Whether the newly released Jan. 4 deadline for healthcare workers to be vaccinated against COVID-19 changes any minds of nursing home staff here won’t be known for several weeks.

But some of the most recent numbers for Indian River County from the CMS – Centers for Medicare and Medicaid Services, from which the federal health care mandate emanates – lay out a daunting personnel challenge among critical service providers in one of the largest employment sectors here.

In the most recent reports on nursing home employees, numbers of Indian River County vaccinated workers in mid- to late-October were so low that if they don’t improve, healthcare entities here stand to lose one-quarter to two-thirds of their staff come the start of 2022.

Three of the six skilled nursing facilities had rates lower than the Florida average of 59 percent, and that rate put the state fifth from the bottom in the U.S. for vaccinated nursing home staff, according to a spokesman for the state AARP.  “This is still very slow progress,” said Jamie Champion.

From nursing homes to hospitals, the stubbornly high numbers of unvaccinated workers in the two months since a federal vaccine mandate was announced appear to show just how entrenched is the anti-vaccine contingent in their ranks.

Four of the six nursing facilities showed essentially no new vaccinations among staff in the last two weeks of October, despite learning of the coming mandate in mid-September. Those included Palm Garden, which stood at 64 percent vaccinated by the end of October; Orchid Cove at 55 percent; and Florida Baptist, at 73 percent.

Sebastian River Medical Center's rehab wing stood at 55 percent. That could be a hint at the rate overall at the north county hospital though a spokesperson did not reply to a request for figures.

Of the three that did show improvement, it was a matter of a few percentage points. Vaccinations rose by 4 percent for Consulate, with 60 percent of staff vaccinated; 6 percent improvement at Sea Breeze, up to 37 percent; and an increase of 8 percent for Willowbrooke Court, the nursing home at Indian River Estates.

That facility now stands at 91 percent of staff vaccinated, the highest in the county, and up from 65 percent at the start of October.

While providers aren’t yet releasing plans on how to get to 100 percent, the delay could mean the push to vaccinate may turn increasingly to a shove if minds don’t change on their own soon.

“It appears the line in the sand is now drawn,” said Don Wright, owner of three assisted living facilities in Indian River County and someone who has tried diligently to convince his workers to get vaccinated. So far, staff vaccination rates at his communities range from 55 percent to 75 percent.

“We have been chipping away at those numbers each month, one person at a time.”

At Cleveland Clinic Indian River Hospital, Dr. Greg Rosencrance, hospital president, said 74 percent of staff is now vaccinated. But the hospital did not provide numbers from prior months as requested to show whether staff vaccinations were trending up or leveling off.

“We have continued to provide information and education to our caregivers about the safety and efficacy of the COVID-19 vaccine,” Rosencrance said Friday, after the Biden administration finally released an early January deadline for the mandate announced Sept. 9.

That mandate, separate but similar to the mandate for large businesses which has been challenged by Gov. Ron DeSantis and others, calls for healthcare workers at entities participating in Medicare or Medicaid to be vaccinated by Jan.4, or to have qualified for a medical or religious exemption.

There is no option to be tested regularly, as there is in the parallel mandate for businesses with over 100 employees.

Without a valid medical or religious exemption to present on that date, workers could be fired; unlike the mandate for large businesses, there is no option in the healthcare mandate to be regularly tested in lieu of vaccination.

The healthcare mandate applies to employers or practices accepting Medicare or Medicaid reimbursement for their services.

For personnel who continue to refuse the vaccine, the only option left may be changing jobs. And those nurses, aides, physical therapists and even doctors will be competing for a much narrower range of jobs at institutions that don’t accept those federal dollars.

Among the possibilities: working for private-pay facilities including people’s homes, or working for insurance companies, though they too may fall under the Occupational Safety and Health Administration (OSHA) mandate, assuming they have 100 or more employees.

Still others may take early retirement rather than be vaccinated, according to Becker’s Hospital Review, which in April predicted early retirements among healthcare workers could be “drastic” – even before mandates began to pop up among major hospital systems. Becker’s cited a Pew Research study from last November that showed 1 million more baby boomers were retired compared to previous years.

Another survey, this one in March, showed the number of people expecting to work past 67 dropped to a record low of 39.2 percent. Those sectors could well include a disproportionate number of physicians, nearly a third of whom are over 60.

Even if physicians themselves tend to be happily vaccinated at a rate of 96 percent, their retirement could mean fewer options for unvaccinated nurses looking to join small practices that do not accept Medicare or Medicaid.

Some hospitals who implemented their own mandates months ago say workers placed on unpaid administrative leave ended up getting vaccinated and coming back to work. Unlike in most states, DeSantis has pledged to pay those workers who lose their jobs unemployment benefits.

While the vaccine mandate for businesses with 100 or more employees, ordered through OSHA, hit a temporary snag in a federal appeals court over the weekend, a similar mandate for healthcare workers is effective through a rule from the Centers for Medicare and Medicaid Services.

A week earlier, the Supreme Court declined to block an even tougher Maine mandate for its healthcare workers, a vaccine requirement that does not include a religious exemption.

The healthcare mandate applies to entities that are reimbursed by Medicare or Medicaid.

Wright’s facilities – Rosewood Manor, Pelican Garden and Dixie Oaks Manor – are assisted living facilities, which don’t receive Medicare funding.

But some assisted living facilities – including Wright’s – do get Medicaid funding, and so fall under the mandate, as do all nursing homes in Florida, which are required by law to accept Medicaid patients.

That means, barring an exemption for medical or religious reasons, all healthcare workers at nursing homes will fall under the mandate. They may be able to find work at assisted living facilities – provided they don’t have residents on Medicaid.

But for the most part, assisted livings rely almost entirely on CNAs, or nursing aides, employing only a couple of licensed nurses – practical nurses or registered nurses – for every 50 or 100 residents. And those few upper-level positions may fall under the OSHA mandate, since many assisted living facilities, as well as nursing agencies, in Indian River County are part of larger chains likely to have 100  or more employees.

So far, Wright hasn’t released a formal plan to inoculate more staff at his three facilities, saying he has been “waiting on the sidelines to see the final ruling.”

Rosencrance at Cleveland Clinic Indian River also appeared to be waiting to hear more.

“Cleveland Clinic is currently reviewing the rule, and will comply with requirements that apply to our health system,” he said. “We will have more to share in the coming weeks.”

But Dr. Gerald Pierone, founder and medical director of Whole Family Health Center, already put a mandate in place for staff at the community clinic. “We now have all staff vaccinated,” he said.

That achievement, though, was not without a cost. He said the clinic “lost a number of medical staff because of our mandate.”

“Staffing is a major challenge and we are trying to recruit new employees,” he said.

Pierone cited one positive change coming out of the pandemic: Paychecks got more generous as the demand for labor rose. “Wages for entry and lower-level positions in many organizations, including ours, have increased significantly,” he said.

“I don’t know what the future holds for medical personnel who decline SARS-CoV-2 vaccines.”

Pierone pointed out some may get religious or medical exemptions. Others fear they may leave the field.

Previously, Wright worried about enacting a mandate of his own because employees “have other options.” With the current shortage in healthcare staffing, skilled nurses are much in demand as are aides and therapists.

“A federal mandate should take some of those options off the table, assuming employees want to stay in the industry,” Wright said.

Wright said among the staff members he considers excellent, there are some who are unvaccinated. “We do not want to lose anyone,” he said.