Vaccine Mandate Reignites Call for Federal Funding for Nursing Homes

While the Biden administration’s decision to mandate COVID-19 vaccinations at nursing homes across the country received immediate criticism from lobbying groups and operators that already face worsening staff shortage challenges, others say it could put more pressure on the federal government to better support nursing homes.

“If anything positive came out of this it [will be] that everyone recognizes the need for additional funding in the space. It’s underfunded and it’s overutilized,” Brad Haber, principal and co-founder of Innovative Health, told Skilled Nursing News. “Bringing that to light is a positive thing in the long run if there is additional funding available.”

Calls for additional federal funding for nursing homes have continued throughout the summer. The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) sent a letter to Department of Health and Human Services Secretary Xavier Becerra earlier this month, urging the government to release the remainder of the Provider Relief Fund to long-term care facilities.

Mark Berger, CEO of Skokie, Ill.-based Villa Healthcare, hopes the mandate comes with a clear message from the administration that nursing homes will be supported.

“With or without this mandate, our legislators must recognize that the health care sector is on the verge of a complete collapse which would compromise all of our ability to get proper care and treatment in our local hospitals, urgent care centers, at home, or in post-acute settings, if we do not address the staffing shortage,” Berger said.

He wants to see the federal government become more proactive in helping the nursing home industry, especially if it exacerbates a continued staffing crisis, as many believe it is expected to. 

“We’re going through the worst staffing crisis I’ve ever faced in my almost 30 years,” Berger said. “It is already extremely difficult to find staff and for those that are finding staff, it is costing 30-40% more than it has in the past.”

A recent National Investment Center for Seniors Housing & Care executive survey revealed that all 70 small, medium and large senior housing and skilled nursing operators surveyed were experiencing staffing shortages and were currently paying staff overtime.

“The research we’ve done tells us that this mandate will cause a 30% reduction of staff due to a mass exodus,” Berger said. “The only way that number gets reduced is if this mandate is applied to all health care workers throughout the country.”

Israel Nachfolger, CEO of Maine-based Pinnacle Group of the Hudson Valley, has slightly lower but similar expectations on what this mandate could do to nursing home staff across the industry.

Current Centers for Medicare & Medicaid Services (CMS) data shows that the national percent of vaccinated staff per nursing home facility is at 60.5% nationwide.

“I spent the last two days talking to employees and some might be convinced, others will not be,” Nachfolger said. “Of the 40% that remain unvaccinated, let’s say your success rate is 50%, that means you’re looking at a 20% reduction of your workforce.”

With a 20% staff reduction, he expects an already “absolute flaming staffing crisis” could get even worse.

“That is going to hurt seniors,” Nachfolger said. “It’s not that the mandate is misguided, it’s the execution that is a problem.”

He said some facilities in the Pinnacle Group are at 90% staff vaccination rates, while others are lower.

At this point, the mandate is going to cause more problems than it solves for Nachfolger.

“It’s going to be chaos,” he said. “We have minimum staffing ratios and there’s absolutely no way that you can be in compliance with that. They can’t just mandate, they need a plan for how it’s going to work.”

Harvard University professor David Grabowski said that even a 10 to 20% reduction in staff as a result of the mandate could have dire consequences for the industry as a whole.

“At 30% under staffed, that’s not even a facility that can operate, but even if it is 10 to 20% understaffed, that’s still really dangerous for resident care,” Grabowski said.

One of his concerns is that quality of care will suffer due to understaffed facilities.

“What a lot of people don’t understand is, let’s say we put a mandate on Starbucks, they can raise the price of coffee and pass that through to customers, potentially,” Grabowksi explained. “Nursing homes can’t do that, except for private paying residents and they don’t have a lot of them.”

With the vast majority of nursing home residents Medicare and Medicaid patients, facilities don’t set prices, the government does.

“Unless the government adjusts payment rates, the facilities are sort of stuck here,” Grabowski said. “They don’t have a lot of resources to simply draw from and pay higher wages.”

He hopes the mandate pushes the government to better support nursing homes, which he said would be an “incredibly positive outgrowth” from a challenging situation.

“In addition to the Biden administration’s move to penalize nursing homes with low vaccination rates, they should also find some dollars to actually put into the pay of these staff because I think that would actually help kind of address the broader problem here,” Grabowski added.