The news has been full of alarming statistics about the high percentage of long-term care workers refusing the COVID-19 vaccine. Given the more than 100,000 COVID deaths nationwide of long-term care residents, the implications are obvious.

How are we ever going to get COVID under control if a large percentage of hands-on caregivers in long-term care refuse to get vaccinated? Does the long-term care industry have legal and ethical responsibilities to ensure a safe environment for both staff and patients?

I spoke with Nick Van Der Linden, director of communications for Florida Leading Age, and he reports that about 40% to 50% of long-term care staff in Florida are “vaccine hesitant.” Leading Age of Florida represents over 500 assisted living and skilled care facilities, life care communities, home care and more, so the vaccine reluctance is across the entire spectrum of senior living. When queried if they were going to make the vaccine mandatory for staff, 98% of their members replied no.

It is widely accepted that vaccinating as many staff as possible is the goal, so why aren’t mandatory vaccines a no-brainer? At what point might these measures backfire when staff shortages are rampant? Should an excellent worker lose employment for refusing the vaccine? A facility cannot maintain quality of care without staff.

Legal ramifications for terminating an employee would make most businesses nervous. Where does safety end, and employee rights begin? The Food and Drug Administration authorized both the Moderna and Pfizer vaccines for emergency use authorization but they cannot protect facilities from employee lawsuits.

According to the JD Supra legal website, “Long-term care facilities can require facility employees to receive the COVID-19 vaccine as a condition of employment … However, the rule is not absolute, and there are important exceptions such as some physical disabilities and sincere religious objections.” Would you like to figure out these rules?

The Equal Employment Opportunity Commission states, “[a] conclusion that there is a direct threat would include a determination that an unvaccinated individual will expose others to the virus at the worksite.” An employee is entitled to reasonable accommodations up to a point, but that is not entirely feasible with front-line workers in long-term care facilities.

“If the employer cannot reduce the threat,” the commission says, “it can prevent the employee from physically entering the workplace, but that does not mean that the employer can automatically terminate the employee.”

Few large companies have taken the plunge. Atria Senior Living, a company with more than 185 locations in 26 states and 11,000 employees, has made taking the vaccine a “condition of employment.” CEO John A. Moore called the company’s decision “the responsible thing to do in light of the threat posed by COVID-19.”

One caveat? Employees have to May 1 to comply, likely with the hope of giving staff time to come around.

Many senior living corporations have mounted major marketing campaigns to motivate and educate employees with catchy phrases and vaccine parties. Providers are offering $100 to $200 cash bonuses, gift cards and raffle prizes for those who complete the two-shot process. But as Van Der Linden pointed out, most companies understand that to make serious progress they will need to create a culture of vaccine acceptance.

One facility that has had remarkable success is River Gardens in Jacksonville. About 70% to 75% of their 325-plus staff and 97% of residents have been vaccinated, according to Bobbie Jo Mentz, associate administrator. Gov. Ron DeSantis made an appearance there Jan. 25 to mark the accomplishment.

How did they do it? Staff and family education began as soon as they learned of vaccine release plans back in November. Numerous easy-to-attend town halls were held, in person and virtually. Peer-to-peer discussions were encouraged.

As Mentz said, “We are all family here. We care about everyone’s health and safety.” They listened; they cared. This is an example of attempting to balance the rights of both patients and staff.

The results speak for themselves.

Success will likely not come from making vaccines mandatory, even though it seems sensible on the surface. According to the latest Kaiser Family Foundation survey, “over half (52%) of long-term care workers are people of color … of which roughly 15.5 million are estimated to have direct patient contact.” Let’s not forget that they died, too.

Terminating workers who are afraid to get the vaccine would be adding insult to injury. While we know the clock is ticking, I feel that education and patience will pay off. Time will tell and our front-line workers deserve it.