President Joe Biden speaks Wednesday, Aug. 18, during a White House press briefing.
President Joe Biden announced sweeping measure to enhance vaccination of nursing home employees and school personnel.

President Joe Biden announced late Wednesday afternoon that U.S. nursing homes must use workers vaccinated against COVID-19 or risk losing vital Medicare and Medicaid funding.

Providers immediately criticized the announcement for not including other healthcare sectors in the mandate.

“Vaccination mandates for healthcare personnel should be applied to all healthcare settings. Without this, nursing homes face a disastrous workforce challenge,” said American Health Care Association President and CEO Mark Parkinson in a prepared statement that was echoed by LeadingAge President and CEO Katie Smith Sloan..

“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. It will make an already difficult workforce shortage even worse,” Parkinson added. “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.”

Added Sloan: “We are on wartime footing. Defunding the care providers who continue to fight on the frontlines would be a tragic misstep.”

Overall nursing home staff vaccination rates have lagged around 60%, with many far below that, according to federal statistics. This, despite nursing homes being among the deadliest places affiliated with COVID-19, accounting for approximately one-third of all coronavirus deaths in the U.S.

“I’m using the power of the federal government as a payer of healthcare costs to ensure we reduce those risks for our most vulnerable seniors. These steps are all about keeping people safe and out of harm’s way,” Biden said in a press conference from the White House. “Now if you visit, live or work in a nursing home you should not be at a high risk of contracting COVID from unvaccinated employees.” 

More than 130,000 nursing home residents have died from COVID, he noted, adding that a study has shown that a “highly vaccinated nursing home staff” is associated with “at least 30% less COVID cases among long-term care residents.”

These new regulations would apply to more than 15,000 Medicare- or Medicaid-certified nursing facilities, which employ approximately 1.3 million workers and serve approximately 1.6 million nursing home residents.

The administration edict carries powerful implications for providers. About 60% of all nursing home care is paid for by Medicaid, with about 20% more by Medicare.

It was not immediately clear how regulators expect to audit or enforce the newly announced mandate. CMS said in a statement that guidance would be coming in September, when new rules are expected to go into full effect.

“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,” the statement said. “CMS expects nursing home operators to act in the best interest of residents and their staff by complying with these new rules, which the Agency expects to issue in September.”

Agency officials said they also expect operators to “use all available resources to support employees in getting vaccinated, including employee education and vaccination clinics, as they work to meet this staff vaccination requirement.”

Delta is a new stage

The rise of the delta variant put health officials and providers on high alert after a spring and summer largely enjoying precipitous drops in patients’ COVID infections and deaths. From December through March, federal authorities put nursing home residents at the top of the vaccinations priority list and sponsored free clinics for all willing nursing homes. 

About 62% of nursing home staff are currently vaccinated as of August 8 nationally, according to CMS. Vaccination among staff at the state level ranges from a high of 88% to a low of 44%, the agency added in a press release.

The emergence of the Delta variant has caused cases in nursing homes to soar, from a low of 319 on June 27, to 2,696 cases on August 8, federal figures show. Many of the recent outbreaks have occurred in facilities in areas with the lowest staff vaccination rates, officials said.

Current patient vaccination rates stand above 82%. But many are still seen as at risk, due to much lower community and staff vaccination rates.

“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 Wednesday. “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.”

Some providers already mandating

Some providers’ self-imposed mandate deadlines already are staged to kick in from August 23 through Nov. 1, as of press time, setting up potential showdowns at staffing-strapped facilities around the country.

Many providers have struggled with what many have called an ethical imperative to mandate the vaccine in their buildings, while others fret what that might do to resistant workers who could walk away from the job rather than get the shots. An AHCA survey in June said that 94% of providers were already reporting worker shortages. 

LeadingAge is part of a coalition of nearly 60 healthcare groups that on July 26 called for vaccine mandates. AHCA did not issued a similar call but eventually has expressed support for the growing list of providers issuing mandates.

The biggest shoe regarding long-term care providers and mandates dropped when Genesis, the nation’s largest nursing home chain, announced Aug. 2 that it was giving employees three weeks to get at least a first vaccination shot. Others, including PruittHealth followed with similar announcements, though the majority of U.S. long-term care providers have not announced mandates on their own.

About one-fourth of hospitals have already mandated vaccinations for employees, according to the American Hospital Association, an amount currently much greater than nursing homes.

Please check back for updates to this developing story.