot or have finally given in and made an appointment to get one.
Bea Grause, president of the Health Care Association of New York State, which represents hospitals, said her organization is working with members to address potential workforce shortages.
But, she added, “The good news is the mandate is working. Vaccination rates have gone up at health care facilities across the state.”
This story was updated to add Governor Hochul's statement about a potential emergency declaration.