The Biden administration on Wednesday unveiled plans requiring nursing home staff to get vaccinated against COVID-19, but that directive is already sparking worry in the industry.
The federal government tied nursing home facilities' Medicare and Medicaid funding to staff vaccinations, which the White House said will "ensure consistent and equitable standards across the country." California, New York, New Mexico and Maryland have already mandated healthcare staff be vaccinated.
But the requirement could worsen an already precarious workforce crisis and affect facilities' ability to care for residents.
"Defunding the care providers who continue to fight on the frontlines would be a tragic misstep," said Katie Smith Sloan, president and CEO of LeadingAge, which represents more than 5,000 nonprofit providers of aging services, including nursing homes.
As of Aug. 8, only about 62% of nursing home staff were currently vaccinated nationally, ranging from a low of 44% to a high of 88% at the state level, according to CMS.
"I don't know how a nursing home survives without those payments," said David Grabowski, a professor of healthcare policy at Harvard Medical School.
Nursing homes, which are heavily reliant on Medicare and Medicaid funding, will have to work hard to get their staffs vaccinated and will have to either lay off unvaccinated workers or look for new employees who are vaccinated, Grabowski said.
"It could potentially put some nursing homes in a precarious position," he said. "I think we're going to see a tremendous amount of pushback in the industry."
Grabowski said that while a national requirement will level the playing field for nursing homes looking for workers, it will be a challenge for the industry to keep those employees, who might leave for retail, restaurant or hotel jobs that offer 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," Grabowski said.
The White House said the new regulations will affect more than 15,000 nursing homes, which employ about 1.3 million workers and serve about 1.6 million nursing home residents.
"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," CMS Administrator Chiquita Brooks-LaSure said in a statement. "We will continue to work closely with our partners at the CDC, long-term care associations, unions and other stakeholders to advance policies that keep residents and staff safe. As we advance these new requirements, we'll work with nursing homes to address staff and resident concerns with compassion and by following the science."
The requirement is expected to go into effect in September.
Tausha Moore, director of public relations for ProMedica, said the company will review regulations from CMS when they become available.
"In the meantime, we continue to work on educating and increasing vaccination rates among our employees, as we know the vaccine is one of the best ways to protect against the virus," Moore said.
Nan Impink, a spokesperson for SavaSeniorCare Administrative and Consulting, said the company will begin to develop protocols to address the requirement as soon as the regulations have been finalized.
"However, prior to this announcement, we initiated a company vaccination policy, launched in phases, which we expected to be fully in place by early this fall," Impink said. "We believe that implementing this policy is a necessary step in the continued fight against COVID-19."
Since the emergence of the Delta variant in the U.S., COVID-19 cases among nursing home residents have increased from 319 cases on June 27 to 2,696 cases on Aug. 8, with many outbreaks occurring in facilities in states with low staff vaccination rates, CMS said.
Both CDC and CMS data show a strong relationship between the increase of COVID-19 cases among nursing home residents and the rate of vaccination among nursing home workers, the White House said.
Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, which represents more than 14,000 nursing homes and assisted living facilities across the U.S., said he appreciates the administration's efforts to increased COVID-19 vaccinations but said the action doesn't go far enough.
"The government should not single out one provider group for mandatory vaccinations. Vaccination mandates for healthcare personnel should be applied to all healthcare settings. Without this, nursing homes face a disastrous workforce challenge," Parkinson said. "Focusing only on nursing homes will cause vaccine hesitant workers to flee to other healthcare providers and leave many centers without adequate staff to care for residents."
Parkinson said the requirement would "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," Parkinson said.
Smith Sloan of LeadingAge said a vaccination requirement should be extended to all healthcare workers in all settings.
LeadingAge in July recommended that its members make COVID-19 vaccination a condition of employment for nursing home staff.
"But to penalize nursing homes by withholding or withdrawing funding is not the right way to increase vaccination rates. Without Medicaid and Medicare funding, nursing homes cannot provide the quality care that our nation's most vulnerable older adults need. 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. They cannot bear additional financial losses after more than a year of shouldering historic COVID-related costs," Smith Sloan said.