Biden Nursing Home Vaccine Mandate Expected to Devastate CNA Recruitment, Retainment

The Biden administration’s vaccine mandate on nursing home staff has some operators preparing for a staff exit of up to 30%, the bulk of which is expected to be positions like certified nursing assistants or CNAs.

For an industry already in the midst of an unprecedented staffing shortage, fanning the flames for CNAs to seek employment elsewhere, whether that be in another industry or health care setting, is not the answer, according to Lori Porter, co-founder and CEO of the National Association of Health Care Assistants (NAHCA).

“It’s going to be devastating,” she said. “No skilled nursing facility can afford to lose one good certified nursing assistant at this point in time and we’re factoring in that at least 20% will seek employment elsewhere.”

Porter said the organization is doing everything it can to mitigate the potential exit, but admitted “it’s a very bad time to lose 20 to 30% of our CNAs.”

CNA turnover was a problem before the pandemic as the association has repeatedly advocated for better funding and better support for the workforce.

A study using nursing home payroll-based journal data from 2017 and 2018 found that the median turnover rate at U.S. nursing homes was 94%, and the average for CNAs was at 129.1%, data from more than 15,000 facilities across the U.S. showed.

While the number of nursing home staff who choose to exit the industry following the government’s announcement remains to be seen, Harvard University professor David Grabowski fears that many CNAs will seek other employment. 

“Where I worry a bit more is with a certified nurse aide,” he said. “That’s the bulk of the workforce. They often move out of the health care system, they’re paid close to minimum wage and that workforce is very fluid … they can earn similar pay at a range of retail, restaurant and hotel jobs.”

Grabowksi hopes the mandate will come with better reimbursement as many direct caregivers struggle to make a living wage in many parts of the country.

“This is not just a problem of low vaccination rates, it’s a problem of undervaluing our direct caregivers,” he said.

Grabowksi, like many in the nursing home space, also hopes that nursing homes will not be singled out by the administration.

Trade associations such as the American Health Care Association and National Center for Assisted Living asked for all care settings to be included in the mandate almost immediately after the announcement was made as nursing homes face a disastrous workforce challenge.

In a letter to the Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS), AHCA/NCAL feared Biden’s mandate would cause a mass exodus from the nursing home profession.

“Our ability to serve our communities and provide quality care directly correlates with the number of staff we employ,” Stonerise Healthcare CEO Larry Pack told Skilled Nursing News. “Encouraging nursing home staff to seek employment elsewhere will diminish the amount of patients we are able to serve and in turn create a discharge challenge for hospitals.”

Through aggressive campaigns since December 2020, Stonerise has seen its vaccination rate rise to 88% of patients and 73% of team members as of Aug. 13, but for the 27% vaccine hesitant staff that remain, Pack is concerned the mandate will cause them to seek employment in other health care settings.

“We strongly encourage the Biden administration to consider broadening this requirement to all health care settings to avoid making an already difficult clinical workforce challenge even worse,” he said.

Alex Markowits, president, CEO and founder of Spring Hills, agreed.

“In our view, the mandate should apply universally, to all health care workers, not only to skilled nursing staff, but for all staff in all health care settings,” he said. “As providers of long-term care, we’re concerned with the complexity of caring for high-acuity patients and ensuring we have sufficient staffing to deliver high quality, consistent care.”

Factors impacting vaccine hesitancy

With the nursing home staff vaccination rate ranging from 86.89% in the country’s highest rated state, Hawaii, to 46.33% for the country’s lowest rated state, Florida, several factors including location are expected to impact whether an operator can get vaccination rates up without losing workers.

Porter, who is located in Missouri, has spoken with some facilities that have an 18% vaccination rate, or lower, among its staff. Missouri has the third lowest vaccination rate amongst nursing home staff in the country.

CNAs seem to be among the most hesitant health care workers when it comes to getting vaccinated, Porter admitted.

The Centers for Disease Control conducted its own study into vaccine mandates for long-term care workers and, according to self-reported data from 300 facilities from March 1 through April 4, aides, which includes CNAs, nurse aides, medication aides and medication assistants, had the lowest vaccination rates at 45.6%, compared to 56.8% for all staff.

Nearly a third of respondents, or 33.2%, declined the vaccine outright and the percentage of aides who were completely vaccinated was lower among those working in facilities located in zip code areas with higher proportions of ethnic and racial minorities, lower household median income, higher poverty and lower higher school completion, the study showed.

“They get their news in different places, they don’t always have an understanding of the science,” Porter said. “What we’re doing is simply just continuing to promote confidence in it and our membership has moved from 74% hesitancy to more like 54%.”