By Madeline Fuerstenberg, Wisconsin Watch

Hannah Miller, a nursing student and employee of a long-term care facility in Eau Claire, Wisconsin, received her first dose of the COVID-19 vaccine on Aug. 23 — and not voluntarily.

“(The vaccine) hasn’t been out long enough to know what long-term effects are,” Miller told Wisconsin Watch. “We don’t know if it could cause bigger health issues in the future or cause issues, such as fertility.”

Miller said she was required to receive the vaccine by the hospital where she is completing her clinicals for school. She said she would not be able to graduate without getting it. Miller asked that her school and her workplace not be disclosed in this article.

Increasingly, health care facilities in Wisconsin and around the country require their employees to be vaccinated. Yet in long-term care facilities such as nursing homes — where residents are highly susceptible to severe illness and death from COVID-19 — some workers refuse the shot.

As of late August, Wisconsin’s rate of fully vaccinated nursing home employees was around 60%. Wisconsin’s total rate of fully vaccinated individuals between the ages of 18 and 64 is about 58.4%. By contrast, the rate among residents 65 and older is around 95%.

In mid-August, President Joe Biden ordered long-term facilities that receive federal Medicare or Medicaid funding to require their workers to be vaccinated, citing studies that show having a highly vaccinated nursing home staff is associated with a 30% reduction in COVID-19 cases. Of the 355 nursing homes in Wisconsin, 353 are Medicare and Medicaid certified. Still, some Wisconsin nursing homes are not requiring staff to be vaccinated, a spot check of facilities by Wisconsin Watch showed.

On Sept. 9, Biden upped the ante, ordering all hospitals, home health-care companies and other medical facilities that receive Medicare or Medicaid to mandate that their staffs be vaccinated. The move will affect an estimated 17 million workers at 50,000 locations across the country.

Nationwide, more than 134,000 long-term care facility residents have died from COVID-19. In Wisconsin, 3,220 people have died in such facilities as of Sept. 3 — or 42% of all COVID-19 deaths in the state, the Wisconsin Department of Health Services reports. In one of the worst outbreaks in Wisconsin, the agency found 191 residents and workers were infected in a single unnamed nursing home.

A chart shows the percentages of COVID-19 deaths in Wisconsin by housing setting. As of Sept. 3, 2021, residents of long-term care facilities accounted for 42% of the 7,652 confirmed COVID-19 deaths in the state. (Credit: Wisconsin Department of Health Services)

The president’s decision to issue the mandate was prompted by a Centers for Disease Control and Prevention study which found the effectiveness of the Pfizer and Moderna vaccines is waning among nursing home residents — among the first to be vaccinated in early 2021.

Decreasing vaccine-induced immunity and the emergence of the highly infectious Delta variant may be to blame, the researchers said.

“Because nursing home residents might remain at some risk for … infection despite vaccination, multiple COVID-19 prevention strategies, including infection control, testing, and vaccination of nursing home staff members, residents, and visitors, are critical,” the study recommended.

FDA approval doesn’t erase unease

As a health care employee, Miller said she will continue to do her part to keep the people around her safe by wearing a mask and washing her hands. However, Miller pointed out that the vaccines “didn’t eradicate the disease,” and she could still catch it even if she’s vaccinated.

She believes it’s too soon for a mandate. Miller said she has family members who work in health care who have quit their jobs instead of getting a required shot.

The CDC found that unvaccinated people are 29 times more likely to end up hospitalized with COVID-19 than vaccinated people. As for Miller’s concern about her ability to have children, the CDC advises that “currently no evidence shows that any vaccines, including COVID-19 vaccines, cause fertility problems (problems trying to get pregnant) in women or men.”

“I fully encourage vaccines once they have been tested and are FDA approved,” Miller said. “Vaccines are valuable and are needed, but I don’t want to be the guinea pig. I still believe everyone should have their freedom on whether to be vaccinated or not.”

The Wisconsin Health Care Association and the Wisconsin Center for Assisted Living are promoting vaccination among long-term care staff. But their national organizations warn vaccine mandates could worsen a shortage of workers in the industry. (Credit: Wisconsin Health Care Association / Wisconsin Center for Assisted Living)

Days after Miller spoke with Wisconsin Watch, the Pfizer vaccine was granted full approval by the Food and Drug Association. Still, she hesitated to endorse it.

