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New York state officials are bracing for staffing shortages when the state’s health care worker vaccination mandate takes effect on Monday, and could be looking to the National Guard — as well as medical professionals from other states and countries — to help address them.

Gov. Kathy Hochul released a plan on Saturday, outlining the steps she could take to increase the workforce in the event that large numbers of hospital and nursing home employees do not meet the state’s deadline.

“We are still in a battle against COVID to protect our loved ones, and we need to fight with every tool at our disposal,” she said.

That could mean declaring a state of emergency to allow health care professionals licensed outside of New York, as well as recent graduates and retirees, to practice there. Other options include deploying medically trained National Guard members, partnering with the federal government to send Disaster Medical Assistance Teams to local health and medical systems and “exploring ways to expedite visa requests for medical professionals.”

The state’s labor department has also issued guidance clarifying that workers who are terminated because they refuse to be vaccinated will not be eligible for unemployment insurance, “absent a valid doctor-approved request for medical accommodation.”

All health care workers at New York’s hospitals and nursing homes are required to have at least one dose of a COVID-19 vaccine by Monday, according to state regulations and a mandate issued by former Gov. Andrew Cuomo last month. Staff at other institutions including home care, hospice and adult care facilities must be vaccinated by Oct. 7.

The most recent numbers suggest the state still has a ways to go: As of Wednesday, 84% of all hospital employees were fully vaccinated. And 81% of staff at all adult care facilities and 77% of nursing home facility staff were fully vaccinated as of Thursday.

Health care systems statewide and nationally are already struggling with staffing shortages.

Critics of the requirement have challenged it through protests and lawsuits, as North Country Public Radio reports, opposing mandatory vaccination and challenging the lack of exemptions for religious objections.

At this point, health care workers have the option to apply for a religious exemption until at least Oct.12, when a federal judge will consider a legal challenge in favor of such exemptions.

As hospitals readied their contingency plans — which for many includes limiting certain procedures — late last week, Hochul held firm to the deadline. She told reporters on Thursday that there are “no excuses” for workers refusing to get vaccinated, and called the impending shortages “completely avoidable.”

How health care systems are preparing for the deadline

Hospital systems and nursing homes across the state are encouraging their employees to get vaccinated, and preparing for disruptions if they do not. Some are cutting back on elective surgeries, limiting admissions and retaining volunteers.

Northwell Health, the state’s largest health care provider, has been holding meetings with staffers in an effort to persuade “thousands of holdouts,” The Associated Press reports. Some 90% of its 74,000 active personnel had been vaccinated as of Thursday, though the hospital said it’s not expecting full compliance and has more than 3,000 retirees, students and volunteers on standby.

Erie County Medical Center Corporation in Buffalo anticipates that roughly 10% of its workforce (some 400 workers) may not get vaccinated by Monday, according to AP, and is prepared to potentially suspend elective inpatient surgeries, reduce hours at outpatient clinics and temporarily stop accepting ICU transfers.

As NPR has reported, Lewis County General Hospital in Lowville, N.Y., said it would pause maternity services starting this weekend because dozens of staff members quit rather than get vaccinated.

Unvaccinated employees of New York City’s 11 public hospitals (which cites a roughly 88% compliance rate) will be put on unpaid leave but could return to work if they get vaccinated soon, CNN reports.

Some hospital systems are seeing an increase in vaccination rates. New York-Presbyterian, for example, enacted its own mandate with a deadline of midnight on Wednesday, and reported that only about 250 of its 48,000 staffers did not comply.

The University of Rochester Medical Center said in a statement that 99% of professional medical staff and 91% of all employees across its six hospitals were partially or fully vaccinated as of last week.

Dr. Michael Apostolakos, its chief medical officer, said that critical care and many-critical services will continue uninterrupted — but staffing shortages unrelated to the mandate are prompting a pause in some services.

Patients will see longer wait times for routine appointments, some employees will be asked to take on additional responsibilities and beds could be temporarily closed, Apostolakos said in a statement.

One piece of a national conversation

New York is not the only place mandating vaccinations for health care workers — California announced a similar policy over the summer, and the U.S. Department of Veterans Affairs is also requiring front-line health care workers to get vaccinated.

President Biden announced earlier this month that the 17 million health care workers at facilities that receive Medicare or Medicaid funding will have to be vaccinated or regularly tested, with details to be finalized in the weeks ahead.

While such workplace requirements have the support of many public health experts — and more than half of nurses, according to one recent survey — some politicians and hospital officials have expressed concern. And that’s especially true in rural areas, where vaccination rates are low and hiring is already difficult.

Chiquita Brooks-LaSure, the administrator of the Centers for Medicare and Medicaid Services, told NPR that the Biden administration is pursuing a mandate because of how stagnant vaccination rates are in the country’s hospitals. She noted that while many hospitals are worried about staffing shortages, employees missing work because of illness or quarantine is an issue of both staffing too — and safety.

“It’s very clear from the data that staff who remain unvaccinated are affecting both the patients who are coming in to the facilities as well as their colleagues,” she said.

It remains to be seen how severe staffing shortages will be, in New York and elsewhere. Though one state has already enacted a health care worker vaccination mandate, and could serve as one data point.

Maine’s governor announced a mandate for health care workers in mid-August, and hospitals are only reporting a handful of resignations so far — though enforcement doesn’t start until Oct. 29.