Category: Blog

A recent, and well deserved, trend in media outlets is congratulating and thanking health care workers for being heroes in the unprecedented crisis of Covid-19. While the Delta variant and battles over vaccine mandates still rage, there are many taking a cautious sigh of relief that the end is in sight for our healthcare struggles. Unfortunately, Covid-19 may have exacerbated an existing issue within the healthcare industry that will lead to a new crisis in the near future: healthcare worker shortage.

The American Association of Colleges of Nursing (AACN) has been sounding the alarm for years that the rate of job growth in the healthcare industry, especially in the area of registered nurses, is not sufficient for rising healthcare needs. In 2017, more than 50% of registered nurses were over the age of 50, and it is projected that 200,000 new nurses will be needed every year to meet healthcare needs and to recoup staffing losses from retiring nurses. The dark shadow hanging over the head of the healthcare industry is the rapidly approaching retirement of the Baby Boomers. The largest generation in America’s history is entering their twilight years and want to retire. As of September 2020, 40% of all Baby Boomers have entered retirement. Not only is the healthcare industry losing millions of workers to retirement, as is evident by the disproportionately older demographics in the nursing field, but the Boomers themselves will be a severe stress on our nation’s healthcare. Baby Boomers live longer and are likely to suffer from high rates of obesity, hypertension, high cholesterol, and diabetes. The healthcare industry’s labor shortage was already a fire beginning to grow, but the pandemic has done more than fuel the flames.

Covid-19 has intensified the terrible problem of burnout in the healthcare field. Many of the Healthcare Heroes that we adore for their selfless service are considering getting out of the field altogether. Over half of healthcare workers, which includes the nursing assistants found in retirement homes, have reported burnout from work. The stresses of working in unprecedented conditions have taken their toll on our severely needed healthcare professionals. Additionally, the push against Covid vaccines has led to many workers feeling betrayed by the people they painstakingly served. Many have become disillusioned with the profession and are considering switching careers. The poor disposition of current healthcare workers must serve as a deterrent for those who are desperately needed to join the field. The inevitability of Baby Boomers entering retirement and stressing the system was already not being alleviated by projected employment increases and who knows how badly the effects of burnout will worsen the situation. This loss of faith in the system comes at the worst possible time, as the already existing labor shortage was not being treated.

Thankfully, the Federal government seems to be aware of the present danger that a healthcare worker shortage presents. Before the American Rescue Plan Act was passed, Congress modified it to direct more funds to the public healthcare system. Specifically, the act sent over nine billion dollars towards workforce related support, which will primarily assist in hiring new staff with proper equipment. Some members of Congress are trying to further assist current healthcare workers, such as Representative Maloney with her reintroduction of the Student Loan Forgiveness for Frontline Health Workers Act. This act would reward the service of healthcare workers by forgiving their student loans; however, Congress seems hesitant to pass additional costly legislation after the difficulty they had with the American Rescue Plan Act.

The importance of healthcare workers is undeniable, and they certainly deserve the title of “heroes” for their service. A large debt is certainly owed to the professionals that pulled us through the worst of the pandemic. The American Rescue Plan will hopefully address the worker shortage, and it might be a sign that society at large is acknowledging the plight of our vital healthcare heroes. 

The United States began widespread COVID-19 vaccine distribution on December 14^th, 2020; however, after ten months the CDC reports that only 56% of the U.S. population is fully vaccinated. When compared to other high socioeconomic (SES) nations, the U.S.’s vaccination rate ranks among the lowest. While the people of low SES nations are pleading to high SES nations to increase their access to this preventive medicine, the people of the United States are privileged to not face this access-related issue. Instead, a barrage of misinformation has convinced a large portion of the U.S. population to not get fully vaccinated. Efforts to counter vaccine misinformation have done little to repair the damage created in the public’s perception of the COVID-19 vaccine. The Biden Administration must follow through on their proposed OSHA COVID-19 vaccine mandate and expand those mandates to cover other gaps in our public health intervention. 

