A commendable cascade commenced when Mayo Clinic and Sanford Health recently announced new COVID-19 vaccine requirements for employees.

Other hospitals and clinics serving Minnesota followed suit. Over the past week, M Health Fairview, Allina Health, HealthPartners and Children's Minnesota, as well as northern Minnesota's Essentia Health and St. Luke's, moved to put in place similar workforce requirements.

The state would be well served if this ripple effect repeats in long-term care centers, whose residents are at highest risk for severe COVID. Two Minnesota senior care systems merit praise for setting a strong example for others to follow — St. Paul's Episcopal Homes and Moorhead-based Eventide Senior Living Communities.

The two organizations are requiring employees to get the COVID vaccine, a conscientious move with the highly transmissible delta strain circulating. Unvaccinated staff can expose frail residents to needless illness. Breakthrough cases can occur even in those immunized.

While 90% of nursing home residents statewide are fully vaccinated, only 65% of the staff have gotten the shots. The Star Tribune Editorial Board sounded the alarm about this gap in early July, and concerns are mounting nationally.

A vaccination mandate is the most effective remedy. Still, it took courage on the part of Episcopal Homes and Eventide to move forward. The two organizations are believed to be the first Minnesota-based long-term care organizations to do so, though some facilities owned by out-of-state firms are putting requirements in place.

Long-term care centers face staffing challenges even when there's not a pandemic. The current labor shortage has added to the difficulty. Although it's likely those adamantly opposed to getting the COVID shots are a small percentage of this workforce, losing even a few employees is daunting.

Episcopal Homes and Eventide took this into account and went ahead anyway. According to their respective chief executives, Marvin Plakut and Jon Riewer, the decision came down to what is best for seniors' physical and emotional well-being. The vaccine doesn't just deter illness, it could prevent another round of lockdowns that put a painful halt to in-person visits. "That is brutally difficult on residents and their loved ones," Plakut said.

High vaccination rates are the best way to stop COVID, and both leaders stepped up. "I'm hopeful that our example will increase the confidence of some of my colleague organizations to go with the same decision," Plakut said.

Said Riewer: "We might be a drop in the ocean. But if it's not us, then who? We've got to start somewhere.''

Episcopal serves around 1,400 residents annually, and Eventide provides care to about 1,200. So far, both leaders report overwhelmingly positive feedback. As for staff departures, the two expect to lose some employees but not a large enough number to make staffing unmanageable. "It won't be completely painless, but we're going to find ourselves on the right side of history,'' Riewer said. "We are prepared. It might mean a CEO washing bedpans if that's what it takes."

Plakut said he is sympathetic to smaller, rural care centers that don't start out with his organization's advantage: 80% of Episcopal's staff is already vaccinated. Others may also not have a large city in which to find new employees.

That recruiting reality is a key reason why Mark Bertilrud, executive director of northwest Minnesota's Warroad Senior Living Center, isn't requiring the vaccine. There's stiff competition for the limited labor pool from nearby manufacturers. About 40% of the staff has been vaccinated, a rate reflective of the surrounding community's.

The example set by Episcopal and Eventide is welcome and should spur others to follow their lead. But for some centers, such as Bertilrud's, this may not be an option. Policymakers need to encourage facilities to mandate the shots. But they also need to understand that some centers face larger obstacles and help them find ways to boost vaccinations as much as possible.