Feds announce plan to require worker vaccinations for nursing homes in order to keep Medicare, Medicaid

The nation’s nursing homes are under additional pressure from the federal government to increase worker vaccinations, according to a new emergency regulation announced Wednesday (Aug. 18) from The Centers for Medicare & Medicaid Services (CMS) in conjunction with the Centers for Disease Control (CDC).

The federal agency said it is imposing a new regulation requiring staff vaccinations within the nation’s more than 15,000 Medicare and Medicaid-participating nursing homes. A time frame for the vaccinations to be completed was not disclosed in the announcement from CMS.

All 222 nursing homes in Arkansas could be affected by the order.

“Keeping nursing home residents and staff safe is our priority. The data are clear that higher levels of staff vaccination are linked to fewer outbreaks among residents, many of whom are at an increased risk of infection, hospitalization, or death,” said CMS Administrator Chiquita Brooks-LaSure. “We will continue to work closely with our partners at the CDC, long-term care associations, unions, and other stakeholders to advance policies that keep residents and staff safe. As we advance these new requirements, we’ll work with nursing homes to address staff and resident concerns with compassion and by following the science.”

The Arkansas Health Care Association (AHCA), which represents the state’s nursing home and assisted living facilities, reports the percentage of vaccinated residents in Arkansas facilities is 82.61% whereas the national average is 82.4%. It also reports that 61.03% of staff in Arkansas facilities are vaccinated whereas the national average is 60%. A representative of the national nursing home industry said the plan will cause unintended consequences.

“In light of the recent announcement on vaccine requirements for nursing homes, we remain focused on supporting our healthcare workers and ensuring adequate staffing in our facilities,” said Rachel Bunch, AHCA executive director. “Arkansas has the highest COVID-19 vaccination rate in the region and surpasses the national rate for staff and residents. In addition, some facilities have already required employees to vaccinate, absent a medical or religious exemption request that can be reasonably accommodated. AHCA is proud of the work that we have done to educate our people regarding vaccination, provide resources for staff, and coordinate efforts to vaccinate our residents, their families, and our staff. We believe in and will continue to encourage vaccinations, and will help facilities navigate the barriers to vaccination to comply with the federal mandate. Fear, misinformation, and lack of a trusted medical provider or advisor all serve to discourage individuals from vaccination, including health care workers.

“Unfortunately, long term care providers were given a clear choice by the President: risk losing essential frontline workers, or risk the state and federal reimbursement it will take to compensate those workers. This has the potential to exacerbate an existing workforce crisis and jeopardize access to care for Arkansans statewide, and unfairly targets nursing homes and their staff instead of treating all healthcare providers equally,” she added. “Arkansas cannot afford a long term care staffing crisis and we must work together to ensure this does not happen. We are calling on state and federal leaders to support our nursing home providers, healthcare heroes and the residents they serve as we monitor the rise of COVID-19 cases in our communities.”

CMS said the emergence of the Delta variant in the U.S. has driven a rise in cases among nursing home residents from a low of 319 cases on June 27, to 2,696 cases on August 8, with many of the recent outbreaks occurring in facilities located in areas of the U.S. with the lowest staff vaccination rates.

Also on Wednesday, the Biden administration announced it would roll out a plan to provide booster shots to American adults already fully vaccinated beginning this fall.

STATISTICS SQUABBLE
Earlier this week, the Arkansas Center for Health Improvement (ACHI), a nonpartisan, independent health policy center, launched a dashboard to track COVID-19 cases, deaths, and vaccination rates among residents and healthcare staff of Arkansas nursing homes.

ACHI’s dashboard reported that 43 out of 152 Arkansas nursing homes had COVID-19 vaccination rates below 50% among health care staff as of Aug. 1. ACHI also reported that counting previous reports, 71 out of 222 nursing homes, or 32%, did not reach the 50% threshold. The group also reported the 61% staff vaccination level among Arkansas nursing home healthcare staff.

On Wednesday, the nursing home industry pushed back on the ACHI dashboard, which is reportedly collected from public data provided by nursing homes to the federal government.

“The dashboard misrepresents facts and sensationalizes the pandemic at a time when healthcare workers need our support the most. The ACHI dashboard numbers fail to emphasize the date that vaccines were made available to LTC [long-term care] facilities. Accordingly, they fail to tell the story of the before and after vaccine availability, and how successful they are in preventing serious illness and death in this population. If the goal of the website is transparency, isn’t that something to emphasize?” Arkansas Health Care Association executive director Rachel Bunch said.

Dr. Joe Thompson, CEO of ACHI, replied, “That statement is false. We do report on the dashboard when COVID-19 deaths occurred, as self-reported by the nursing homes to the Centers for Medicare and Medicaid Services, before and after vaccine availability.”

Bunch also took issue with the dashboard’s failure to identify if residents may have been admitted to long-term care facilities already infected with COVID-19.

“The data also fails to identify residents that are admitted to facilities already infected with COVID-19. Facilities stepped up and created COVID-19 units to admit individuals with the virus that had to be discharged from the hospital to free up valuable hospital beds. The numbers instead mislead readers into assuming that all nursing home cases were the result of employees’ infections and/or failure to vaccinate. Our vaccination rates exceed national rates and are the highest in the region,” Bunch said.

Thompson said that data is not captured by CMS.

“CMS, the source for all of the data on our dashboard, does not provide data on this point. However, if it is true that COVID-19 is entering nursing homes from new patients already infected, then that is a strong argument for more health care workers to be vaccinated,” he said, in reference to the CMS emergency regulation announced today.

Bunch also said the information in the ACHI dashboard is “sensationalized,” a point that Thompson refuted.

“For example, in one location, deaths are reported as a raw number, and in another, they’re listed as a percentage of total COVID-19 cases,” Bunch said. “If a facility had only two cases and one death, that’s automatically reported as a 50% death rate, which is alarming and misleading to the public and damaging to these facilities that have worked so tirelessly for a year and a half.”

“The statement that ACHI’s dashboard reports that a facility with only two cases and one death has a 50% death rate is false. This is true of CMS’ website, but on our dashboard we have removed the percentages for these facilities because of small numbers,” Thompson said.