August 20, 2021

Biden unveiled a vaccine mandate for nursing homes. What does it mean for the staffing crisis?

Daily Briefing

    On Wednesday, President Joe Biden unveiled a new plan requiring nursing homes to vaccinate their employees or lose federal funding. Industry members are concerned the mandate will exacerbate current staffing shortages and make it harder for facilities to care for their residents. 

    Biden ties employee vaccination to federal funding for nursing homes

    Biden announced on Wednesday that nursing homes will have to require their workers be vaccinated against Covid-19 to receive Medicare and Medicaid funding, the New York Times reports.

    CMS is expected to release an emergency rule covering this new requirement in September, according to Roll Call. Officials said the decision will affect more than 15,000 nursing homes with around 1.3 million workers across the country.

    In a statement, CMS administrator Chiquita Brooks-LaSure said, "Keeping nursing home residents and staff safe is our priority. The data are clear that higher levels of staff vaccination are linked to fewer outbreaks among residents, many of whom are at an increased risk of infection, hospitalization, or death."

    As of Aug. 8, federal data showed that around 62% of all nursing home staff are currently vaccinated. But vaccination rates vary widely by state, with a high of 88% in some states and a low of 44% in others.

    In addition, according to data from CMS, nationwide Covid-19 cases in nursing homes have increased from 319 cases on June 27 to 2,696 cases on Aug. 8. Since the beginning of the pandemic, federal data shows that around 134,000 nursing home residents and nearly 2,000 employees have died from Covid-19.

    How will the vaccine mandate affect nursing homes?

    According to Roll Call, divisions among nursing home staff about a vaccine mandate has some people in the industry—which has long suffered staffing shortages—concerned that even more workers will leave.

    Lori Porter, CEO of the National Association of Health Care Assistants, said she is worried the industry could lose 20% to 30% of its workforce over the new vaccine requirement.

    And Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, said a broader vaccine mandate for all health care organizations, instead of just nursing homes, is necessary to prevent further staffing shortages.

    "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," Parkinson said. "It will make an already difficult workforce shortage even worse."

    Similarly, Katie Smith Sloan, president and CEO of LeadingAge, a nonprofit that represents more than 5,000 aging services providers, said the vaccine mandate should be extended to all health care workers in all settings. She also voiced concern that cutting funding to nursing homes will further hurt facilities that have struggled financially throughout the pandemic.

    "Without Medicaid and Medicare funding, nursing homes cannot provide the quality care that our nation's most vulnerable older adults need," Smith Sloan said. "Our mission-driven nursing home members, who operate on narrow margins in the best of times, depend on those funds alone to care for their residents."

    Separately, David Grabowski, a professor of health care policy at Harvard Medical School, said funding cuts could put some nursing homes "in a precarious position" and that he believes there will be a "tremendous amount of pushback in the industry."

    Grabowski noted that while a national vaccine mandate could "level the playing field" for nursing homes looking for employees, they may still struggle to retain employees with jobs in other areas, such as retail or hotels, offering similar pay. "I think this is a good measure, but it needs to be paired with additional resources to help pay staff and make sure these are jobs they want to stay in," he said. (Clason, Roll Call, 8/18; LaFraniere et al., New York Times, 8/18; Christ, Modern Healthcare, 8/18)

     

    Advisory Board's take

    This is a bold step—but it's the right thing to do. Here's why.

    By Monica Westhead, Managing DirectorMonica Westhead

    Mandating vaccinations for staff in skilled nursing facilities (SNFs) is definitely a bold step—but ensuring all staff are vaccinated is unquestionably the right thing to do. As health care leaders, it is our responsibility to care for our patients, our staff, and our communities, and during this pandemic, vaccination is the best way to do that. 

    Nationally, staff working in post-acute and long-term care settings have been among the groups most hesitant to take a Covid-19 vaccine. The combination of the extremely vulnerable patient populations in those settings and the lack of voluntary vaccination was likely what motivated this move.

    I don’t want to imply this will be easy. Many SNFs will struggle to achieve universal vaccination, and there is understandable fear associated with having to let go of staff in what is an extremely tight staffing environment. 

    However, in my view, the staffing implications will be less severe than many believe. In some ways, a national mandate actually makes it easier for providers, because individual staff members can’t simply go work for another facility in order to avoid getting their shot. And as more and more employers across the country begin to mandate vaccinations—a list that so far includes large employers like Walmart and Tyson Foods—staff members will have minimal opportunities for alternate work arrangements that do not require them to get the vaccine. For many staff, even those who have refused in the past, the elimination of other options that would allow them to remain unvaccinated may give them the push they need to get the vaccine.

    Some staff will refuse and leave the industry. In the short term, this will increase pressure on already tight staffing. In the medium to long term, however, a fully vaccinated workforce is better for providers. It’s better for recruiting, because it attracts potential workers who want to be in a safer environment. It’s better for the existing workforce, who will likely need to take fewer sick days. And it’s better for the reputation of the industry. In our summer consumer survey, we found that 76% of respondents would be more likely to receive care at a skilled nursing facility if all of that facility’s staff were vaccinated. Staff vaccination helps build a level of community trust in the safety of the facility, which will be critical as SNFs seek to return to growth during and after the Covid-19 pandemic.

    Check out our resources for building consumer confidence in post-acute and senior care during and beyond a crisis. For help with how to prepare your staff and residents for the vaccine rollout at your facility, review our guide for long-term care leaders.

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