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Feds Say Nursing Homes Must Vaccinate Workers Against COVID-19

Facilities who do not comply could see their federal Medicare and Medicaid funding withheld

spinner image a nursing home worker getting her covid vaccination shot
Boston Globe/Getty Images

U.S. nursing homes that participate in the federal Medicare and Medicaid programs must require their workers to be fully vaccinated against COVID-19, President Joe Biden announced Wednesday.

"More than 130,000 residents in nursing homes have sadly over the period of this virus passed away,” Biden said in a White House address. “At the same time, vaccination rates among nursing home staff significantly trail the rest of the country."

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"These steps are all about keeping people out of harm's way,” he said.

Only 60 percent of nursing home workers were fully vaccinated as of mid-July, according to an AARP analysis of federal data, even though those workers were among the first in the country to be eligible for the shots last December. Meanwhile, about 82 percent of nursing home residents are fully vaccinated. Vaccination rates among staff at the state level vary significantly, from a low of 44 percent in Louisiana to a high of 87 percent in Hawaii, AARP's analysis shows.

AARP applauded the administration's decision to mandate staff vaccinations, after calling for the requirement last week. The announcement “is a significant step in the fight against this pandemic,” said Nancy A. LeaMond, AARP's executive vice president and chief advocacy and engagement officer.

"As the new variants are emerging, facilities cannot let preventable problems be repeated,” she said. “Increasing vaccination rates in nursing homes is one of the most common sense and powerful actions we can take to protect the lives of vulnerable older adults."

spinner image president biden giving a speech at the white house
President Joe Biden delivers remarks on the COVID-19 response and the vaccination program on August 18, 2021 in Washington, DC.
Anna Moneymaker/Getty Images

Biden's announcement comes as the delta variant rapidly spreads across the country, driving up cases among nursing home residents from a recent low of 319 on June 27 to 2,696 on Aug. 8, with many of the outbreaks occurring in facilities with the lowest staff vaccination rates. About 30 percent of U.S. coronavirus fatalities have occurred in long-term care facilities, including nursing homes, assisted living facilities and other senior care homes, even though less than one percent of the population lives in such facilities.

The move also comes as the government reviews a recommendation that all adults who received Pfizer or Moderna vaccines get a booster shot eight months after their second dose due to delta's newfound force and the growing evidence that the vaccines’ protection fades over time. The boosters could become available as early as Sept. 20 and nursing home residents and staff will be among the first in line.

The new emergency regulation mandating vaccines for nursing home workers is slated to be handed down to facilities by the federal Centers for Medicare & Medicaid Services (CMS) at some point next month. CMS “strongly encourages nursing home residents and staff members to get vaccinated as the Agency undergoes the necessary steps in the rule-making process over the course of the next several weeks,” it said in a statement on Wednesday.

"CMS expects nursing home operators to act in the best interest of residents and their staff by complying with these new rules,” it read.

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While the rules are yet to be finalized, facilities who do not comply with the new mandate could see their federal Medicare and Medicaid funding, a huge revenue source, withheld. While estimates vary, Medicaid pays somewhere between 45 and 65 percent of the total nursing home costs in the U.S., while Medicare pays around 20 percent.

Biden did not specifically mention withholding funding for noncompliance but said he is “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.”

LeadingAge, a national association representing 5,000 nonprofit aging services providers, including nursing homes, said that while it supports COVID-19 vaccination mandates for nursing home staff, it does not support withholding or withdrawing funding for noncompliance.

"Without Medicaid and Medicare funding, nursing homes cannot provide the quality care that our nation's most vulnerable older adults need,” said Katie Smith Sloan, the organization's president and CEO, in a statement. Its members “depend on those funds alone to care for their residents,” she said.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), which represents more than 14,000 senior care providers, released a statement that appeared to welcome the administration's mandate while criticizing its limited scope. “The government should not single out one provider group for mandatory vaccinations,” said Mark Parkinson, president and CEO. “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."

Several states, including California, New York, Connecticut, Massachusetts, Oregon and Washington, and some of the nation's largest long-term care chains, including Genesis HealthCare, Brookdale Senior Living and Good Samaritan, had recently introduced COVID-19 vaccine mandates for nursing home staff, ahead of Biden's announcement.

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