Many adult foster homes likely to opt for religious exemptions to Covid-19 vaccine

UPDATED: This story has been updated with outbreak data

After the state announced a vaccine mandate affecting thousands, dozens of owners of adult foster homes caring for seniors and people with disabilities warned that they would be forced out of business.

They told officials at the state Department of Human Services Department in emails obtained by the Capital Chronicle that the state has no right to impose a medical treatment. 

The owners and operators said they didn’t want the shot. Some worried they would suffer side effects. Others opposed the mandate on principle. It applies to staff but not to residents or visitors.

Although 74 adult foster homes predicted in a September survey that they would close over the mandate, only three have done so, Elisa Williams, a department of human services spokeswoman, told the Capital Chronicle on Monday.

Rather than closing, many adult foster home owners and their staff plan to claim a religious exemption, according to one longtime owner who created an online group for nearly 230 providers who oppose the vaccine.

“That is a great option, and most adult care homes will exercise that option,” Ana said in a text message. She requested that her last name not be used out of fear of retribution.

The Oregon Health Authority will allow medical and religious exemptions from the mandate taking effect Monday, Oct. 18. A medical provider must sign the medical exemption but the latter does not require third-party verification.

The rule stipulates that the person requesting a religious “exception” fill out a form with  “a statement describing the way in which the vaccination requirement conflicts with the religious observance, practice or belief of the individual.”

The employer – not a religious official – decides whether the claim is valid.

“The actual enforcement of the mandate is through the Oregon Health Authority,” Lynette Caldwell, adult foster home manager at the human services department, told 500 adult foster providers during a call in September.

One of the providers asked what would prevent an owner from claiming a religious exemption for political reasons.

“I would say probably nothing,” Caldwell responded.

The Oregon Health Authority has no intention of policing the mandate. The agency said that’s up to employers or the state Bureau of Labor and Industries, if it receives a complaint. 

If the health authority obtains evidence that someone has submitted false information to comply with the mandate, however, it can alert law enforcement. Class A misdemeanors are punishable by up to 364 days imprisonment and a $6,250 fine.

The mandate will become part of the licensing requirements to operate adult foster homes. Caldwell indicated that providers are unlikely to face any questions as long as they have the documentation.

“It will be under the caregiver requirements, but it will not be linked to mandatory civil penalties,” Caldwell said. “You are responsible as a self-employed individual for approving your own religious exemptions.”

One home provider asked what would prevent someone with political objections from claiming a religious exemption. 

“I would say probably nothing,” Caldwell responded.

Nevertheless, many adult foster home owners worry the exemption could be withdrawn in the future.

“They’re so stressed out,” Ana said in a phone interview.

Mom and pop solution to long-term care

The human services department licenses about 1,400 adult foster homes. By law, each one can serve no more than five clients, including seniors with dementia and people with disabilities. The state estimates they have an 80% occupancy rate – about 6,500 people. 

That compares with about 30,000 Oregonians in nursing homes, assisted living, memory care and residential care, according to the Oregon Health Care Association, the industry’s trade association group.

Adult care homes lack a lobbyist in Salem. They’re the state’s mom and pop solution to long-term care.

Some are owned by nurses, and most employ just a few staff.

A large segment of homes in the Portland area are owned by Romanians, like Ana and Ligia Ifrim, who runs a home in Lake Oswego.

They came to the United States to be freed from the grip of government, both said.

“My father risked his life and escaped communist Romania in 1985,” Ana  said. “We had to forfeit our home and entire livelihood to the Communist government to come to America for religious freedom.”

Ifrim expressed similar sentiments.

“Everything was so controlled (in Romania),” Ifrim said. “You couldn’t even trust your neighbor.” 

The mandate reminds them of what they disliked about their native country. But now, they said, the rights they sought in the United States are being challenged.

“I am not anti-vax,” Ana wrote  in an August email to state officials and other adult foster home owners. “I’m anti-mandate.”

Others in the email chain agreed.

“I am for vaccines when it (is) by choice,” one owner wrote. “No government should be able to make that decision for me.”

She said adult foster homes and their clients had fared well during the pandemic.

“We have made it through the pandemic with PPE and diligent infection prevention strategies,” she wrote. “We are a small environment where we have more control over environmental factors.”

No published data on outbreaks

Not all Romanian adult foster home owners are against the vaccine. Mihaela Ion, who’s owned a home in Clackamas County for seven years, said she and her staff are vaccinated.

“We did what they asked us to do,” Ion said. “We are all vaccinated; we’re all happy.”

But she acknowledged that there is “a big group of people” who don’t want a Covid-19 shot.

It’s unclear how many adult care home residents or staff are vaccinated. The Oregon Health Authority does not publish that data.  The agency’s communication staff also did not respond to a request for outbreak data in adult foster homes by late Monday. Its outbreak report does not list the names of small facilities with cases for privacy reasons. The health authority said that 317 homes with five or fewer beds had reported three or more Covid-19 cases and one or more deaths, but those data are not limited to adult foster homes. The Department of Human Services said that 22 adult care facilities had reported confirmed or suspected cases by Oct. 8.

The health authority does track vaccination rates and outbreaks in long-term care facilities, however. Data show that nearly 90% of long-term care residents are vaccinated, compared with just over 70% of staff. Though long-term care facilities have only accounted for 4% of cases – among more than 340,000 in Oregon – one-third of the 4,000 deaths have occurred in these large settings.

One adult care home owner said she wished the state would allow facilities to test unvaccinated staff weekly instead of imposing vaccination. In response to the email chain to the state, she said she and her husband have been providers for 27 years. 

“If we can’t mandate our residents and visitors, the state should not be able to mandate us,” she wrote. “Our bodies. Our choice.”

Ifrim has another concern. She’s worried about potential side effects of a shot because of health issues. But her physician would not sign an exemption.

“I need to have proof (I would suffer) an anaphylactic shock in order to get that,” Ifrim said. 

Providers also worry about liability if an employee were to have a reaction to the vaccine.

“Who will be responsible if a lawsuit arises?” Ana wrote in an email. “Who will take care of the medical bills? DHS and the government should be responsible.”

As for herself, she declined to say whether she was vaccinated against Covid-19.

“Medical info should be private,” she said.