According to the scientific journal, Nature, low SES nations collectively have a vaccination rate of less than 1%. The low vaccination rate experienced in these nations is directly attributed to strict pharmaceutical patents in the United States and other western nations that are preventing these nations from producing cheaper alternatives. The UN Development Programme projects that low SES nations are expected to lose over $220 billion as a direct result of the COVID-19 pandemic. This immense economic loss will cause deep social impacts to these nations, likely impacting human rights, education, and food security. 

The people of U.S. do not experience the access-related issue that low SES nations face, on the contrary there is an overabundance of the vaccine, allowing immunocompromised people to receive third doses. The main driving force behind the low vaccination rate in the U.S. is the bombardment of misinformation, which has its biggest impact on marginalized and working-class communities. Much of this misinformation targets the mistrust these marginalized groups already have in public health intervention, especially relating to abuses like the Tuskegee Study and the early stages of HIV/ AIDS outreach. When it comes to working-class communities, finding time to get the vaccine can be hard due to potentially missing work or lack of adequate transportation.  For many working class people, these factors in conjunction with misinformation, causes many workers to view missing work to receive the vaccine doses as too risky. 

In September of 2021, the Biden administration announced that it will compel OSHA to mandate vaccinations for all companies with more than one hundred workers. The Administration projects that this mandate will push “80 million American workers” to vaccinate. While this will be great at incentivizing more workers to receive the vaccination, it will significantly burden marginalized and working-class individuals if these mandates aren’t coupled with protections and benefits. These could include providing subsidies for the transportation cost and missed work, as well as protections from employer retaliation. Further, the Administration can compel other agencies to promulgate rules that expand the mandate even more. For example, the Administration can compel the Department of Transportation to mandate proof of vaccination for all interstate public transportation. With these modified actions, the Biden Administration can help to significantly increase the United States’ vaccination rate.

As employees start to head back to the office there is one question on their mind – do I have to get vaccinated to go back to the office?  While many employees voluntarily chose to get the Covid-19 vaccine, others are concerned about losing their job if they choose not to get vaccinated.

Whether an employer can require an employee to get vaccinated depends on state law.  With the ever evolving circumstances surrounding the COVID-19 pandemic, states are still in the process of passing legislation surrounding employer’s requirement or discrimination based on receiving the Covid-19 vaccine.  Several states have pending legislation that would not allow employers to require employees to receive the Covid-19 vaccine as part of their employment.  Other states have pending legislation to protect employers who require employees to be vaccinated.

Federal law may still offer some protections to employees who choose not to get vaccinated.  Employees may be exempt for religious beliefs or medical issues.  Employees that are covered by the Title VII of the Civil Rights Act of 1964 who have made employers aware of their religious beliefs may have the foundation to receive a religious exemption.  Additionally, the Americans with Disabilities Act may protect individuals that have a protected disability that would be medically averse to receiving a vaccination.  Employers will need to make appropriate accommodations for employees with disabilities.

For employers that do require employees to be vaccinated, there are limitations on what they can ask employees.  Employees who receive their vaccination aside from employer sponsored vaccination, are not required to show medical proof of vaccination.  Employers may ask employees whether they are vaccinated against COVID, but that is the extent of proof employers can require from employees.  As the world enters a new phase, many questions are still left unanswered surrounding the COVID-19 vaccine. Alternatively, will employers be held liable if they do not require vaccinations?  Some legal professionals would be surprised if employers were but it is not outside the realm of possibility.  

Requiring vaccinations may largely depend on the employer’s industry.  For example, hospitals and other medical entities may require employees to be vaccinated.  Employers in the medical industry already require employees to receive other routine vaccinations and tests as part of their continued employment.  There are, however, employees who work from home or have limited contact with the public. In these instances, an employer may decide not to require employees to get vaccinated since they do not regularly enter the workplace.

The U.S. Center for Disease Control regularly encourages everyone to receive a COVID-19 vaccine in the interest of public health. Nonetheless, whether employees are vaccinated or not, employers are still encouraged to maintain safety protocols to protect their employees and the public from being exposed to the COVID-19 virus.  

