As a traveling certified nursing assistant, Amelia Thornton has encountered all types of opinions about the COVID-19 vaccine among workers in Eastern Washington long-term care facilities.

Some workers got the vaccine — as she did — as soon as it became available to long-term care staff. Others, despite evidence of the vaccine’s effectiveness, remain hesitant, wanting to learn more about what’s in the shot. And she’s heard from a few who say, now that they will be required to be vaccinated, they plan to switch careers.

“I honestly wouldn’t blame them, if they are not making significantly more money than you would at a Walmart or something,” said Thornton, who lives in Quincy, Grant County. “There is just so much misinformation. I try not to judge.”

Opinions about COVID-19 shots aside, all Washington long-term care nurses, aides and other employees will be required to be vaccinated by Oct. 18 against the virus that has been more deadly among the residents they care for than any other population. But as of Aug. 8, just 68% of nursing home workers in the state have been vaccinated, compared with 83% of residents, according to the Centers for Medicare and Medicaid Services, which doesn’t track numbers for other long-term care facilities.

Some organizations representing long-term care facilities praised Gov. Jay Inslee’s sweeping mandate, which goes further than President Joe Biden’s directive that only applies to nursing homes. Requiring all workers in nursing homes, assisted-living facilities and adult family homes to be vaccinated, advocates say, ensures that employees don’t just leave one facility and go to another, unvaccinated. Residents, staff and others associated with long-term care residents account for 43% of Washington state’s more than 6,400 COVID-19 deaths.

Industry critics of the mandate, while encouraging all to be vaccinated, say adding a requirement could be detrimental to facilities that struggled with staffing levels pre-pandemic and that compete with service jobs, wage-wise. In small nursing homes or adult family homes, losing just one worker who is vaccine-hesitant could have a critical impact.


With less than two months before the deadline, providers are working to strike a balance: Advocate for workers to get a vaccine and ensure residents are properly cared for, all while preparing for the possibility that someone may not be persuaded and choose to leave.

“When we think about the workforce total, there is a limited number of people doing this work in the state and the country,” said John McReynolds, CEO of North Valley Hospital and its nursing home in Tonasket, Okanogan County. “Even if a small percentage decide to leave that field, it’s a big issue.”

Smaller facilities now are also grappling with an unfortunate trade-off: have an unvaccinated staff member, or go without someone to work a shift. David Grabowski, a health care policy professor at Harvard Medical School who has served on several long-term care expert commissions, said a building that’s short-staffed is a bigger risk to residents than having unvaccinated staff members. But both, ultimately, are a risk, he said.

“I’m supportive of mandates like Washington’s, but we have to get at the root cause of why staffers aren’t getting vaccinated,” he said.

At the Tonasket nursing home, about 60% of the workers are fully vaccinated, McReynolds said. Initially, staff members were nervous because the vaccine was new, and some didn’t feel a sense of urgency — the facility had a significant outbreak in October, so they assumed they were immune. The sentiment now has changed, he said, to a strong distaste for Inslee and perceived unfairness over the government requiring a vaccine.

The nursing home’s vaccination rate also mirrors Okanogan County’s, where about 59% of the eligible population is fully vaccinated, according to the Washington State Department of Health.


“Those same concerns and beliefs are also impactful in the employee base,” McReynolds said. “I’m not proud of that number, it’s not something we feel like should be the case given that people had really easy access and opportunity.”  

SEIU 775, the union that represents long-term care workers, declined to comment beyond its statement to members, saying it will be bargaining with nursing homes on the impacts of the new requirement for caregivers.

The Adult Family Home Council, which represents the state’s roughly 3,380 homes that provide 24-hour care for up to six nonrelated people in a residential setting, has been especially critical of the mandate. During the initial vaccine rollout for long-term care facilities, adult family home providers and employees felt they weren’t prioritized with other sites, leading to a confusing and inconsistent process, said John Ficker, CEO of the AFH Council.

“It seems an aggressive and insensitive jump to go from telling our members that they are not a priority for vaccines, to issuing a mandate,” Ficker said in an email.

The state has lacked sensitivity for the “diverse cultural, economic, educational and political makeup” of adult family homes, Ficker said, adding that in his news conference, Inslee suggested to those who are hesitant that they talk to their primary care physician. Many of the 17,000 adult family home employees, Ficker noted, don’t have health care plans that allow them to develop a relationship with a physician.

Unlike nursing home data, it’s unclear how many adult family home workers are vaccinated — Ficker was told the information wasn’t available at the state level. But based on what they are hearing from providers, the council estimates that more than 500 long-term care beds could be lost because of there aren’t enough workers.


A Pierce County long-term care community, eliseo, formerly known as Tacoma Lutheran Retirement Community, opted to require vaccines for its workers before Inslee’s mandate, though the state’s deadline moved up the facility’s, said CEO Kevin McFeely. About 65% of staff members are vaccinated. For the remaining employees, the provider has distributed a list of FAQs, and McFeely said he’s spoken directly with some employees about their concern. He’s pointed to previous outbreaks, the most recent involving a majority of people who were unvaccinated.

“It’s very easy to show that those who are unvaccinated are at greater risk,” he said.

But come October, he’s not sure how many people will leave. Only one person has left thus far: a maintenance worker who simultaneously quit his job at eliseo and another at a second facility, both without notice.

“We’ll see what happens,” McFeely said.