Nursing Home Employees Must Get COVID-19 Vaccine, says Biden

Only 40% of nursing home employees are vaccinated. Nursing home advocates counter that vaccine hesitancy exists in all health care settings, and if nursing home employees must get the vaccine, the same should apply to all health care workers in the United States.

President Joe Biden yesterday laid down the law: If you work in a nursing home, you need to be vaccinated against COVID-19. Biden wants the Department of Health and Human Services (HHS) to write regulations making employment in nursing homes that receive Medicare and Medicaid funding (which is most of the approximately 15,600 nursing homes in the United States) to make employment at those facilities contingent on getting the COVID-19 vaccine.

Data from the Centers for Medicare and Medicaid Services (CMS) say that only about 40% of nursing home employees have been vaccinated against COVID-19, a point Biden reiterated in his announcement.

Biden said that “vaccination rates among nursing home staff significantly trail the rest of the country…. I’m using the power of the federal government, as a payer of health care costs, to ensure we reduce those risks to our most vulnerable seniors.” Biden added that “now, if you visit, live, or work in a nursing home, you should not be at a high risk for contracting COVID from unvaccinated employees.”

A White House fact sheet accompanying the President Biden’s remarks states that the move in part results from the spread of the highly infectious delta variant. “Since the spread of the delta variant, there has been a rise in the number of COVID-19 cases, especially in those states that have low rates of vaccinated workers,” the fact sheet states. “Both CDC [the Centers for Disease Control and Prevention] and [CMS] data confirm a strong relationship between the increase of COVID-19 cases among nursing home residents and the rate of vaccination among nursing home workers.”

The new regulations could go into effect as early as next month, but CMS officials have promised to work with nursing homes to encourage employees to voluntarily get the COVID-19 vaccines before they’re forced to do so.

At least in the early stages of the pandemic and throughout most of 2020, nursing homes were one of the main sources of contamination. But, as Infection Control Today® (ICT®) reported, nursing home administrators have countered criticism by pointing out that their facilities do not have anywhere near the financial resources to deal with a pandemic that acute care hospitals and other health care facilities have.

There is, however, some speculation that nursing homes and other long-term care facilities (LTCFs) have already gotten an influx of cash since COVID-19 began. The Center for Medicare Advocacy (CMA) issued a report in March that contends that nursing homes have more than enough funding to fix their problems. CMA, a not-for-profit advocacy organization for older Americans and those with disabilities, ticked off several revenue sources for nursing homes and other LTCFs, including the Provider Relief Fund.

Those findings don’t jibe with data collected by the lobbying entity that represents nursing homes, the American Health Care Association (AHCA) and the National Center for Assisted Living (NCAL). (The NCAL is part of the AHCA.) A survey of members of the AHCA/NCAL released in June showed that one quarter of US nursing homes might go out of business this year.

Mark Parkinson, president and CEO of AHCA/NCAL, yesterday pointed out that vaccine hesitancy among health care professionals cuts across all facets of the health care system, as infection preventionists (IPs) can attest. IPs have played a part in both influenzau vaccination drives and in the current push to have health care workers get the COVID-19 vaccine. Parkinson argues that Biden’s proposed regulation should include all health care workers everywhere in the US.

“The government should not single out one provider group for mandatory vaccinations,” Parkinson said in a statement. “Vaccination mandates for health care personnel should be applied to all health care settings. Without this, nursing homes face a disastrous workforce challenge.”

ICT® reported in May on statistics by the U.S. Bureau of Labor Statistics that show that nursing homes are losing employees in droves.

Parkinson said in his statement that “focusing only on nursing homes will cause vaccine hesitant workers to flee to other health care providers and leave many centers without adequate staff to care for residents. It will make an already difficult workforce shortage even worse. The net effect of this action will be the opposite of its intent and will affect the ability to provide quality care to our residents. We look forward to working with the administration in the coming days to develop solutions to overcome this challenge.”

Parkinson’s contention that all health care employees everywhere should be mandated to get the COVID-19 vaccine is held by more and more hospitals across the US who have initiated such mandates, as well as health care experts.

Nonetheless, more challenges await nursing homes. The Nursing Home Improvement and Accountability Act of 2021 currently before Congress would mandate that nursing homes hire fulltime IPs. This is another improvement for which, Parkinson asks, in effect: Where’s the money going to come from?

Parkinson said in another statement released last week that “the proposal to institute permanent minimum staffing requirements without a permanent funding source would be incredibly challenging for long-term care providers. Providers will not be able to meet staffing requirements if we can’t find people to fill the open positions. There must be a comprehensive approach to staffing beyond just numbers.”

Approximately 1.6 million nursing home employees provide care for about 1.3 million residents, according to the CDC. There’s a significant gap between the number of residents who’ve been vaccinated against COVID-19 (82.4%) and the number of nursing home employees who’ve been vaccinated (60%), according to CMS. The data, which were updated August 12, show other gaps as well. CMS says that 664,815 residents got COVID-19, of whom 133,631 died. Meanwhile, 597,087 nursing home employees got COVID-19, of whom 1994 died.