Dr. Jabbar Fazeli works in his office on Washington Avenue in Portland on Dec. 12, 2016. He runs the Maine Medical Directors Association, which recently released a survey finding many Maine nursing homes would require the COVID-19 vaccine if not for staffing shortages. Credit: Troy R. Bennett / BDN

Many Maine nursing homes would be requiring employees to get COVID-19 vaccines if not for staffing shortages exacerbated by the pandemic, a recent survey found.

The ongoing survey from the Maine Medical Directors Association, which had gotten 43 homes to respond as of Wednesday, found 60 percent of those facilities want to require staff to be vaccinated. But long-standing shortages make them wary of implementing requirements as new cases in Maine creep up, driven by the more contagious delta variant.

Maine has largely succeeded in vaccinating the nursing home workforce, with its rate sitting now at 71 percent, according to state data. That is well ahead of the national average of 59 percent. Rates are uneven between homes, however, and the conflict between staffing shortages and mandates makes the path toward stamping out the pandemic more difficult.

It comes as more health care facilities in Maine are requiring vaccines, with the state’s biggest  hospital systems — Portland-based MaineHealth and Brewer-based Northern Light Health — setting mandates in the last week. The Maine Health Care Association, a nursing home advocacy group, recently said it would support providers who choose to require shots.

Momentum could shift further after Genesis, the country’s biggest nursing home provider, announced on Tuesday that it will require staff to begin the vaccination process by Aug. 23. A recent slowdown in vaccination rates still could prove to be barriers for smaller facilities.

“I wish I knew what it would take to get folks to get vaccinated,” said Jim Brown, the administrator of Madigan Estates, a 99-bed nursing facility in Houlton where 67 percent of 194 employees had been vaccinated as of June.

The facility saw an increase in vaccine interest after its first outbreak in April, Brown said. But while new staff seem to be interested in getting shots — the facility is always hiring and saw three new employees come in this week — a core group of longtime employees has continued to wait, Brown said. Without a state or federal requirement, he said mandating a vaccine could cause him to lose those experienced staffers to another place.

Most of the facility’s residents have been vaccinated, which gives Brown some cover. But the lingering gap of employees means the company still has to have two different standards of personal protective equipment and quarantining protocols if there is exposure to the virus, which is something else that could continue to cause staffing problems, he said.

Vaccines have largely stopped the spread of the virus in long-term care facilities, where COVID-19 spread rapidly at the outset of the pandemic nationally and at one point represented about half of virus-related deaths in Maine, which still has one of the lowest nursing home death rates in the nation. They were prioritized at the outset of the pandemic and 13 states reported virtually no deaths in those homes in June, according to the Kaiser Family Foundation.

Nursing home staff shortages have long been a problem in Maine, driven by a rapidly aging population heavily reliant on a pool of low-wage workers. Nursing assistants made $15.71 hourly in 2020, according to state data, a wage comparable to retail workers.

The pandemic has further disrupted many industries with nursing homes uniquely struck by the virus. Despite being prioritized for vaccinations, there was initial resistance, with a quarter of nursing homes saying in January less than half of their staff agreed to get the shot.

Dr. Jabbar Fazeli, who leads the association and is medical director at Durgin Pines in Kittery, said the results indicate a desire to mandate the vaccines at facilities. If homes cannot fill the gap in vaccinations and no federal or state requirement arises, he worried the delta variant could cause a resurgence of outbreaks as the school season approaches.

“Clearly the administrators see this as a way out of the crisis, but are struggling with that decision,” he said.

The survey results were not surprising, said Nadine Grosso, vice president of the Maine Health Care Association. But while the increase in cases makes for additional urgency in increasing staff vaccination rates, Grosso said the most effective method of convincing hesitant workers to get the vaccine is to consistently communicate with them and address concerns.

“The choice to mandate at this point is really employer-driven,” she said.