State council approves caregiver vaccine mandate expansion

BOSTON — The Baker administration’s COVID-19 vaccine mandates for home care workers and staff at rest homes, assisted living residences and hospice programs got a green light Wednesday from the Public Health Council, which unanimously approved regulatory changes to implement the requirements.

The regulations were approved on an emergency basis and will be subject to a public comment period.

Introducing the measures to the council, the Department of Public Health’s Marita Callahan described caregiver vaccinations as “critical” to protecting the health of vulnerable individuals.

The Baker administration announced last week that it would seek the council’s approval to extend an existing vaccine mandate on certain long-term care staff to include additional caregivers and facilities, in an effort to protect older people from COVID-19.

Council member Mary Moscato, the president of Hebrew SeniorLife Health Care Services and Hebrew Rehabilitation Center, described the mandates as a step that “really does protect our seniors and patients.”

The policy will apply to up to 100,000 home care workers, 62 freestanding rest homes, 85 hospice programs and 268 assisted living residences, according to the administration. The affected workforce will have until Oct. 31 to get vaccinated, unless they qualify for a medical or religious exemption.

Kathleen Carey, a professor of health economics at the Boston University School of Public Health, said the state should keep an eye on the mandates’ potential impact on staffing levels. She said there have been cases nationally of hospital staffing shortages that have been “somewhat exacerbated” by vaccination requirements.

The council also voted 9-4 to finalize the repeal of universal mask mandate regulations that are no longer in effect.

The council repealed those regulations on an emergency basis in June, and since then some members have raised concerns around the message it would send to formally strike the mask rules while the more infectious Delta variant has led to increased spread of the coronavirus.

The widespread masking mandate in place in Massachusetts earlier in the pandemic has been replaced by an advisory for people to wear masks in indoor public places if they or someone in their household is vulnerable to the disease, along with targeted mandates applying to specific settings like schools, transit and health care settings.

“I don’t think we’re really protecting the public to the full extent if we have a piecemeal, incremental approach,” said Dr. Edward Bernstein, an emergency medicine professor at the BU medical school.

He said dynamics around the virus have changed since the June vote.

Bernstein said he was voting no “until we have something in place that proposes masking in all public spaces where you can’t maintain distance,” and Lisette Blondet, director of the Massachusetts Association of Community Health Workers, said she cast her vote against the repeal “in order to protect the entire state population.”

Blondet said that she lives on Cape Cod, where there is a large senior population, and that she sees most other shoppers unmasked when she goes to the grocery store now that face coverings are not mandated.

“We are making decisions based on what’s true for the entire state and leaving out pockets of very, very vulnerable populations who are very confused, and I think that repealing these regulations will continue to leave these people out, will fail to protect the public the way I feel we are charged to do,” she said.

Dr. Larry Madoff, the medical director for the DPH Bureau of Infectious Disease and Laboratory Sciences, said the state’s current policy “normalizes mask-wearing” by requiring or recommending it in many situations. He said the state is “balancing risks and incentives” while keeping the importance of protecting the vulnerable “paramount in our thinking.”

“We think that the incentive for the unvaccinated to get vaccinated so that they are no longer recommended for mask-wearing in most situations is really an important component of our strategy to maximize vaccination and to maximize the protection of the community and those most vulnerable,” he said.

DPH staff said they would continue to monitor the data around COVID-19, and that the official repeal of the prior regulations would not prevent them from bringing forward any new precautionary measures in the future.

State epidemiologist Dr. Catherine Brown said evaluating that data will be particularly important as the seasons change and temperatures drop.

“As people come indoors, we’re really going to have to watch and see what happens,” she said. “We absolutely need to continue to monitor the data, literally on a daily basis, and to adjust and adapt the recommendations and requirements as needed.”

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