Five States Now Require COVID-19 Boosters For Nursing Home Staff

Amid the latest COVID-19 surge, Massachusetts, New York and Connecticut became the latest states this week to require health care workers, including nursing home staff – to get a booster shot.

They join California and New Mexico, bringing the total number so far to five.

Massachusetts elder health care workers must receive their booster shot by Feb. 28, according to an emergency order issued by Gov. Charlie Baker.


The order is part of other measures focused on reducing a bottleneck in state hospitals — patients in need of post-acute care or a long-term care bed have had to wait weeks for available spots, with facilities freezing admissions amid omicron outbreaks and an ongoing staffing shortage, according to a report by the Boston Globe late Friday.

New York Gov. Kathy Hochul during a press conference outlined the state’s booster mandate for health care workers – staff will be given two weeks to get boosted once eligible, local news outlets have reported. The mandate does not include a test-out option but does allow space for medical exemptions.

The state’s Public Health and Planning Council needs to approve the requirement before it goes into effect, local outlet CNY Central has reported. Gov. Hochul said during the press conference that she “confident” the order will be approved.


Meanwhile in Connecticut, operators must have their staff boosted by Feb. 11, according to a statement issued by Gov. Ned Lamont’s office, or risk facing a $20,000 civil per day penalty. Lamont appears to be the only state governor at this time to tie monetary penalties to booster noncompliance.

The mandate specifies long-term care facilities to include nursing homes, residential care homes, intermediate care facilities for individuals with intellectual disabilities, managed residential communities, chronic disease hospitals and assisted living services agencies.

“We know for a fact that the initial vaccinations significantly and immediately reduced the rate of hospitalizations and deaths that were occurring in these facilities,” Gov. Lamont said in a statement. “Now, we need to fight against the impacts of waning immunity, and that is why everyone who is able should get a booster shot.”

Another executive order issued the same day applies the requirement to state hospitals as well.

New Mexico and California issued similar orders at the end of last year, with Jan. 17 and Feb. 1 deadlines, respectively, or upon becoming eligible.

Booster eligibility was updated on Jan. 4 by the Centers for Disease Control and Prevention (CDC) to be five months after the initial vaccination series for the Pfizer shot – the Food and Drug Administration (FDA) made the same call for the Moderna vaccine on Jan. 7.

New Mexico Gov. Michelle Lujan Grisham was first to issue the booster order on Dec. 2, citing concern expressed by the World Health Organization (WHO) and other international governments regarding the omicron variant. All hospital workers, congregate care facility workers and employees of the governor’s office must receive the booster, unless they qualify for an exemption, the order states.

The state’s booster requirement applies to workers in “higher-risk environments,” including staff in all health care and congregate care settings. Public school workers and state employees are required to test weekly for the virus if unvaccinated.

California Gov. Gavin Newsom announced the new state requirement on Dec. 22.

California was a leader among states in requiring vaccinations for all health care workers back in August. The state aims to administer the booster to an estimated 2 million health care workers and nursing home staff.

Booster rates for nursing home staff is just 27.6%, well behind the national average of 35%, Dr. Janell Routh of the Centers for Disease Control and Prevention (CDC) said in a Jan. 6 nursing home stakeholder call. Resident booster efforts have fared better, Routh added during the Thursday call, noting the statistic has increased to 62%.

The CDC is reporting more than 490,000 cases on average each day, a 98% increase just compared to last week, added Dr. Lauri Hicks, a medical epidemiologist with the CDC Respiratory Diseases Branch, during the call. Omicron is responsible for an estimated 93% to 97% of all new cases across the country, according to Hicks.

“The extremely rapid spread of omicron underscores the fact that booster vaccinations are absolutely essential to protect our dedicated long-term care staff and, by extension, the most vulnerable Connecticut residents in skilled nursing facilities and other long-term care settings,” Connecticut Social Services Commissioner Dr. Deidre Gifford, whose agency administers Medicaid in the state, said in a statement.

The Connecticut booster orders are similar to employee vaccination requirements for the state – initial doses had a deadline of Sept. 27.

On the federal level, boosters have not been included in either the Centers for Medicare & Medicaid Services (CMS) mandate or the vaccinate-or-test requirement issued by the Occupational Safety and Health Administration (OSHA), despite the current case surge.

Arguments discussing the constitutionality of the federal vaccine mandates were heard in the Supreme Court on Friday, after the government agencies appealed lower court decisions to issue injunctions temporarily blocking the CMS mandate in half the country.

SCOTUS is not yet determining whether the vaccine mandate is constitutional, rather, it could decide whether either mandate should stay in place while the cases play out in court.