Nursing Home Vaccine Mandate-Induced Staff Exodus Largely Unfounded As Booster Requirements May Be Next

As the skilled nursing sector looks back at a year and a half of vaccination efforts, data has shown that mandates at the federal and state level – specifically those without a test-out option – were an effective policy tool to increase rates without contributing meaningfully to worker shortages.

Initial fears of a mass exodus of nursing home workers after the vaccine was mandated was “largely unfounded,” according to Brian McGarry, assistant professor and lead author of a study published in JAMA Health Forum on Friday.

Litigation between the Centers for Medicare & Medicaid Services (CMS) and certain state attorneys general culminated in a Supreme Court decision at the beginning of the year to uphold the federal vaccine mandate for health care providers that receive federal reimbursement.


Data supports the recently upheld federal mandate and should inform ongoing discussions about mandating booster shots or additional doses, McGarry said, as the fall and winter seasons approach alongside new Covid waves.

“What I hope people take away is that we actually did make policy progress on this, in large part because of the mandate at various levels,” McGarry said. “We’ve had individual nursing home chains implement their mandates, we’ve had states do it and now we have a federal mandate.”

Staff vaccination rates per facility is averaging 87%, according to CMS data. About 54.5% of staff have received booster doses.


There is one caveat: staff departures were self-reported.

“Self-reported staff shortages are somewhat of a crude measure. It’s possible we are missing some departures,” McGarry said, adding that researchers are working on studies right now that utilize staffing data from the Payroll Based Journal rather than relying on self-reported numbers.

Nursing homes submitted weekly survey responses about staffing shortages to the U.S. Centers for Disease Control and Prevention’s National Healthcare Safety Network Long-Term Care Facility COVID-19 Module.

Perhaps unsurprisingly, states with mandates and no test-out option saw the highest increase in staff vaccination coverage compared to states without a mandate – a 6.9% increase 10 weeks after mandate announcement. Facilities in mandate states with the test-out option, in contrast, saw a 3.1% increase.

“It seems like when push came to shove, and nursing home workers were required to get the vaccine, those who were on the fence … they came off the fence and got the vaccines without that confirmed spike in staff shortages,” McGarry said.

Mandate effects were more significant in Republican-leaning counties, according to the study, with vaccination rates increasing 14 percentage points in states with a mandate and no test-out option, compared to 4 percentage points in Democratic leaning counties in the same states.

There was no evidence of increased staff shortages in either type of county, McGarry said.

The study included data from nursing homes across 38 states during the timeframe of June to November 2021. According to the study, 26 states had no mandate, four had a mandate with a test-out option and eight had a mandate with no test-out option.

Changes in weekly staff vaccination rates and reported staffing shortages for nursing homes in states with mandates were compared to the same data for facilities in states that did not require vaccination.

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