Seven years ago, the U.S. media began reporting on the water crisis in Flint, Michigan. While the City of Flint has finally replaced its pipes and the 95,000 residents of Flint have become eligible to receive a portion of a $650 million dollar settlement, many residents of Flint still do not trust their water. This lack of trust stems from years of community neglect and environmental racism. The water crisis experienced by Flint, Michigan isn’t a rare incident, many communities around the U.S. lack access to clean drinking water. As the Biden Administration engages in partisan negotiations over the proposed infrastructure bill, the American Jobs Plan, repairing U.S. water infrastructure must remain a priority. 

It is estimated, that every year, nine to forty-five million Americans obtain their drinking water from a source with contaminants that violate the Safe Drinking Water Act. These contaminants have a wide variety of health effects, from acute effects like stomach disturbances, to chronic effects like certain cancers and neurological disorders. Under the Environmental Protection Agency’s (EPA) Lead and Copper Rule,  lead concentrations must not exceed 15ppb and copper concentrations must not exceed 1.3ppb in more than 10% of the sampled taps of residents. The regulation provides that if levels exceed this, the public must be informed, and service lines may need to be replaced in order to protect public health. However, many of the small, rural communities struggling with unsafe drinking water can’t even afford to hire a full-time water treatment operator, so the idea of these communities being able to afford the costs associated with replacing their drinking water infrastructure without adequate federal funding and oversight, is not realistic. 

Under the current American Jobs Plan proposal, $111 billion in total will be allocated to improving U.S. drinking water. Within that total, the Administration proposes that $45 billion dollars in grants will be enough to replace 100% of U.S. lead pipes and service lines. Also, within that total, the Administration proposes providing $56 billion in grants and federal loans to help modernize rural water infrastructure and $10 billion to be allocated to water surveillance programs. While media coverage and the GOP make these costs seem way over budget, are these proposals even enough to fully address the issue at hand? According to a Drinking Water Infrastructure Needs Survey and Assessment released to Congress by the EPA in 2018, the costs associated with repairing U.S. drinking water utilities is estimated to be $472.6 billion. The costs associated with replacing pipes, service lines and mains alone are estimated to cost $312.6 billion, according to the EPA’s survey, drastically above the proposed $45 billion. 

As Congress and the Biden Administration are actively engaged in negotiating the terms of the American Jobs Plan, the allocation of funds to repair our nation’s drinking water needs to increase rather than decrease. Access to cleaning drinking water is a human right that has been established under the United Nation’s Sustainable Development Goals, a right that should be guaranteed in both developing and developed nations like the United States.

As the US begins to turn a new page since the Pandemic first devastated our country in 2020, many Americans plan to be vaccinated in efforts to return to life as they once imagined. The Biden Administration has placed tremendous support and funding behind vaccines produced by Pfizer, Moderna, and the Johnson & Johnson (J&J). While public health experts, including the CDC, deem all three vaccines safe with varying efficacy levels there is concern about the implications about the recent pause to the production of the Johnson & Johnson vaccine.

According to the CDC, the “pause” was recommended after some people developed “a rare and severe type of blood clot” two weeks after being vaccinated. Although alarm is expected, the occurrence of these type of blood clots is small (approx. 6 cases) compared to the 6.8 million doses issued. Health experts recommend for those originally signed up to receive the J&J vaccine simply attempt to reschedule to receive either the Pfizer or Moderna vaccine. Although the J&J vaccine which has passed vigorous testing and oversight from the CDC and FDA, the Janessen (Johnson & Johnson) company is expected to meet with regulators this month to ensure that vaccines continue to be safe for distribution. That meeting is open to the public. The meeting will be held by the CDC’s Advisory Committee on Immunization Practices the whose job it is to determine how the J&J vaccine will be used and changes in vaccine supply.

In terms of new production, the producers of the J&J vaccine are dealing with potential quality issues. The FDA further requested that J&J vaccines undergo additional testing and identify any potential sources of contamination. After an inspection of one production facility in Baltimore, the FDA noted several issues that would have to be addressed in order to continue to a supplier of vaccine products during COVID. In a statement released by J & J the roll out of the vaccine has been delayed in both the US and Europe. The statement also included information for those who are concerned about recognition and treatment of the related to that type of rare blood clot.

