John and Jan Hanson of Fryeburg worry about the potential closing of the group home their 42-year-old son lives in, a repercussion from the COVID-19 vaccine mandate for health care workers imposed by Gov. Janet Mills.

The mandate goes into full effect on Oct. 29, when some health care workers will be out of a job for refusing COVID-19 immunization. How many workers is unknown, but the mandate could have an outsized impact on services for vulnerable populations living in group homes already struggling with long-term staffing shortages.

The Hansons’ son, Jess, has severe intellectual disabilities and the brain functioning of a toddler. He is prone to violent, unpredictable actions, his parents say.

Jess Hanson lives in a group home in Auburn, and requires three or four staff to provide 24-hour care. When he goes on outings – like to a Sea Dogs baseball game – three staffers have to surround him at all times to protect people in his vicinity.

He could lose his placement in the group home as soon as this week because some workers at the nonprofit agency where he lives are refusing to get vaccinated, and finding other placements would be difficult as the supply of group homes shrinks. But bringing Jess home to live with his senior citizen parents would be unsafe, the Hansons said.

“We’d both get hurt, there’s no question about it,” John Hanson said.

They would also have to install security cameras and alarms because in the past he has wandered off.

“We support people being vaccinated – both of us are vaccinated – but there has to be some acknowledgement that this is going to cause some harm,” said John Hanson, 70, massaging his forehead from the stress. “There’s no flexibility at all with this mandate. These are unintended consequences, we realize, but these are consequences nonetheless. And this is after we worked so hard to get him into a place where he would be set up for life.”

Health care workers, including employees of group homes and nursing homes, must be vaccinated for COVID-19 under an order imposed by Mills in August that the state intends to enforce on Oct. 29. Requiring health care workers to be vaccinated is paramount for patient and staff safety and to prevent COVID-19 outbreaks, Mills and Maine’s top public health officials have said.

Compliance has been strong in most sectors, with some hospitals reporting well over 90 percent of their workers getting the vaccine. Workers in group homes have lagged other health care sectors, however. And the homes are already staffed with thin margins.

Through the end of September, the latest data available, 84.5 percent of workers in group homes were vaccinated against COVID-19.

The adults receiving these services are some of the most vulnerable in the state. More than 1,500 people live in group homes for people with disabilities such as autism, Down syndrome or the effects of brain injuries and who need 24-hour care. About 4,000 adults with intellectual disabilities statewide receive some type of state services, such as day programs, which are also threatened.

Muffett Dulac, whose 42-year-old son, David, has Down syndrome and lives in a group home in Auburn, said she supports vaccinating as many people as possible, but the rule is going to cause families to suffer.

“To jeopardize the gains these families have made because flexibility is not allowed in these situations is criminal,” Dulac said.

Ray Nagel, executive director of the Independence Association in Brunswick, which operates group homes, said the “vaccine mandate is going to cause so many difficult stresses on a system that is already stressed out.”

Nagel said he’s not anticipating closures at the Independence Association. But he’s heard other agencies across the state, especially in areas where vaccine uptake is low, are expecting closures.

State officials said they are working on plans – including promoting employee signing and retention bonuses of up to $2,000 – to try to avoid as many closures as possible.

CHRONIC STAFFING SHORTAGES

The nonprofit agencies that operate the group homes contend that some of the staffing shortfalls could be devastating, with some group homes and day programs that provide services for adults with intellectual disabilities on the chopping block.

“We’ve struggled with chronic staffing shortages that pre-date the pandemic,” said Laura Cordes, executive director of the Maine Association for Community Service Providers, a group that represents the nonprofit agencies.

The workforce for all services for adults and children with intellectual disabilities is about 8,000, with about 2,500 employed in adult group homes, according to MACSP estimates. Cordes said the workforce has already shrunk 20 percent during the pandemic.

The further culling of the group home workforce puts families in “an awful and terrible predicament,” she said.

Cordes said they support the vaccine mandate but wish the Mills administration would be more flexible in the way it’s enforced.

Agencies could lose 10 percent of their workforce when the mandate fully kicks in Oct. 29, Cordes said, with prospects of quickly replacing the employees slim. She is appealing to the state to allow some flexibility in the rule, such as permitting unvaccinated workers to stay on the job past Oct. 29 while agencies work to find replacements or persuade the remaining workers refusing to get a shot to get immunized.

State officials say they are providing other help to try to avoid closures,  but the Mills administration has so far been unwilling to delay further enforcement of the rule to protect patient and staff safety, and avoid the need to quarantine and isolate unvaccinated staff.

Cordes said she appreciates the new state rule that permits new hires to start working after getting one shot while waiting for the second dose.

“But it assumes there will be an influx of new employees that isn’t there,” Cordes said. Despite recent increases in state reimbursement rates to help nonprofits attract and retain workers – with rates pegged to 25 percent above the minimum wage, or about $15.20 per hour – the overall workforce shortage has caused wages in other industries, such as retail, to rise much higher than minimum wage.

That has left the agencies scrambling for workers despite the reimbursement rate boost.

