A healthcare worker receiving a vaccine shot

Nursing home advocates Thursday cheered news that federal regulators are relaxing their instructions to surveyors when checking for staff compliance with a federal vaccine mandate.

The Centers for Medicare & Medicaid Services in an updated memo to state surveyors defined noncompliance as a vaccination coverage rate of less than 100% of unexempted staff. But the revisions also encouraged surveyors to limit or avoid enforcement action if a facility could demonstrate it had implemented a plan to achieve a 100% vaccination rate.

LeadingAge Director of Nursing Home Quality and Policy Jodi Eyigor said the memo, issued Wednesday, was “positive, and, arguably, a demonstration of good news and reflection of providers’ hard work.” 

“One of the more notable aspects of the memo is changed guidance on determining scope and severity of citations,” Eyigor told McKnight’s Long-Term Care News. “We appreciate the direction on citing scope and severity and CMS’s consideration of providers’ good faith efforts toward compliance as they balance the health and safety of residents and staff with every individual’s right to autonomy.”

But Harvard healthcare policy professor David Grabowski, PhD, pushed back against the seemingly relaxed vaccine mandate standards, saying CMS was taking a less cautious approach to managing virus spread in long-term care facilities.

“The pandemic is not over for nursing homes and their residents,” he told McKnight’s. “Although this group should be a major policy priority, the CDC and CMS seem to be moving the opposite direction. For example, I believe it was a mistake to lift the mask mandate in nursing homes. Nursing home residents are the most vulnerable individuals in our health system and there is no reason not to continue to wear masks in this setting.”

While the mandate only requires a primary vaccination series for healthcare workers, Grabowski was particularly concerned about COVID boosters. Only 39.5% of patients and 25.2% of staff as of Oct. 16 were up to date on all appropriate boosters, according to CMS data.

“I would recommend mandating boosters for staff,” he said. “Moreover, many nursing home residents have not received their booster doses. This should be a major CMS priority. I would bring booster clinics to nursing homes with low uptake.”

Alexis Roam, a curriculum development specialist for AAPACN, encouraged facility staff to review the updated memo to understand new components of the policies and procedures, and to ensure that CMS will see them as acting in good faith.

“Audit the facility’s policies and procedures to identify any missing components and revise accordingly,” Roam suggested. “Next, conduct a root cause analysis to determine why the requirement of a 100% COVID-19 staff vaccination rate is not being met. Once the root causes are known, involve staff in designing solutions that directly address the root causes. And finally, document all these actions to show evidence to the surveyors of a good faith effort to correct noncompliance.”