A nurse receives the COVID-19 vaccine.
Credit: EvgeniyShkolenko/Getty Images Plus

Long-term care providers fear the federal government’s interim final rule requiring COVID-19 vaccination for all staff at Medicare- and Medicaid-funded facilities could have dire workforce consequences due to its tight deadlines and lack of financial support. 

“A hard deadline with no resources for providers or glide path for unvaccinated workers is likely to push too many out the door and, ultimately, threaten residents’ access to long-term care,” Mark Parkinson, president and CEO of the American Health Care Association, said in a statement Thursday following the rule’s release. 

“Even a small percentage of staff members leaving their jobs due to this mandate would have a disastrous impact on vulnerable seniors who need around-the-clock care,” he added. 

The rule issued Thursday morning sets a Jan. 4, 2022 deadline for all eligible staff to be fully vaccinated against COVID-19. It also requires that facilities establish a policy ensuring all eligible workers have received the first dose of a two-dose regimen or a one-dose vaccine prior to providing any care, treatment or services by Dec. 5.

The regulation covers all healthcare facility employees, regardless of whether they have a clinical role. It allows for exemptions for medical conditions or religious beliefs, observances or practices. Facilities will be required to develop a plan for permitting these exemptions that align with the rule.  

“While we appreciate the interim final rule’s ramp-up period for compliance as well as its plan for safe exceptions for medical and religious reasons, we are concerned about the impact on aging services workforces,” Katie Smith Sloan, LeadingAge President and CEO, said in a statement Thursday. 

“The policy could further complicate staffing issues (including the prospect of additional departures) for our members who are already contending with longstanding workforce challenges exacerbated by the pandemic,” she added. “We cannot overemphasize the need for staffing support and will continue to make our members’ needs known to the administration and to CMS.” 

No test-out option

The emergency regulation was issued in conjunction with the Labor Department’s COVID-19 vaccination policy for companies with 100 or more employees. Unlike that policy, the healthcare worker rule does not allow for a test-out option, federal health officials confirmed Thursday.


“I am not surprised there wasn’t a test-out option,” Amy Stewart, vice president of education and certification strategy for the American Association of Post-Acute Care Nursing, told McKnight’s Long-Term Care News Thursday. “Testing alone is not an effective strategy to protect the frail elderly population in our facilities. Testing identifies COVID. It doesn’t prevent serious illness or mitigate the transmission. Vaccines do.”

Harvard healthcare policy expert David Grabowski, Ph.D., also said it’s good CMS didn’t allow for a test-out option for nursing home workers. He added he hasn’t “seen a lot to make me believe that testing could be effectively implemented to protect nursing home residents and staff.” 

Officials during a national stakeholder call on Thursday clarified that the timetable for compliance with the rule has two phases. The first phase requires that within 30 days of publication, or Dec. 5, facilities have all processes and plans in place for vaccinating staff, providing exemptions and tracking staff vaccinations.

The second phase requires that within 60 days of publication, or Jan. 4, 2022, staff must be fully vaccinated, with exceptions made only for those who qualified for exemptions. 

“We believe that 30- and 60-day timeframes are reasonable and allow for facilities to implement staff vaccination plans while expeditiously getting healthcare staff vaccinated as quickly as possible,” CMS’ Chief Medical Officer Lee Fleisher, M.D., said during the call.

Image of David Grabowski, Ph.D.
David Grabowski, Ph.D.

Grabowski explained that the vaccine mandate will have its intended effect in increasing vaccinations and even bring back some workers who left the sector because of pandemic-related safety concerns. However, it will also have the unintended effect of causing others to leave. 

“I am particularly worried about those nursing homes that currently have low staff vaccination rates,” he said. “For a facility that is currently struggling, it will be particularly challenging to meet the requirements of the rule by early January.” 

Communication, support key

Stewart stressed the importance of framing the conversations around the mandate “in the best possible manner” since there will be staff who refuse to get vaccinated, leaving vacant positions facilities can’t afford.

“Focus on what it means to be a fully vaccinated workplace and the increased safety for residents and staff. Throughout the pandemic, staff have been concerned about bringing COVID home to their family. Being vaccinated lessens the likelihood of this,” Stewart said. 

Grabowski added that the rule will ultimately help protect residents and staff from future COVID-19 outbreaks. He called for additional federal support for providers. 

“CMS will need to work with facilities that experience staffing shortfalls due to the mandate,” Grabowski reiterated. “CMS should have a plan in place to assist these facilities such as strike teams, additional dollars for agency staff, and other approaches such that facilities do not have to choose between having unvaccinated staffers or a staffing crisis.”