Philadelphia’s vaccine mandate deadline for health-care workers is here. Now enforcement begins.

The Philadelphia Department of Public Health has told city hospitals and nursing homes that it will take the first step toward enforcing its vaccine mandate for employees Saturday.

Oct. 15 was the deadline for those workers, as well as people who work at higher-education institutions, to receive at least one COVID-19 vaccine dose.

Earlier this week, the Pennsylvania Health Care Association said many nursing home employees were unlikely to meet the deadline. The industry group, which represents nursing homes, asked for another extension, which the city denied. In August, the city said employees had to be fully vaccinated by Friday, but it eased the deadline earlier this month.

Eric Heisler, director of external communications for the association, said Friday that there had been a last-minute surge in employees getting vaccinations or providing exemptions. “Things are trending in a better direction,” he said.

In a letter dated Oct. 12, the health department told nursing homes that employees who had not received at least one shot could not work after Friday. Partially vaccinated employees have until Nov. 15 to get their second dose. In the meantime, they must undergo extra testing and wear two masks or an N95 mask.

» READ MORE: Full list of places in the Philly region where you need to show proof of vaccination (so far)

The city is threatening nursing homes that violate the rules with closure and fines of up to $2,000 per violation.

Vaccine uptake among city hospitals has been faster. Last month, the University of Pennsylvania Health System announced 99% compliance with its own mandate, which went into effect Sept. 17. At Temple Health, 98% of the system’s 10,795 employees had complied with the city’s mandate by Friday, said Jeremy Walter, director of media relations. The 160 unvaccinated employees without an exemption will be placed on unpaid leave and given until Oct. 29 to get a shot.

After that, those who are still unvaccinated will lose their jobs. Jefferson Health declined to give specific numbers Friday. It said it was not terminating unvaccinated employees yet, but they won’t be allowed to work. “The number of unvaccinated employees is not expected to affect operations and patient care,” it said in a statement.

Among local universities, Penn, Drexel, and Temple all said at least 96% of employees have been vaccinated. La Salle University said less than 1% of its employees are out of compliance with the mandate.

James Garrow, the health department’s communications director, said that the city doesn’t expect ”all institutions to submit vaccination data immediately following the deadline … so it will take some time before we’re sure that all covered institutions have met and are following the mandate.”

He said the city will send surveys to collect data on vaccinations in nursing homes on Saturday. They must be completed by Oct. 24. “This process does not preclude us from direct requests with much shorter deadlines if we feel the need,” he said.

PHCA warned earlier in the week that as many as 2,400 employees might lose their jobs because of the mandate. The group did not supply specific examples of nursing homes that planned to fire large numbers of unvaccinated workers or would find it difficult to operate. Multiple nursing homes that have reported low employee vaccination rates did not respond to interview requests from The Inquirer.

Garrow said the city has no plans to help nursing homes with potential staff shortages.

» READ MORE: Penn State implements vaccine mandate for faculty and staff on its main campus

Heisler said one city facility told him Thursday that 21 of 175 employees had not yet had their first dose. It expected six to leave, while the other 15 promised to get their first doses on Friday.

Joshua Uy, medical director of Renaissance Healthcare and Rehabilitation Center in West Philadelphia, said the vaccination rate among Renaissance’s 140 employees rose from 75% to nearly 100% after the city set its deadline. As of Friday morning, only five employees were still unvaccinated.

He said he has had many one-on-one conversations with hesitant employees, and worries about the emotional cost of coercing people to get the shot.

“It’s really important to me that, if we do get to firing people, … that we let them know that we are so thankful to them for being with us through the absolute darkest days of long-term care,” he said.

He also wants staffers to know they can return if they get vaccinated.

“I am worried, as everyone in long-term care is, that we simply will not get those staff back, ever,” he said. Applications for open positions have fallen from 100 to 200 a week to around five.

According to data from Oct. 3, the most recent available, the employee vaccination rate for Philadelphia’s 47 nursing homes was 79%, up three percentage points from the previous week’s data, Heisler said. Twelve nursing homes reported that fewer than 70% of their employees had been vaccinated, with two below 50%.

Inglis House, which was listed in the Oct. 3 report as having a staff vaccination rate of only 43%, actually had 85% of staff fully vaccinated by Oct. 7, said Gary Bramnick, director of marketing communications. He did not know why the report was inaccurate. As of Friday, 96% of employees had met the deadline. He said the facility was prepared to use workers from staffing agencies if necessary.

» READ MORE: Philadelphia officials rebuff nursing home group’s request to extend vaccine mandate deadline

The health department said it would examine vaccination records either on a schedule or through “unannounced in-person or electronic compliance audits of records by department personnel.” These audits could be triggered by data from the U.S. Centers for Disease Control and Prevention or complaints.

Heisler said facilities are continuing to educate employees about vaccination and vaccines are readily accessible at many institutions.

PHCA, he said Thursday, “may not have a clear picture [of staffing challenges] until after the weekend.”

Heisler said PHCA has asked Cheryl Bettigole, acting health commissioner, to “collaborate on a plan to support providers with staff and any sort of logistical planning if residents need to be discharged or transferred.” He said she suggested putting unvaccinated workers on paid leave rather than firing them. This, he said, would not address immediate staffing problems.

Earlier in the week, Bettigole said that mandates have been “very effective at increasing vaccination rates.”

Some long-term care companies have been successful with their own mandates, so widespread vaccination of nursing home staff members is achievable.

For example, Kennett-Square-based Genesis HealthCare, one of the nation’s largest nursing home operators, announced in August that it was requiring all employees to be fully vaccinated by Sept. 22. Spokesperson Lori Mayer said all employees are now vaccinated except a small number who qualified for religious or medical exemptions. The company, which has one nursing home in Philadelphia, declined to say how many employees either left voluntarily or were fired because of the vaccine mandate.

The nursing-home industry had trouble recruiting and keeping staff well before the pandemic. These facilities were particularly hard-hit by the virus, and staffing problems worsened, nursing home leaders have said. Nonetheless, Mayer said Genesis has been able to replace employees who left because of its vaccine mandate.

Mayer said the company’s vaccination rate grew after it announced the mandate as the result of “thoughtful and supportive dialogue, hundreds of clinician-led and peer discussions about the safety and efficacy of the vaccines, and the looming federal mandate.”

Inquirer staff writers Jason Laughlin and Susan Snyder contributed to this report.