“I feel better now that they have approved it, but I’m still nervous about what could possibly still happen in the future,” Miller said of the change. “It usually takes years for the FDA to approve a vaccine and this one was done so fast that I feel it may have been rushed to convince more people to get it and I feel like there is still information missing.”

Strife over vaccine mandates continues

Miller isn’t the only long-term care facility employee concerned about vaccine mandates. In recent weeks, health care workers have protested at the state Capitol and outside their places of work.

And the nation’s leading nursing home association worries the existing severe labor shortage in long-term care will only grow with a vaccine mandate. In Wisconsin, nearly one out of every four jobs remains unfilled, according to the Wisconsin Health Care Association and Wisconsin Center for Assisted Living.

Protesters hold up signs in front of Ascension SE Wisconsin Hospital in Franklin during a rally against mandatory vaccination of employees on Aug. 27, 2021. President Joe Biden ordered that federal funding be withheld from long-term care facilities that do not require their staff to be vaccinated. The industry has complained it is being singled out, potentially driving already scarce workers to other health care sectors. (Credit: Scott Ash / Now News Group)

Rock County’s Rock Haven nursing home in Janesville is one example of a facility that tried to implement such a policy. In December, the county-run nursing home mandated staff vaccinations, prompting legal action from some employees. They claimed the rule was a violation of their rights to “decide whether to accept or refuse administration of the COVID-19 vaccines.” In response to the legal challenge, the Rock County Board rescinded the mandate in late May.

Marilyn Burns, Rock Haven’s infection preventionist, released a statement confirming there is no vaccine mandate at the nursing home — which has been battling a COVID-19 outbreak.

“We understand some members of the Rock Haven community are unhappy with Rock Haven employing unvaccinated staff,” the statement noted, adding, “We are unsure how this (Biden) mandate will affect our facility.”

Wisconsin vaccination rate 32nd

In late August, Wisconsin’s rate of fully vaccinated nursing home employees was around 62%. The state is ranked 32nd among the 50 states, Puerto Rico, Guam and the District of Columbia.

Hawaii leads the country with a long-term care facility staff vaccination rate of around 88%. Louisiana was last at 49%.

The average number of health care personnel with completed COVID-19 vaccinations was 62% in Wisconsin, as of late August. Hawaii is the state with the highest percentage of health care staff that is fully vaccinated, while Louisiana is the lowest. (Credit: Centers for Medicare & Medicaid Services)

The Wisconsin Department of Health Services stated vaccines are the “most important tool” to protect people from COVID-19 and that “it is vitally important” that employees of long-term care facilities get vaccinated.

As of Sept. 5, the agency had conducted 2,678 public health investigations related to COVID-19 at long-term care facilities around Wisconsin. It found the median number of confirmed cases per investigation is three, the average is 11, with one unnamed facility reporting 191 confirmed cases of COVID-19.

A chart shows the month-to-month number of Wisconsin Department of Health Services investigations of facilities for COVID-19 outbreaks. Facility types include health care, long-term care, group housing, educational, workplace and others, with the largest numbers reported during the late 2020 wave of the pandemic. (Credit: Wisconsin Department of Health Services)

In Wisconsin, an investigation of a long-term care facility is automatically launched whenever a case of COVID-19 is detected, including an examination of how the person may have gotten infected, said Elizabeth Goodsitt, DHS communications specialist.

Although the total number of active investigations has declined over the past year, DHS has reported a steady uptick over the course of the summer.

Labor shortages feared

Also rising are concerns in the long-term care industry around Biden’s vaccine mandate. In a statement, Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, objected to Biden singling out one health care provider group.

“Focusing only on nursing homes will cause vaccine hesitant workers to flee to other health care providers and leave many centers without adequate staff to care for residents,” the statement said. “It will make an already difficult workforce shortage even worse. The net effect of this action will be the opposite of its intent and will affect the ability to provide quality care to our residents.”

Ultimately, Miller said she believes all people — including health care workers — should be allowed to control their own health care, not the government.

“In nursing school we are constantly taught that the patient has rights,” Miller told Wisconsin Watch. “They can choose to not take medications, decline treatment or refuse exams. We are patients in our own way, so why don’t we have those same rights to refuse?”

Madeline Fuerstenberg’s work on this story was sponsored by the Ann Devroy Fellowship at the University of Wisconsin-Eau Claire. The nonprofit Wisconsin Watch collaborates with Wisconsin Public Radio, PBS Wisconsin, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by Wisconsin Watch do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.