A nursing home resident receives a booster shot

The Biden administration on Tuesday announced a six-week $475 million campaign to raise the COVID-19 vaccination rate among nursing home residents, and the sector’s leaders responded immediately with a unified demand for shared responsibility by other providers and stakeholders.

Several direct threats were leveled at nursing home operators amid the White House’s multi-pronged plan to increase booster shot awareness and vaccination accessibility to the frail and elderly.

The Department of Health and Human Services and Centers for Medicaid & Medicare Services each put out companion announcements highlighting pieces of the overall announcement. The White House announcement singled out nursing homes in the context of federal enforcement of guidelines to educate staff and residents and offer vaccinations to residents. 

“CMS will make clear that nursing homes with low vaccination rates will be referred to state survey agencies for close scrutiny, and that facilities that do not comply with the requirement to offer and educate on the benefit of lifesaving COVID-19 vaccinations will face enforcement actions, including the need to submit corrective action plans to achieve compliance,” the White House statement said.

In addition, the White House is enlisting governors to increase pressure on providers, noting the administration will “highlight for them how their states are performing against their peers.”

In addition, CMS will share data with states and health plans to highlight “the poorest performing nursing homes to help them encourage action” to increase vaccination uptake.

Providers defend record

The American Health Care Association/National Center for Assisted Living and LeadingAge promptly pushed back with a special, combined statement in defense of providers.

“Nursing homes have done a remarkable job at vaccinating residents, but we have work to do with the most recent booster,” AHCA/NCAL President and CEO Mark Parkinson and LeadingAge President and CEO Katie Smith Sloan said in a rare joint statement. “According to the Centers for Disease Control and Prevention, 43% of residents are up to date on their COVID vaccinations, which is nearly four times higher than the dismal 11% rate among the general population.

“We all share the same goal: ensuring the health and wellbeing of older adults. We believe we can continue to increase that booster rate and to do so requires a shared commitment from the government and other health care providers. For example, 90 percent of residents are admitted to nursing homes from hospitals, and very few of those residents are current on their vaccines upon admission. Through collaboration with hospitals, vaccine numbers can be improved.”

The Biden administration said it wants to help the cause by: making vaccinations more convenient; increasing funding for community-based organizations and health centers; emphasizing enforcement of nursing homes’ requirements to educate staff and residents on vaccinations and to offer them to residents; continuing to work with communities and organizations on providing pop-up clinics; and raising awareness.

Booster clinics are one solution

One prominent nursing home advocate said the campaign could work with additional federal help.. Enforcement of guidances by Health and Human Services and Centers for Medicaid & Medicare Services is likely not enough to ensure vaccination increases in nursing homes, said David Grabowski, PhD, professor of healthcare policy in the Department of Health Care Policy at Harvard University to McKnight’s Long-Term Care News.

“Some facilities have done great with administering boosters, but others have really struggled,” Grabowski said. “For those facilities with low booster rates, I am not convinced you can get them to an acceptable level through fines. These are facilities that are often facing bigger challenges in addition to boosters.”

Grabowski has consistently encouraged the use of booster clinics at nursing homes. 

“This approach worked with the original vaccine rollout and I believe it can work for boosters,” he said. “They worked under the original Long Term Care Pharmacy Program, but I am not aware that they are being used widely for boosters. It would clearly take federal dollars and a similar type of national pharmacy partnership that was used in the original vaccine rollout.”

The administration seemed to be heading in that direction with Tuesday’s announcement, but it was unclear how the scope of involvement would compare to the federal government’s original outreach after COVID vaccines became available. In addition to $350 million for community center involvement, officials said they would be designating $125 million for organizations that serve seniors and disabled individuals and to help hold “vaccination events at senior and community centers.”