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In Pocatello, one nursing home can’t take new residents.

In Boise, a large nursing home soon may hit the maximum number of patients it can care for.

And in Moscow, another long-term care facility has limited its admissions amid a wave of COVID-19 patients that has overwhelmed hospitals.

When long-term care facilities struggle, it multiplies strain on the entire health care system. Long-term care facilities provide relief to hospitals by allowing them to discharge patients who no longer need acute care but should still be cared for and supervised.

The strains in long-term care facilities come at a critical juncture in the pandemic as hospitals statewide risk rationing care due to a wave of COVID-19 patients.

But on Thursday, one type of long-term care facility received a major reprieve when the Biden administration expanded vaccine mandates to include all federally funded health care facilities, industry leaders say.

Previously, the administration only had a mandate for workers in nursing homes — which care for patients who are especially vulnerable to COVID-19. Some in the industry felt the prior mandate, which did not have a stated date to take effect, singled nursing homes out with a universal vaccine requirement. Critics say unvaccinated workers who didn’t want to be inoculated could simply leave to go work at hospitals or other facilities without mandates.

“Mandating all health care workers to be vaccinated is a good thing for skilled nursing facilities,” said Troy Bell, president and CEO of TanaBell Health Services, which operates nine long-term care facilities in Idaho, including Quinn Meadows Rehabilitation and Care Center in Pocatello, which has been full lately.

“It allows health care providers to staff and recruit fairly,” Bell said. “This does not allow our licensed health care workers to leave us and just go down the road to the next provider that was not mandated. If they want to use their license and stay in health care, they will have to choose the vaccination.”

Outbreaks are re-igniting

Amid a surge of new COVID-19 cases, outbreaks are re-igniting in swaths of long-term care facilities in Idaho.

The outbreaks are a consequence of rising coronavirus cases in the community, experts say, because viral spread outside of facilities can leak into facilities through staff members, who have low vaccination rates in Idaho, or visits from family and friends.

So far, more than three-quarters of facilities in Idaho have reported at least one outbreak. And at least 208 facilities in Idaho have had more than one outbreak, said state health department spokeswoman Niki Forbing-Orr.

It wasn’t immediately clear how many re-outbreaks occurred this year, but the Post Register’s analysis of state data found that the number of resolved outbreaks in Idaho declined by 74 between mid-July and now, meaning that facilities with outbreaks that were once resolved have begun again.

Right now, about one in four Idaho long-term care facilities have active COVID-19 outbreaks, the Post Register found. There are 402 long-term care facilities in Idaho, Forbing-Orr said. That number has declined since May, when there were 420 facilities in Idaho. State data show there are 104 active long-term care facility outbreaks in Idaho.

In eight of the nine TanaBell facilities, there have been re-outbreaks, Bell confirmed in an email on Friday.

But cases and deaths aren’t growing as quickly as they did last year, despite a monumental surge of new cases and hospitalizations outside these facilities.

Some medical experts also say infections in residents, who are overwhelmingly vaccinated, are not leading to as many deaths, suggesting that their outbreaks could serve as another real-world example of the vaccine’s effectiveness.

“To me, this is screaming the vaccine works and is living evidence the vaccine works,” said Dr. Megan Dunay, medical director for the Idaho State Veterans Home in Boise.

The majority of residents in Idaho facilities are vaccinated, but staff vaccination rates lag behind. In Idaho, almost 82% of nursing home residents are fully vaccinated for COVID-19, according to data from the Centers for Medicare and Medicaid Services. The agency said about 58% of workers in Idaho nursing homes are fully vaccinated. Nursing homes make up about 20% of long-term care facilities in Idaho. Vaccination rates are not available for the other facilities, which are state-regulated. Nursing homes are federally regulated.

“Nursing homes with an overall staff vaccination rate of 75% or lower experience higher rates of preventable COVID infection,” the Centers for Medicare & Medicaid Services said in a news release Thursday.

Staff shortages strain the system

Idaho Department of Health and Welfare Director Dave Jeppesen said in a Tuesday news conference that long-term care facilities still have bed capacity, but their biggest challenge is staffing. In the $10 million Gov. Brad Little approved recently for COVID-19 aid, there is a program that will pay extra money to long-term care facilities to take patients from the hospital, Jeppesen said.

Staffing “has presented some challenges, particularly for discharging patients, particularly COVID positive patients into those long-term care facilities, mainly because it requires more staffing,” Jeppesen said.

That reality is clear in the Idaho State Veterans Home in Boise, a nursing home licensed for 162 beds but which is capping its patient census at 90, said Rick Holloway, the facility’s administrator. Holloway said Friday that the facility could be at max capacity soon because it already has 86 patients and is helping discharge patients from the VA Medical Center in Boise to help clear out its beds.

If it fills up, hospitals could not transfer patients to it.

“The lack of a post-acute care continuum, specifically the lack of availability of post-acute and long-term care beds, which is being driven by staffing shortages in long-term care facilities, represents an existential threat to the health care system in this state and throughout the United States in regions experiencing surges,” said Dunay, who also routinely visits other facilities.

To Bell, with TanaBell, it’s the worst staffing crisis he has seen in his nearly two-decade career.

“We are barely able to meet the minimum requirements in a lot of facilities because we have so many call-offs and a lot of people evacuating the industry,” he said. “As you see throughout all of Idaho, everybody is looking for labor. In a difficult industry like health care, and with COVID, it makes it that much more difficult to staff.”

In the Moscow Good Samaritan Society facility, administrators have been forced to limit admissions because of an active COVID-19 outbreak, said Nate Schema, vice president of operations for the Evangelical Lutheran Good Samaritan Society, which oversees the facilities. The company also required vaccines months ago in all of its facilities, with its mandates taking effect Nov. 1. Schema said the potential for staff leaving isn’t at the top of his mind, though.

“We know that mandating the vaccine is a risk, and that some employees may leave their job over it. No employer wants that. But our number one priority is to protect our residents and staff, and the safest, most effective way to do that is to require the vaccine for all staff. We strongly believe this may actually help attract more staff because of the safety precautions we’re taking.”

Schema applauded the Biden administration’s broader health care mandate announced Thursday, saying that “Mandating the COVID-19 vaccine for all health care workers is absolutely the right thing to do.”

Another industry leader discussed the move, but questioned whether enforcement would match the nursing home mandate previously issued.

“We believe that vaccinations are the only way through this pandemic. We wish that all who are eligible for the vaccine would choose to become vaccinated. But if there is a government mandate, we certainly don’t want to be the only sector that faces a mandate. That would be disastrous as many of our vaccine-hesitant staff would leave for another job without a government mandate,” said Robert Vande Merwe, director of the Idaho Health Care Association, which represents long-term care facilities.

Vande Merwe said he still has many questions, including about whether the option for weekly testing for unvaccinated people will apply for the nursing home mandate. He also said he is not sure what effect the new mandates will have on employees potentially leaving jobs with mandates.

A day before President Joe Biden unveiled his sweeping vaccine mandates that would affect nearly 100 million American workers in the private industry, health care and federal government, Idaho Gov. Brad Little’s spokeswoman Marissa Morrison told the Post Register that Idaho has no plans to mandate vaccines in all long-term care facilities.

Reporter Kyle Pfannenstiel can be reached at 208-542-6754. Follow him on Twitter: @pfannyyy. He is a corps member with Report for America, a national service program that places journalists into local newsrooms.

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