‘Stagnant’ Policy on Staff Boosters Imperils Nursing Homes, Initial COVID Vaccine Push Saved Lives 

While much focus has been on vaccinating nursing home residents, policymakers may want to consider longer-term policy options to increase the uptake of booster doses among staff in nursing homes.

That’s according to new research published in JAMA Network Open, which involved a study of 15,042 nursing homes. Researchers found that an increase in staff vaccination rates of 10 percentage points was associated with fewer weekly COVID-19 cases among residents, fewer weekly COVID-19 deaths among residents, and fewer weekly COVID-19 cases among staff.

Researchers estimated that if they extrapolated their findings to one year, a 10 percentage point increase in staff vaccinations would have prevented 102.9 cases per 1,000 residents, 15.6 deaths per 1,000 residents, and 21, 000 staff cases nationwide.

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However, as newer, more infectious and transmissible variants of the virus emerged, the original 2-dose regimen of the COVID-19 vaccine was not as effective. Researchers said that going forward, additional booster doses for staff may be needed to effectively manage the pandemic in nursing homes. And mandates for those boosters — similar to mandates for the initial two doses — might be appropriate.

“Although the original vaccination campaign in nursing homes was highly successful in bringing down case and death rates, and mandates led to staff vaccination rates exceeding the thresholds we found for high effectiveness, these policies cannot remain stagnant,” the report states. “As the pandemic evolves, staff vaccination mandates need to evolve as well.”

The Biden administration has emphasized that vaccinating nursing home residents is a priority and is considering enacting mandatory staffing ratios; research has indicated that higher staffing ratios are helpful in containing outbreaks in nursing homes. However, studies have also shown that more staff traffic between facilities and in and out of areas with high virus prevalence was associated with more cases and deaths in the nursing homes where the staff worked.

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With increased staff and more infectious variants, policymakers may need to consider extending vaccination mandates to include updated boosters. Some states have already begun to take action to require staff to get vaccinated.

“The public interest in protecting the general populace against vaccine-preventable diseases in health care settings using safe, effective vaccines is not outweighed by the hardships experienced to accomplish that interest,” U.S. District Judge Donald Molloy of Montana concluded in his December ruling that a person’s choice to decline vaccinations does not outweigh public health and safety requirements in medical settings.

The suit concerned a Montana law that supporters said would prevent employers from discriminating against employees who opt out of COVID-19 vaccinations. The ruling blocked that protection for health care workers, who will now be required to be “up-to-date” on their vaccinations.

Other state lawmakers – or the federal government – may need to make a decision on mandatory vaccination for staff soon. In recent days, national news outlets have covered the lack of COVID-19 booster shot administration in nursing homes with more urgency, reminding the public that older adults are hit the hardest by COVID fatalities, making up 71% of COVID deaths in November, according to CDC data.“We need that to increase particularly as we go into these winter months when we are anticipating potential spikes of respiratory illness,” a CMS official said during December’s Open Door Forum call with operators and industry stakeholders.