close up hand of doctor put label covid-19 vaccine sticker on vaccination certificate card and passport

Despite high compliance rates among nursing home residents and staff, nearly 20,000 industry staff members nationwide have been granted exemptions from mandated COVID-19 vaccinations, according to a new report from ProPublica. That amounts to about one in 100 workers, it said.

On Thursday, the watchdog news group began reporting staff vaccinations in its Nursing Home Inspect database, which already tracked citations and other data to allow facility comparisons. In an accompanying investigation, it reports on both climbing rates of staff vaccinations and requests for medical exemptions. 

Staff uptake now at 89%

The number of industry staff members receiving the shots has steadily risen since a federal vaccine mandate went into effect in January. Uptake increased from 65% in September to 89% in late March. But the number of staff who have obtained medical exemptions also rose, from 9,400 when the vaccine mandate was announced (in November 2021) to just under 20,000 in March.

The relatively high percentage of people asking for exemption has left scientists skeptical about potential abuse of these requests. Unlikely clusters of exemptions may be a sign of this, they told the news organization. In Ohio, for example, 15% of staff across 27 of the state’s 900 nursing homes have claimed exemptions, ProPublica reported.

According to the Centers for Disease Control and Prevention, only people with life-threatening allergies to the vaccine or to one of its ingredients should avoid it, it added in the report.

AHCA weighs in

One long-term care advocate, meanwhile, said that the industry has made progress in encouraging staff members to get the protective shots, despite “rampant misinformation spreading online.”

A “multipronged, persistent approach” must be taken to increase rates, the American Health Care Association/National Center for Assisted Living said in a statement, according to ProPublica.

“Each hesitant staff member has their own unique reason(s) for choosing not to get the vaccine,” it said.

Meanwhile, about 164,000 nursing home workers have opted out of vaccination for other reasons, which include religious convictions. The federal government does not track religious exemptions.

When accounting for all reasons for COVID-19 vaccine exemptions, three states have the highest rates of unvaccinated nursing home staff, ProPublica reported. In Montana, Wyoming and Ohio, more than one in five nursing home workers are not vaccinated, the watchdog said.

Steady progress

Despite the high number of exemptions, the overall gains in protective vaccination can’t be denied, federal health officials said. A CMS spokesperson told the news organization that it “remains pleased by progress to date” and does not wish to focus on discipline. Under the mandate, however, facilities face penalties for low levels of vaccinations among workers.

“No exemption should be provided to any staff for whom it is not legally required or who requests an exemption solely to evade vaccination,” CMS said in a statement.

The full report, including examples of exemption rates among specific operators, was published on ProPublica’s website.