So where do we go from here? According to a report from CNN, the impact of the J &J pause should be minimal. Nonetheless, for Americans that are already skeptical about being vaccinated under emergency procedures this adds to the list of reasons not to be vaccinated. Health experts continue to stress the importance of putting this incident into context. Specifically, the CNN report points to the fact that the other vaccines by Pfizer and Moderna are designed differently from Johnson and Johnson and are completely safe. As Americans continue to decide whether to vaccinated, health experts hope that vaccine safety concerns won’t thwart the efforts of health experts, the Administration, and the public to move toward a coronavirus-free nation.

As of March 2021, over 174,000 people living and working in nursing homes and long-term care facilities in the United States have died as a result of COVID-19; these deaths account for approximately forty percent of the COVID-19 deaths that have occurred in the United States. Many government officials, on both sides of the aisle, are working to understand why so many federally certified nursing homes and long-term care facilities failed to protect our most vulnerable citizens from COVID-19. Evidence shows manipulation of the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare Five-Star Quality Rating System may be contributing to the problem. This emerging evidence has prompted State Attorneys General (AGs) to hold facilities manipulating the System accountable for deceptive practices.

In 2008, CMS implemented the Five-Star Quality Rating System to help families identify safe and reliable facilities for their loved ones. The ratings are based on independent, third-party health inspections; self-reported staffing levels based on the number of hours of care provided on average to each resident per day; and self-reported quality measures that include how well residents’ physical and clinical needs are met.

Families relying on this tool may assume that placing their loved one in a five-star-rated facility means they are in a safe facility, but families should be aware of long-standing concerns with the Rating System. In 2014, the New York Times published a report on the System’s shortcomings. The report found that, although the Rating System encouraged some nursing homes and long-term care facilities to improve, some facilities’ ratings improved even when care did not.

Unfortunately, allegations of the manipulation of self-reported data continue today. Thus, some top-rated facilities remain ill-prepared to handle the day-to-day needs of patients and lack capacity to manage the current public health crisis. As death tolls have climbed in these facilities, the New York Times published another investigatory report highlighting the Rating System’s shortcomings on March 13, 2021. The report reviewed the reliability of self-reported data by analyzing nursing home payroll records, records of state inspections of facilities, and financial records.

The report found that much of the information provided to CMS by nursing homes was wrong. Reported staffing levels included employees on vacation. Resident accidents and health problems went unreported. Facilities with five stars for quality of care were almost as likely to fail in-person inspections as to pass them. Facilities received advanced notice of surprise inspections—defeating the purpose of the only independent evaluative factor. More than two-thirds of five-star facilities were also cited for infection control or patient abuse problems. Despite incidences of rape, homicide, and rampant COVID-19 spread, many homes maintained a five-star rating. These issues are difficult for government officials to ignore.

State AGs are pursuing litigation against facilities that have manipulated the Rating System to secure higher ratings and further investigating the allegations contained within the New York Times report. Former California State AG Xavier Becerra sued Brookdale Senior Living, Inc., the largest senior living facility in the United States, based in part on manipulated self-reported data. The complaint alleges that Brookdale engaged in false and misleading statements and unlawful, unfair, and fraudulent business practices by, among other things, providing CMS false information and falsely advertising about the quality of its facilities. California is not the only state pursuing these issues. New York AG Letitia James issued a report in January 2021 on the response of New York nursing homes to the pandemic. Her report revealed that more nursing home residents died than reflected in New York’s data; nursing homes with low CMS ratings had higher COVID-19 deaths; and among other things, the failure of nursing homes to comply with infection control protocols increased COVID-19 risks.

Lawsuits like the one against Brookdale Senior Living, Inc., will hopefully begin to accelerate reform in nursing homes and long-term care facilities. CMS should consider not only restructuring its Rating System, but also working to improve federal oversight of the nursing home and long-term care facility industry and patient mistreatment. Placing a loved one in these facilities is a difficult decision for many families. The unreliable Rating System, particularly during the pandemic when families cannot physically check in on their loved ones in these facilities, creates an unacceptable situation that CMS must address. Our loved ones deserve better.

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