Leaders of five organizations that represent home health agencies and other health care-related workforces have asked Gov. Janet Mills to delay implementing her vaccination mandate, which takes effect Oct. 1.

The organizations said in a letter Thursday that they support the mandate, but there simply isn’t enough time for unvaccinated workers to get their shots or, alternatively, to find replacement workers for those who might leave.

For unvaccinated employees to be fully vaccinated by the Oct. 1 deadline, they would have needed to have a first shot of Moderna vaccine by Aug. 20, a first shot of Pfizer vaccine by Aug. 27, or the one-dose Johnson & Johnson vaccine by Sept. 17. Mills announced the vaccination requirement on Aug. 12, and most health care workers have been eligible to receive a vaccine since January.

“We fully agree that it is ideal for every worker who cares for a vulnerable person to be vaccinated. However, the mandate is not allowing sufficient time to get staff vaccinated, to find replacement staff for those who will leave, and to create contingency plans for safely moving residents from facilities that need to close due to inadequate staffing,” read the letter. It was signed by the directors of the Maine Association of Community Service Providers, the Maine Council on Aging, the Alliance for Addiction and Mental Health Services, LeadingAge, and the Behavioral Health Community Collaborative.

The groups, which stressed that they don’t oppose the mandate, asked for an additional 45 days, or until implementation of a federal mandate, whichever is sooner. They also asked for the administration to allow new hires who have had one shot in a two-shot series to work in these facilities beyond the Oct. 1 deadline, “to avoid critical staffing shortages.”

The organizations collectively represent dozens of agencies across the state that manage group homes for disabled adults, individuals with severe and persistent mental illness, those battling substance use disorder and nursing homes and assisted living communities for older Mainers.

Maine Department of Health and Human Services spokeswoman Jackie Farwell made clear in a written statement Friday that the Mills administration is not likely to extend the deadline.

“The emergency rule’s October 1 effective date provides health care workers adequate time to get vaccinated, particularly given that the vaccine is free and widely available throughout the state,” she said, adding that the state has procured 10,000 additional doses of the one-shot Johnson & Johnson vaccine.

As for concerns raised about staffing shortages and the potential disruption of service for any vulnerable patients, Farwell said, “DHHS stands ready, as always, to do all we can to support providers with safe transitions in the event that alternative placements for patients or residents are required.”

She also pointed out that the governor is acutely aware of the workforce shortage, which is why she prioritized workforce-related funding in her budget and through the Maine Jobs & Recovery Act, which is the state’s portion of the most recent federal pandemic funding.

On Friday morning, about 800 people from across the provider spectrum participated in a webinar with DHHS officials, including Maine Center for Disease Control and Prevention director Dr. Nirav Shah.

Many expressed concerns about the impact of the mandate on the workforce, but two people who participated said those concerns were not adequately addressed. The providers asked not to be identified because they didn’t want to subject their employer to any scrutiny by the state.

One wondered why the department met with stakeholders two weeks after the mandate was announced, instead of two weeks before.

Since the governor announced on Aug. 12 that her administration was updating its rules to include a vaccine mandate for health care workers, there has been pushback among some groups.

This week, dozens of emergency medical services professionals spoke out during a public meeting of the state’s EMS board. The board responded by passing its own rule that would give licensed EMS workers an additional month to become fully vaccinated and would exempt EMS dispatchers and students who don’t work directly with patients from the mandate.

It’s not clear whether that rule supersedes the rule drafted by DHHS.

On Wednesday, a group of health care workers sued the Mills administration because the mandate does not include a religious exemption. Under the proposed rule change, medical exemptions can be granted for people whose physicians deem immunization “medically inadvisable.”

There also have been protests over the mandate, some of which have been organized by anti-vaccine activists and amplified by Republican lawmakers who have opposed the requirement.

Amid the criticism from some within the health care community, Mills and her top health officials have not wavered.

“It is imperative that health care workers take every precaution to protect themselves and those they serve, particularly now more than ever as the dangerous and highly transmissible Delta variant has taken hold in Maine, illnesses and deaths are on the rise, and half of Maine’s open outbreaks are in health and long-term care facilities,” said Farwell, the DHHS spokeswoman. “Further, the governor believes that every person in Maine who is placed in the care of health care personnel has the right to expect – as do their families – that they will receive high-quality and safe care, which includes having their care providers be fully vaccinated in order to protect them against this deadly virus as much as possible.”

The state has been tracking vaccination rates among health care workers for months and rates are generally high, although they vary. According to the most recent data available, which is through July 31, employees of ambulatory surgical centers have the highest rate, at 86 percent, followed by hospital workers at 80 percent. Staff at assisted living facilities have a rate of 74 percent, followed by 70 percent of nursing home staff. The least vaccinated group, at 68 percent, is employees of intermediate care facilities for individuals with intellectual disabilities.

Representatives of the five agencies that sent a letter to Mills on Thursday credited the administration for acting to protect the most vulnerable. But they also fear existing workforce shortages could be exacerbated by the mandate.

“As you know, Maine has a severe and worsening essential support workforce crisis. Before COVID, Maine’s essential support workforce was running on fumes. A year and a half into COVID, underpaid, discouraged, and exhausted workers are leaving this workforce for higher paying, less stressful jobs,” they wrote. “As soon as the vaccine mandate was announced, both unvaccinated and vaccinated workers indicated their intent to leave facility-based care jobs. They’ve had enough. We expect nursing homes, group homes and residential care facilities to close due to the mandate. This will displace hundreds of older people and people with intellectual disabilities and behavioral health challenges. Where will they go?”

Malory Shaughnessy, director of the Alliance for Addiction and Mental Health Services, said providers are only asking for more time and clarity about the mandate.

For instance, she said, residential substance use treatment facilities still don’t know if their employees are included or not. She also said that home health agencies that are certified and licensed fall under the mandate, but those that are only registered are not.

“If this is about public health, it should be uniform,” she said.

Dale Hamilton, executive director for Community Health and Counseling in Bangor, said he’s prepared to lose staff. He doesn’t know how many yet, but said it’s a certainty.

“At this point, the reasons why people don’t want to get vaccinated don’t really matter, the problem still exists,” he said.

Hamilton said he believes the state is trying to do the right thing and is well-intentioned but isn’t sure leaders thought through the unintended consequences.

“What I hope will happen is that we’ll have an opportunity to talk more about the impact and what it means for the people we’re serving,” he said.

Laura Cordes, executive director of the Maine Association for Community Service Providers, said the workforce was already hampered before the pandemic.

“We have lost over 20 percent – 30 percent of our workforce in the last 18 months and are now running on empty. The vaccination mandate will mean a further loss,” she said, adding that a survey of 35 providers last week suggested more than 80 percent of those supporting adults with intellectual and developmental disabilities anticipate staff losses.

Many of the EMS professionals who spoke against the mandate Monday also said they fear many will leave their jobs, which could put a strain on that workforce and on critical services. But they also spoke about the need to respect medical choice and some pushed misinformation about the vaccines’ effectiveness and safety.

The agencies representing Mainers in group homes and assisted living communities have take a different approach – one that focuses more on the impact of vulnerable individuals. If group homes must close because of staffing shortages, they fear what would happen next.

“For many of these residents, the loss of their homes will be very traumatic for them and for their families. They will want to stay near their families and support systems, but it’s highly unlikely beds will be available in facilities near where they are currently living. In some cases, no beds may be available,” they wrote to Mills. “This will create great disruption for hundreds of vulnerable people and will require careful and considerate planning.”

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