The crux of the problem is that workers can make more money in lower-stress jobs – such as in fast food or big box retail – than the difficult jobs providing care for adults with ID, leaders of nonprofits say.

The Hansons said they don’t know if their son’s group home – operated by John F. Murphy Homes in Auburn – will close. All families who have placements with the agency have been told that closures will happen, and the specific decision on what group homes will close will be announced on Wednesday or Thursday, said Todd Goodwin, CEO of John F. Murphy Homes.

Goodwin said he expects 10-12 clients will lose their housing placements through John F. Murphy Homes, and Cordes said other agencies are also sounding the alarm that closures are likely.

Jackie Farwell, spokeswoman for the Maine Department of Health and Human Services, said federal money from the American Rescue Plan could be used for “recruitment, retention and support,” such as signing bonuses for new workers or retention bonuses to keep workers on and avoid closing group homes. Maine received $126 million in Medicaid funding for workforce issues, and Farwell said the state is working with the federal government on exactly how the money can be spent.

The current plan submitted by Maine to Medicaid would allow retained workers to get up to $2,000 in bonuses, and new workers to get a $1,500 signing bonus.

“We are in frequent communication with CMS to obtain the needed approval,” Farwell said, referring to the U.S. Centers for Medicare and Medicaid Services. “We are requesting that the bonuses be approved retroactively to July 1 of this year, and have heard from several provider agencies that they have proceeded with paying bonuses.”

Goodwin said he’s unwilling to spend John F. Murphy Homes money on bonuses to retain or sign employees without approval from the federal government. “I’m reluctant to put forth money absent clear and unambiguous guidance and rules from the department. Risky proposition,” Goodwin said.

Goodwin said the bonuses are welcome, but it is a “finger in the dike” at addressing the problem.

Farwell said Maine DHHS is working in other ways to give nonprofit agencies flexibility.

“We have worked with several agencies to reconfigure their services,” Farwell said. “For example, an agency may have two homes with four beds each, but only two beds are filled at each home. In such a case, with the residents’ consent, we can approve temporary or permanent closure of one home and movement of residents into the other.”

Farwell said Maine DHHS is also, during the pandemic, allowing an “agency to hire family members, which some agencies have found very effective as an interim solution.”

Donald Lagace said his sister, Roxanne, 64, has cerebral palsy and needs 24-hour in-home care at her Augusta apartment, but the vaccine mandate has caused her services to be cut back. Lagace said his family has had to pick up 10-30 hours of shifts per week, and they can do it because they have five family members who can help Roxanne and share in the work.

“It’s a challenge, but we will do whatever it takes for Roxanne,” Lagace said.

But Lagace said he realizes many who have adults with intellectual disabilities in their families do not have the same amount of nearby help available if they were to lose services.

Farwell said some closures will unfortunately happen.

“We have seen closures over the past several months, and expect there will be more, given the prolonged strain of the pandemic and shortage of workforce in all sectors of the economy,” Farwell said.

FAMILIES LEFT WITHOUT SERVICES

For the Hansons, losing a placement for their son would be difficult for their safety, but also his well-being, because he has bonded with staff there and has lived in the same home for 20 years.

“It would be awful for him because he has a happy, comfortable life there and the staff knows how to manage him,” John Hanson said.

But over time, Jess has become more unpredictable and more aggressive, and they don’t know why.

“I don’t hug him anymore, we do high-fives,” said his mother, Jan Hanson. “He’s 250 pounds; I can’t stop him.”

John Hanson said his son has “no impulse control” and they had to place him in a group home setting in New Hampshire when he was 12. He moved to the John F. Murphy Homes in his early 20s.

“As he’s gotten older, he’s gotten a lot more aggressive, and we don’t know why,” Hanson said. “We could all be laughing, talking and watching the game together, and suddenly he might pick up a radio and throw it across the room at you.”

It’s not just the group homes that are threatened, but also day programs that give the adults a place to go and do things, such as outings, arts and crafts, life skills such as learning how to do laundry and cooking, and socializing. The Shop day program in Auburn has already closed, Goodwin said, because of the vaccine mandate.

David Dulac goes to The Life Center in Auburn five days per week, where he does odd jobs around the house, volunteer work in the community and trains for the Special Olympics.

“I run the 100 (meters), long jump, shot put,” Dulac said. The Life Center also has a basketball court and bocce court on site. A group of clients were playing cards in the game room on Friday, others went on a hike.

Dulac said he’s preparing for The Life Center’s Halloween party this week, and the people there have already decorated for the holiday.

Patty Whitmore, program administrator at The Life Center, said the day program is a “lifeline” for the clients, and it would be terrible for them if it closed.

“It gives them a sense of belonging, friendship, a wider social network and a feeling of inclusion in the community,” Whitmore said.

Muffett Dulac said if her son lost his group home placement and day program, they could take him back in at home, but it would be a “huge setback.”

“It’s not fair. If all of (a) sudden he got up in the morning and would have nowhere to go, it would be a significant loss in his life,” Muffett Dulac said. “Throughout David’s life, we have worked as hard as possible to give him as much independence as possible. He would feel a loss of his independence.”

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