What You Need to Know About the Federal Nursing Home Vaccine Mandate

The Centers for Medicare & Medicaid Services has issued an emergency regulation requiring COVID-19 vaccinations of thousands of eligible staff members at nursing homes that participate in Medicare and Medicaid programs.

The regulation, announced November 4, covers about 17 million health care workers at approximately 76,000 providers nationwide, according to a CMS press release. “The regulation will create a consistent standard within Medicare and Medicaid while giving patients assurance of the vaccination status of those delivering care,” the statement says.

Federal Vaccine Mandate Deadlines

Facilities covered by the new regulation must establish a policy ensuring that all eligible staff have received the first dose of either a two- or one-dose COVID-19 vaccine by Dec. 5, 2021 before providing any care, treatment or services. All eligible staff must have received either two doses of the Pfizer or Moderna vaccines or a single dose of the Johnson & Johnson version by Jan. 4, 2022.

The regulation allows for exemptions based on “recognized medical conditions or religious beliefs, observances, or practices,” according to the CMS statement. “Facilities must develop a similar process or plan for permitting exemptions in alignment with federal law.”

In addition to nursing homes, the new vaccination mandate applies to a raft of health care facilities, including:

— Critical access hospitals.

— Long-term care facilities.

— Intermediate care facilities for individuals with intellectual disabilities.

— Psychiatric residential facilities.

— Community mental health centers.

“CMS is taking necessary action to establish critical safeguards for the health of all people, their families, and the providers who care for them,” the agency said in its statement announcing the mandate. “CMS knows that everyone working in health care wants to do what is best to keep their patients safe. Yet, unvaccinated staff pose both a direct and indirect threat to the very patients that they serve. Vaccines are a crucial scientific tool in preserving and restoring efficient operations across the nation’s health care system while protecting individuals. This new requirement presents an opportunity to continue driving down COVID-19 infections, stabilize the nation’s health care system, and ensure safety for anyone seeking care”

The new mandate is part of the Biden administration’s broad strategy to boost the number of people in the U.S. who are vaccinated against COVID-19.

Nationwide, there are 15,655 skilled nursing centers with 1.7 million beds in the U.S., according to the American Health Care Association/National Center for Assisted Living. The advocacy group represents long-term and post-acute care providers, with more than 14,000 member facilities.

At different points during the COVID-19 pandemic, nursing homes have been hotbeds for outbreaks. Nursing homes have elderly residents, many of whom have underlying health conditions — like cardiovascular disease and high blood pressure — that make them particularly vulnerable to severe illness or death from COVID-19.

Some health officials in states that have enacted their own vaccine mandates have noted that vaccination is the best safeguard against the highly transmissible Delta variant. Currently, about 99% of patients hospitalized with COVID-19 are unvaccinated, according to the CDC. Research suggests each of the COVID-19 vaccines remain highly effective in preventing hospitalization or death from breakthrough infections — in which people who have been fully vaccinated become infected and become ill with COVID-19.

“Vaccination is the best way we can prevent further spread, hospitalizations, and death due to COVID-19 and the Delta variant,” says Dr. Ngozi Ezike, director of the Illinois Department of Public Health, in a statement provided to U.S. News. “Data show that the vaccines are preventing severe illness, hospitalization, and death, and are effective against the Delta variant. We have the tools to turn the die of another wave, but we need people to use them.”

[READ: Nursing Homes vs. Assisted Living.]

High Numbers of Nursing Home COVID-19 Deaths

Patients from nursing homes account for a significant number of COVID-19 infections and deaths in the U.S. Overall, there have been 704,233 COVID-19 deaths in the U.S., out of more than 43.8 million cases, according the Centers for Disease Control and Prevention’s Data Tracker.

Nursing homes must report COVID-19 cases and related deaths to federal health authorities.

As of the week ending Oct. 24, according to a data dashboard based on federal data compiled by the AHCA/NCAL, nursing home residents accounted for:

— 252,309 COVID-19 cases.

— 48,537 deaths attributed to COVID-19.

— An estimated 171,520 recoveries from COVID-19.

“There is no higher priority for us than patient health and safety. As the Delta variant strengthens, the Biden-Harris Administration is committed to doing everything we can to keep patients, and those who care for them, safe,” U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra said in a public statement about the federal vaccine mandate. “There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health. Ensuring safety and access to all patients, regardless of their entry point into the health care system, is essential.”

[READ: Nursing Home Facts and Statistics.]

State Vaccine Mandate

Before the announcement of the federal mandate, about two-dozen states enacted their own vaccine requirements, which vary widely in scope.

