[UPDATED] Nursing Home Staff Must Be Vaccinated, Biden Administration Says

Following the Biden administration’s announcement that all nursing home staff must be vaccinated against COVID-19 or risk losing Medicare and Medicaid funding, operators and senior living organization leaders fear singling out one group of health care workers will only exacerbate a continued staffing crisis.

Some state mandates, on the other hand, call on all health care providers across the care continuum to get vaccinated as a term of employment.

About 82.4% of residents and 60% of staff per facility are vaccinated, the Centers for Medicare & Medicaid (CMS) reported.


“…If you visit, live or work in a nursing home, you should not be at a high risk of contracting COVID from unvaccinated employees. While I’m mindful that my authority at the federal level is limited, I’m going to continue to look for ways to keep people safe and increase vaccination rates,” President Joe Biden said Wednesday announcing his plan.

CMS Administrator Chiquita Brooks La-Sure said the organization will work with nursing homes to “address staff and resident concerns,” but neither she nor Biden outlined specific ways of doing so.

“The data are clear that higher levels of staff vaccination are linked to fewer outbreaks among residents, many of whom are at an increased risk of infection, hospitalization, or death,” added Brooks-LaSure. “We will continue to work closely with our partners at the [Centers for Disease Control and Prevention], long-term care associations, unions, and other stakeholders to advance policies that keep residents and staff safe.”


Jay Moskowitz, president and CEO of Vivage Senior Living, said he approves of state mandates where all health care staff are accounted for — he calls the federal mandate a “punishment” to nursing homes.

“The focus just on long-term care is a mistake, because we’re not the only ones that have COVID by employees, or by patients,” Moskowitz told Skilled Nursing News. “I’m very disappointed there’s nothing across the board for all health care providers. You’re going to drive employees out of long-term care and into other fields; we won’t have enough employees to provide the level of care we need to provide.”

Lakewood, Colo.-based Vivage operates in Missouri and Nevada, in addition to Colorado. The operator is currently at 78% for staff vaccination across its facilities, and 85% for residents.

Moskowitz expects SNF employees to jump to other sectors of health care as a result of the mandate.

“We will have throughout the industry a mass exodus of people who don’t want to get vaccinated and jump into other health care spaces — hospital, home care, assisted living,” added Moskowitz. “The CMS guidance for healthcare employees being just nursing is a major, major mistake.”

Nursing homes saw 2,059 new resident cases the last week of July, according to data published by CMS; new staff cases were much higher for the same week at 3,265.

“There’s been a lot of noise and a lot of push for mandates and I think we are, as an organization, very supportive of it,” Tim Fields, CEO and co-founder of Ignite Medical Resorts, said.

He added, however, that the devil is in the details.

“We really feel that it should be all healthcare professionals, otherwise they’re taking a staffing crisis and making it worse,” Fields said. “It should be hospitals, assisted living, it should be all healthcare professionals.”

Fields echoed Moskowitz’s concerns, adding that one of the dangers of singling out nursing homes in the mandate is that people working in these facilities will go elsewhere in post-acute care because of the mandate.

“What I like about it is that it really puts everyone on a level playing field,” Brad Haber, principal and co-founder of Innovative Health, said. “If someone requires the vaccine, the employee can always just go somewhere else.”

While some operators, such as Genesis HealthCare and PruittHealth, elected to require vaccines for their staff prior to Biden’s decision, many did not.

Haber felt the vaccine mandate was a positive step for the industry and the country.

“I think what’s going to happen is a lot of other industries will follow suit, whether it’s restaurants, offices, or hospitals,” he explained. “They’re probably doing the nursing homes first because we were highlighted the most in the news initially.”

Currently, Innovative Health’s staff is at around 80% vaccinated.

“We feel pretty good about that,” Haber added.

He, like other operators on Wednesday, admitted concerns over what this will do to the nursing home industry’s staffing crisis.

“I really don’t want to see people leave the industry because of this,” Haber said. “I think there are really good people that want to work in this industry and giving them another reason to leave is not necessarily a good thing.”

A vaccine mandate across the board for the health care industry would help alleviate some of his concerns.

Mary Haynes, president and CEO of Louisville, Ky.-based Nazareth Home, shared concerns over singling out nursing homes.

“I hope there’s more to the story and that a federal mandate would extend to all healthcare workers and not only those in long term care,” she said. “I certainly understand the fragility of our population but it’s not good for the system to isolate our niche as we try to end this pandemic together.”

The delta variant has been behind 80% to 87% of all COVID cases in the U.S. during the last two months of July, according to data reported by the CDC.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) said that while they appreciate the government’s efforts to get more individuals vaccinated, if the mandate does not apply to all health care settings “nursing homes face a disastrous workforce challenge.”

“Focusing only on nursing homes will cause vaccine hesitant workers to flee to other health care providers and leave many centers without adequate staff to care for residents. It will make an already difficult workforce shortage even worse,” Mark Parkinson, AHCA/NCAL president and CEO, said in a statement. “The net effect of this action will be the opposite of its intent and will affect the ability to provide quality care to our residents. We look forward to working with the Administration in the coming days to develop solutions to overcome this challenge.”

LeadingAge President and CEO Katie Smith Sloan said in a statement that “defunding the care providers who continue to fight on the frontlines would be a tragic misstep.”

“But to penalize nursing homes by withholding or withdrawing funding is not the right way to increase vaccination rates. Without Medicaid and Medicare funding, nursing homes cannot provide the quality care that our nation’s most vulnerable older adults need,” Sloan said in an emailed statement.

“Our mission-driven nursing home members, who operate on narrow margins in the best of times, depend on those funds alone to care for their residents. They cannot bear additional financial losses after more than a year of shouldering historic COVID-related costs.”

Additional reporting by Alex Zorn and Jordyn Reiland

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