The sweeping vaccination mandate issued by Gov. Jay Inslee demands that hundreds of thousands of health care and government workers get fully vaccinated by Oct. 18 or face firing.

That includes doctors and nurses, chiropractors and massage therapists, and people working in dental offices, pharmacies and midwifery centers. It also applies to tens of thousands of K-12 and state government employees, including many still working remotely from home.

Inslee has generally played hardball with his order, declining to offer a regular testing alternative like those offered in other states for employees who don’t want to receive COVID-19 vaccines.

But his order included a big carve-out — exempting tens of thousands of unionized home-care workers who care for older adults and people with disabilities, helping them with meals, dressing, bathing and other daily tasks. On Page 9 of Inslee’s Aug. 20 proclamation was a little-noticed clause stating the mandate does not apply to “individual providers” and others who offer personal care in someone’s home.

Washington has about 45,000 such providers, who contract with the state to provide in-home services to clients who are eligible for care through Medicaid. Thousands more not covered by the mandate are home-care workers who are trained, paid and supervised by larger home-care agencies.

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For some families who rely on these workers, the absence of a vaccination requirement potentially brings a difficult choice: hire someone who is possibly unvaccinated or go without in-home personal care.

The providers are represented by SEIU 775, the politically influential union that has long been a major benefactor for Democrats in the Legislature, and an Inslee ally. The union has regularly poured millions into political campaigns, mostly to keep Democrats in control at the state Capitol, and to pass initiatives for higher minimum wages and other worker protections.

The union also represents long-term care workers who are required to be vaccinated under Inslee’s mandate, which applies to nursing home, assisted-living and adult family home staff. COVID-19 has proven deadliest in these facilities, where residents and others connected to the sites account for nearly half the state’s COVID-19 death toll.

An SEIU 775 leader says the union supports vaccination efforts and did not seek the exemption. Inslee’s office and other state officials said the exemption was justified because of the unique working arrangements of the home-based individual providers and their clients.

In Wenatchee, Kris Keppeler manages the caregivers for her 91-year-old mother, who wants to live at home as long as possible but needs assistance with tasks like preparing her meals, watering her plants and managing her medications. It’s been hard to find caregivers who are available and who her mother likes, so she’s opted to employ the same ones she’s hired before, even though they aren’t vaccinated.

“I’m living with the fact her caregivers may give her COVID every day,” Keppeler said.


One reason for the exemption, Department of Social and Health Services spokesperson Chris Wright said, is that a high proportion of individual providers, at least 75%, are related to the person they provide care for, and roughly 85% work with a single client.

Inslee spokesperson Mike Faulk said in an email the exemption “isn’t about SEIU 775.” He said the governor’s staff was concerned about the difficulty in monitoring and enforcing the vaccination mandate among home-care aides, and also worried about impacts if caregivers refused to be vaccinated — potentially leaving their clients with few options.

“The loss of a home care worker in an individual home could mean moving a person out of their own home into a facility or hospital for care. Not only would that mean moving people away from home-based care, but the long-term care and hospital systems are already incredibly stretched,” Faulk said.

SEIU 775 echoed those concerns, though the union noted in a statement that, based on research from its benefits group, about 70% of home-care workers have received at least one COVID-19 shot.

In a text message, SEIU 775 Secretary-Treasurer Adam Glickman said the union “didn’t really advocate either way” on whether individual providers should be subject to the mandate.

“We are not against a vaccine mandate, though there are some real challenges in how you would implement one in home care while also addressing the needs of the tens of thousands of vulnerable seniors and people with disability who entirely rely on home care workers to live independently in their own homes,” Glickman added in an emailed statement.


Inslee’s vaccine mandate has applied to other workforces represented by politically active unions, including the state teachers union.

Maxford Nelsen, director of labor policy for the Freedom Foundation, a conservative Olympia-based think tank that opposes Inslee’s broad vaccination mandate and other COVID-19 restrictions, questioned the consistency of Inslee’s order. He noted that the mandate does apply, for example, to aides in adult family homes, which serve up to six non-related people in a residential setting.

“Either the vaccine mandates are about public health and that’s all that matters, or they’re not,” said Nelsen, whose organization has filed a records request with the governor’s office related to the exemption and its discussions with the union.

While SEIU 775 says most of its members have been getting vaccinated, a minority remain resistant.

Samone Nutall, who lives in Lakewood, is an individual provider for her mother, a stroke survivor, and receives payments from her mother and the state. Her mother is vaccinated, but Nutall, citing religious reasons, says she won’t get a COVID-19 shot. She’s worried what would happen if the state were to require vaccines for individual providers, and what that would mean for her mother’s care.

“I’m still going to help my mom if they pay me or not,” Nutall said. “I refuse to let her go to a nursing home, I refuse to let her live her years alone and scared and wondering who is going to care for her.”


State and national home care industry groups have pushed for vaccinations among their members, but without advocating a requirement. The National Association for Home Care & Hospice said it believes every provider “must decide for itself how best to serve the interests of its patients, while respecting the sensitivities of its employees.”

Anita Wahler pays for one person to help care for her mother, who is in her 90s, for a few hours a few times a week in their Pierce County home. She would like to hire another home-care worker for more help, but she’s worried that finding another vaccinated caregiver would be difficult, and bringing in a non-vaccinated worker could be even worse.

“I haven’t even tried,” Wahler said. “I don’t feel safe even trying. I can’t face having a decision of mine being the thing that kills my mom. There’s no way an unvaccinated person should be working with highly vulnerable populations.”

Some agencies have opted to add their own requirements. Vaccinations are a condition of employment at SYNERGY HomeCare in Seattle, owner Rich Fitzgibbon said.

“I can’t allow my employees ‘freedom’ if it places clients at risk,” he said in an email.

Dexter Borbe, who owns Interim Healthcare of Bellevue, favors a COVID-19 vaccine requirement for home-care workers, but has so far only highly encouraged vaccines among the company’s roster. He said he consulted with his insurance company, which told him Interim Healthcare wouldn’t be covered if someone had an adverse side effect from getting the shot.


Clients, however, can ask for and then be assigned only vaccinated caregivers, Borbe said. He noticed an uptick in requests starting in April, as vaccines became readily available.

“It’s created a bit of pressure internally,” he said. “If you aren’t vaccinated, the jobs available to you are going to be very limited.”

Alyssa Evans, a home care aide in Concrete, Skagit County, works through an agency that doesn’t require vaccinations. But she chose to get vaccinated soon after she qualified this year. Not all caregivers have the option of working in just one home, and some go from household to household to household, she said.

Not being vaccinated, she added, “is just as ridiculous as walking into the ER without a mask on and saying, ‘Hey, here I am,’ and sneezing on people.”