Masked nursing home worker sitting with a masked resident
Credit: FG Trade/Getty Images Plus

The Centers for Medicare & Medicaid Services has offered several precautionary steps providers can take when it comes to workers who are exempt from the COVID-19 vaccination requirement. 

The additional precautions to reduce the transmission of COVID-19 within facilities include reassigning staff to different work areas or duties. The American Health Care Association detailed recommendations Friday.

For example, non-vaccinated workers could be shifted to non-patient care areas, or doing remote work when possible. It also might involve having these workers around only residents who are not at a high risk of contracting COVID, or giving them assignments with limited contact with residents. 

Other precautions include testing unvaccinated staff more often than what’s required under federal standards, and requiring staff to follow additional infection prevention and control protocols beyond federal standards. 

CMS noted that while providers are not required to follow the precautions, they should be “intentional about establishing appropriate policies around additional precautions and take a layered approach based on risk of COVID-19 transmission to residents they serve.” 

Increased precautions in action

At the Los Angeles Jewish Home, 97% of staff are vaccinated, with the remaining 3% granted exemptions.

Chief Medical Official Noah Marco, M.D., said Monday that the organization had instituted masking and increased testing precautions for the non-vaccinated even before CMS issued its precaution options.

“We said, ‘What can we do that is consistent with science and consistent with our mission to really facilitate our staff getting vaccinated?’ ” Marco told callers on a LeadingAge coronavirus call. “We initiated more frequent testing and N95s for the unvaccinated.”

As early testers of asymptomatic residents and staff, Jewish Home leaders decided to increase from weekly to twice weekly the frequency with which exempt staff would have to be tested. They also immediately required exempt employees to wear N95 masks.

“I can’t wear an N95 for eight straight hours or four straight hours. It’s very uncomfortable,” Marco said. “I thought by both using good science you’re going to need to wear an N95 if you’re unvaccinated it not only protected them and the people around them. But it also created an incentive, I hoped, that would encourage them. I’d rather get the one second of discomfort from the vaccine, or a few hours, (instead of) that day after day discomfort of the N95.”

The LA Jewish home also limited exempt employees from some positions, including in activity areas and community dining rooms that are open to resident groups.

“Nobody walked in that room that was unvaccinated,” Marco said.

That staff reassignment emphasis is echoed in the advice of Mary Madison, RN, a clinical consultant with Briggs Healthcare. She recently told McKnight’s she recommends staff with vaccine exemptions be restricted from bathing responsibilities in nursing homes, given the prolonged close proximity between staff and residents.