The federal COVID-19 vaccine mandate did not significantly reduce staffing levels in nursing homes despite predicted “gloom and doom” scenarios by opponents of the vaccine and mandates at any level, according to new research.
“There’s no evidence that it was this big watershed event that impacted staffing levels inside nursing homes,” said William F. Wempe, PhD, chair of the Accounting Department at Texas Christian University’s Neeley School of Business.
Despite what one of the paper’s authors said was clear evidence that staffing levels weren’t impacted, 22 states’ attorneys general still want CMS to repeal the mandate, which was upheld by the U.S. Supreme Court early last year.
Wempe and co-author Elizabeth Plummer, PhD, published their findings in The Journal of Post-Acute and Long-Term Care Medicine.
Their investigation confirms earlier findings honed from close analyses and providers’ own observations. A separate study published this summer also found that state COVID-19 mandates increased vaccination rates without negatively affecting staffing levels. In that paper, researchers from Harvard, Brown, the University of Rochester Medical Center and UCLA looked specifically at nursing home changes in weekly staff vaccination rates and reported staffing shortages.
Jan. 13, 2022, the Supreme Court allowed the federal mandate requiring all healthcare workers in federally funded facilities to be vaccinated by March 20, 2022. The research analyzed staffing level data from all 15,000 nursing homes in the country from three periods: prior to the Supreme Court’s decision; between the Court’s decision and March 22; and after March 22. Plummer and Wempe also separated out data from states that had their own mandates in place, versus those with no mandate.
“After the Court’s decision, staff vaccination rates increased 5% in non-mandate states and 1% in mandate states (on average),” the research notes. “We find little evidence that the Court’s vaccine mandate ruling materially affected nurse aide and licensed nurse staffing levels, or that nursing homes in mandate states and non-mandate states were differentially affected by the Court’s ruling.”
Nursing homes were the single-most hazardous settings that COVID-19 brought death and dangerous infections to, especially early in the pandemic. The mandate was originally was put into place in September 2021 by CMS. The Office of the Inspector General of the US Department of Health and Human Services noted that nursing home residents had been “disproportionately represented in the number of COVID-19-related deaths” in the United States.
Through Nov. 20, 2022, there were 1.3 million cases and 160,354 deaths of nursing home residents attributed to COVID-19, per the research. Similarly, staff numbers were proportionately higher than the general population with 1.4 million cases and nearly 2,800 deaths.
While the federal and state mandates were, in some places, poorly received, the research notes that there was “some evidence of a modestly greater increase for nurse aide staffing in mandate states than non-mandate states, and a modestly smaller decrease for licensed nurse staffing in mandate states than non-mandate states.”
Mandate did its job
Still, Wempe said it’s worth periodically reassessing the impact of the vaccine mandate.
“The way people think about things evolves over time,” he said. “Vaccination rates among staff have gone up, which you could argue could be a good thing. If people suggest otherwise, there’s not evidence to support [the mandate] was a big deal.”
Vaccine rates, however, may be declining.
According to the Kaiser Family Foundation, nearly 87% of nursing home staff and residents completed the primary vaccine series by Thanksgiving 2022, but just 22% of staff were considered up-to-date due to not receiving boosters. Booster compliance rates range from 10% in Alabama to 48% in California. Alabama is one of 22 states suing to overturn the vaccine mandate for healthcare workers. Alternatively, California required healthcare workers to have the primary vaccine and a booster shot by Feb. 1, 2022.
Mandate opponents recently scored a large victory by forcing an end to the requirement that US service members must be vaccinated. Some observers have speculated that such a move could lead to a toppling of the healthcare worker mandate, but there has been no significant movement in that direction thus far.