Close up image of a caretaker helping older woman walk

The Biden administration raised the stakes significantly in August, first announcing that nursing homes would need to have staff members fully vaccinated to receive Medicaid or Medicare funding, and three weeks later adding healthcare workers in all settings to the plan.

The bold steps now put the industry at the brink of a dramatic workforce showdown. Some observers predicted hundreds of thousands of employees would leave the industry, further restricting its ability to provide quality care or recover census. About 37% of skilled nursing staff was still unvaccinated at press time, despite an increase in providers’ own requirements.

Administration officials said federal guidance would come in an interim rule issued by the Centers for Medicare & Medicaid Services in October, with enforcement to come in steps.

In the meantime, vaccination proponents  — which included a growing number of provider chains and groups — celebrated the “ethical” choice, while angry opponents vowed lawsuits to block the effort.