In this Dec. 15, 2020, file photo, nurse Kayla Mitchell, left, of Maine Medical Center’s COVID-19 ICU unit in Portland, becomes the first person in the state to receive the Pfizer-BioNTech COVID-19 vaccine. Credit: Derek Davis / Portland Press Herald via AP

AUGUSTA, Maine — Weeks after Maine’s vaccine mandate for health care workers went into effect, data suggest it had only a small impact on total employment in the industry, but the state still faces a shortage of health care workers as the pandemic continues.

The continued staffing challenges come as COVID-19 cases in Maine are as high as they have ever been headed into winter, with a record 327 people hospitalized with the virus on Thursday and unvaccinated people continuing to drive the majority of cases.

Early data from the Maine Department of Health and Human Services suggest total health care employment has declined only slightly following the vaccine mandate, although the effects varied by provider and individual facilities, mostly nursing homes, saw a greater drop.

The requirement followed more than a year of falling employment due to the pandemic for an already challenged industry with no easy solution despite additional funding on the way. It is hard to decouple wider effects on this sector and others from the mandate.

“When we talk with our members, the No. 1 reason that comes up why workers leave their positions in long-term care is due to burnout and stress,” said Angela Westhoff, CEO of the Maine Health Care Association, which represents nursing homes and long-term care facilities. “I think the pandemic really has just heightened all of that. The vaccine mandate is certainly part of it, but less so.”

The mandate from Gov. Janet Mills, which went into effect at the end of October, is among the strictest in the nation for health care workers, with no testing option or nonmedical exemption. Vaccination rates rose sharply following it — the rate among nursing home staff rose from 72 percent in July to just shy of 97 percent in October, while it rose from 80 percent to 98 percent among hospital workers.

Over that same period, total employment in hospitals ticked up slightly, state data show. The gains were still uneven. Providers such as Central Maine Medical Center in Lewiston have faced challenges, with the mandate-related departures exacerbating ongoing difficulties in filling empty positions.

Nursing homes, assisted housing and providers serving Mainers with disabilities were more likely to see workers depart after the mandate. Across those provider categories, total employment declined by more than 1,100 workers, or roughly 7 percent, from July to October.

Some workers cited the requirement as a reason for their departure and providers that have closed or cut beds this fall pointed to the loss of those workers as a major reason for their inability to continue to offer full services. Others that closed this year also pointed to unrelated issues, such as lack of affordable housing.

But while employment fell in the months after the mandate was announced, it had also been declining beforehand. Jobs data showed the sharpest drop in employment at nursing homes in the spring of 2020, coinciding with the onset of the virus. Unlike hospitals, which largely rebounded this year after losing staff at the pandemic’s outset, Maine nursing homes that rely heavily on low-wage workers struggled to make up for initial losses.

This decline matches a national trend. A report released earlier this month by the American Health Care Association and National Center for Assisted Living found that employment at nursing homes was down 14 percent nationally since March 2020.

The report, based on federal data, pre-dated the implementation of COVID-19 vaccine mandates. While Maine and a handful of other states now require vaccines for health care workers, all providers that receive Medicare funding — including nursing homes — are set to face a similar mandate beginning in January 2021.

As in Maine, burnout appears to be the leading factor causing nursing home staff to leave across the U.S. for now, said Mark Parkinson, president of the American Health Care Association. But he also pointed to low funding levels, saying long-term care facilities are “struggling to compete” with other providers as well as other sectors in a tight labor market.

In Maine, increasing wages as well as offering sign-on bonuses or bonuses for staff who pick up extra shifts can help facilities combat the worker shortage, said Westhoff of the Maine Health Care Association. Additional funding for providers, such as the $14 million announced by Mills last month to boost recruiting and retention, could help with that, although it is only temporary.

“One-time money helps,” she said, “but it’s one-time money.”