After suffering a stroke and going through extensive rehab, Jessica White’s mother returned to her Manhattan apartment last December. White was relieved when her mother, who now uses a feeding tube, was approved for round-the-clock home care. A nurse and an aide would be assigned to make at-home visits from 8 am to 8 pm, while another pair covered the overnight shift.
But getting those shifts staffed hasn’t always been easy, and White is facing greater uncertainty about her mother’s care now that New York state has required all home care workers to get inoculated against COVID-19.
The vaccination rate among home care staff has shot up in recent days. But advocates for workers, employers and patients say the state has not done enough to prevent elderly and disabled people — who may need basic assistance with using the bathroom or eating — from ending up on their own.
At least 14,500 direct care home care workers are currently opting to miss work rather than take the COVID-19 vaccines, according to data provided by the state Department of Health. And the industry was already experiencing staffing shortages, which industry groups have attributed to the growing senior population and demand for home care outpacing the supply of caregivers.
In White’s case, one of her mother’s nurses is unvaccinated. The deadline to get a shot was October 7th, and White says she wasn’t sure the nurse would be coming in for her shift a few days later. Even the day before it was scheduled, on October 12th, she was still struggling to get answers from the staffing agency.
“It’s just further exacerbated the situation,” White said. “The system is already at a point where I’m like, ‘Am I going to get an aide today?’ I don’t always know.”
White says she often covers the shifts herself when someone doesn’t show up, cutting into the time she should be working her day job.
As of October 12th, about 93.6% of direct care staff working for licensed home care services agencies had taken at least one dose of COVID vaccine, according to a state Department of Health survey. Not all agencies responded, but those that did represented 226,668 direct care employees. That vaccination rate is a major improvement over the 86% who were in compliance when the mandate took effect on October 7th. As in other sectors, these vaccine trends are fluid because many employers are still giving workers a chance to get the shots before losing their jobs.
“The mandates have brought people to the right decision,” Gov. Kathy Hochul said during a press conference Wednesday.
While 14,500 home care employees can’t report to work, the number of patients who are impacted, even temporarily, is likely far greater. Each worker is typically assigned to two to five cases, said Al Cardillo, president of the Home Care Association of New York State. Often patients only have one aide in the home, as the level of staffing in White’s mother’s case is rare.
To cope with staffing losses, some providers may redeploy employees to higher priority cases, Cardillo said. But he worried that could then put lower priority patients at risk.
Let’s take, for example, somebody that’s at a higher risk for falling, Cardillo said: “It may not be that every minute of every day they’re at risk, but if they go several days without their caregiver, that person might’ve fallen, and now they’re sitting there in their home with nobody there.”
With vaccine mandates now in effect for workers in hospitals, nursing homes and home care, Hochul has taken action to allow nursing students and health care professionals coming from outside of the state to substitute for those that are taken off duty. But critics say the state has not provided support tailored to the home care industry.
Ongoing litigation over permission for religious exemptions could decide the ultimate impact of the health care worker mandate. The state sought to eliminate such exemptions, but a judge ruled Tuesday that officials can’t stop employers from reviewing and granting requests to opt-out based on religious beliefs. Hochul has vowed to appeal the ruling.
For now, this uncertainty has prevented White from losing her mother’s unvaccinated nurse, but it’s unclear what will happen long-term. She said the nurse had requested a religious exemption from the staffing agency, Hope Home Care. When White texted a supervisor at the agency Tuesday asking if the nurse would come in the next day, they did not respond directly but instead shared a long, exuberant text celebrating the ruling on religious exemptions.
“BIG VICTORY IN NEW YORK!” began the text, which White shared with WNYC/Gothamist. “The Preliminary Injunction blocks the STATE OF NEW YORK from interfering in the religious exemption process and from FORCING private employers to deny religious exemptions.”
The nurse arrived for her shift the next morning. WNYC/Gothamist has been unable to reach Hope Home Care regarding their staffing situation or the status of pending requests for religious exemptions. The nurse declined to be interviewed.
Valerie Bogart, a lawyer with the nonprofit New York Legal Assistance Group, who often represents home care recipients, said she supports the vaccine mandate but thinks it was rolled out too quickly and that patients and families weren’t given enough information from home care agencies or the state.
“There was no communication, nothing,” Bogart said. “Aides are just simply not going to show up.”