For example, Maryland’s state mandate requires all workers at nursing homes and hospitals to get vaccinated or submit to regular testing for COVID-19. The state of Illinois requires all health care workers, including employees at public and private nursing homes, teachers and staff at pre-K schools and students at higher education institutions be vaccinated.

However, some state vaccine mandates are much narrower and do not require nursing home workers and many other employees at health care facilities to be vaccinated. For example, the state of North Carolina’s mandate does not apply to workers at hospitals or nursing homes. North Carolina requires that all state Cabinet agency employees and other workers who are under the jurisdiction of the governor get the vaccine or undergo regular testing.

State vaccine mandates typically provide exemptions for religious and medical reasons. For example, the Illinois mandate provides an exemption if being vaccinated would require a worker to “violate or forgo a sincerely-held religious belief, practice or observance.”

The Illinois mandate also provide exemptions for people for whom getting vaccinated is medically contraindicated. Each of the vaccines are safe for the vast majority of people, including people with underlying health conditions that make them more vulnerable to severe illness or death from COVID-19, according to the CDC. However, taking a COVID-19 vaccine may not be advisable for some people who have a severe or immediate allergic reaction to any of the ingredients in any of the COVID-19 vaccines, according to the CDC.

[Read: 24 Gift Ideas for Nursing Home Residents.]

Many Nursing Homes Have Their Own Vaccine Mandates

Soon after COVID-19 vaccines became available in the U.S. in early 2021, some nursing homes enacted their own vaccine mandates. Over time, more nursing homes have put such mandates in place.

In early August, Genesis HealthCare announced a vaccine mandate for all of its 40,000 employees, who work in more than 200 facilities in 20 states nationwide. Genesis is one of the largest providers of skilled nursing and rehabilitation nationwide.

The Genesis vaccine mandate requires the following people to get vaccinated:

— All employees.

— Volunteers.

— On-site vendors.

— Care partners (such as hospice nurses).

The Genesis mandate does not require residents to become vaccinated. Months before it enacted its mandate, Genesis began vaccinating patients, residents and employees on a voluntary basis in December 2020. “Genesis strongly encouraged vaccination among staff, residents and families and achieved above average vaccination, with 85% of patients and residents and 65% of staff choosing to get the COVID-19 vaccines,” throughout the company’s facilities, according to a Genesis press release.

Genesis held hundreds of clinician-led and peer discussions about the safety and efficacy of the vaccines and the looming federal mandate, says Lori Mayer, a company spokeswoman. Patients, residents and family members have responded positively to the company’s approach.

She says. “While we unfortunately had some employees who were not willing to comply with the policy, despite the looming federal mandate, we met our deadline of 100% vaccinated staff, as promised (excluding a small number of workers who received medical or religious exemptions),” she says.

Vaccine Mandates Protect Both Staff and Residents

In Washington, D.C., the Knollwood Life Plan Community — which includes sections for independent living, assisted living and skilled nursing — enacted its own vaccine mandate for employees in February 2021, shortly after vaccines became available in the U.S., says Col. Paul Bricker, a retired Army helicopter pilot and Knollwood’s chief operating officer.

The skilled nursing section of the retirement community has 49 beds and about 75 staff members. “We did it (the vaccine mandate) on our own when we saw how effective the vaccines were,” Bricker says. “We provided vaccinations on-site, through Walgreen’s. Some staff left, but (most) got vaccinated.” Though it wasn’t required, all but one resident got vaccinated. The unvaccinated resident was advised against getting the vaccine because of a medical condition.

In the early part of the COVID-19 pandemic, nine skilled nursing residents with co-morbidities died at Knollwood. Co-morbidities are underlying health conditions that make people who become ill with COVID-19 more vulnerable to serious illness or death.

According to the CDC, these co-morbidities include:


— Chronic kidney disease.

— Chronic lung disease.



— Liver disease.


— Smoking.

No Knollwood nursing home residents have been infected since it enacted its vaccine mandate.

“Our philosophy was ‘no seams,'” Bricker says. “We saw an unvaccinated person as a seam.”

This inclusive approach to enacting a vaccine mandate is endorsed by Amy Cameron O’Rourke, a licensed nursing home care administrator with 40 years of experience in the field. She’s the author of “The Fragile Years: Proven Strategies for the Care of Aging Loved Ones,” which was published in July 2021. O’Rourke is based in Orlando, Florida.

“Every staff member in a community should be vaccinated, at all levels,” O’Rourke says. “Certified nursing assistants, nurses, housekeepers, maintenance staff, management and corporate staff. Any vendor who brings products or services should be required to be vaccinated. It is the only way to truly protect the residents.”

More from U.S. News

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What You Need to Know About the Federal Nursing Home Vaccine Mandate originally appeared on usnews.com

Update 11/08/21: This story was previously published at an earlier date and has been updated with new information.

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