Understanding Covid Vaccine Mandates in Nursing Homes

The COVID-19 pandemic arguably hit nursing home residents the hardest in early 2020, before researchers developed vaccines. More than 200,000 nursing home residents and staff members have died of COVID-19 since the start of the pandemic, according to a Kaiser Family Foundation study that relied on federal and state data. Many of those who died of COVID-19 perished in the initial months of the crisis.


The development of vaccines — and the federal government’s mandate, which requires all nursing home workers (with some exceptions) to receive the COVID-19 vaccine and took effect earlier this year– have greatly reduced death and serious illness in nursing homes, says Dr. Kuljit Kapur, chief medical officer at Transitions Care, based in Chicago. Transitions Care helps seniors with end-of-life care, find and manage their primary care and manage chronic symptoms through palliative care services.

“I believe the vaccine has made a large difference in the quality of life as well as the longevity” for nursing home residents, she says. She’s the medical director of Transitions in Indiana and Illinois, and part of her responsibility is to sign death certificates for individuals who died in a nursing home. For about the past six months, Kapur estimates she didn’t sign any COVID-19 death certificates, until she signed one in mid-October. In contrast, during the first months of the pandemic, Kapur says she signed multiple death certificates for nursing home residents who’d died of COVID-19 on a daily basis.

[READ: Nursing Home Requirements: Who’s Eligible?]

Nursing Home Vaccine Mandate

The Biden administration’s vaccine mandate for nursing home workers took effect after the Supreme Court in January turned away a legal challenge from Louisiana, Missouri and other states, mostly led by Republican elected officials, opposed to the requirement. The states argued that the vaccine mandate violates powers reserved for the states under the U.S. Constitution. The challenging states also argued that the directive violates federal administrative law.

The administration argued that vaccinating as many nursing home workers as possible would save lives by boosting the number of vaccinated people. The Supreme Court’s ruling overturned previous decisions by two separate federal appeals courts, in Missouri and Louisiana, that had stopped the mandate from taking effect in a number of states. By a 5-4 vote, the high court ruled that the administration’s COVID-19 vaccine mandate — which covers participants in the Medicare and Medicaid programs, including nursing homes and hospitals — to proceed.

Under the mandate, nursing homes had to develop policies and procedures for following through on the vaccine directive by January 27, 2022. Individuals who have allergies to an ingredient or ingredients in the COVID-19 vaccines can seek an exemption, as can people who say that taking the vaccine violates their religious beliefs. The mandate required 100% of non-exempt staff to be vaccinated by February 26, 2022.

In June, the U.S. Department of Health and Human Services’ Office of the Inspector General released an audit that says 91% of nursing home staffers nationwide have been vaccinated.

A chart posted online by the Centers for Disease Control and Prevention shows a significant decline in deaths of nursing home residents from COVID-19 in recent months. The chart shows deaths of nursing home residents from July 2020 through the week ending October 9. Information about the deaths is from the CDC and the National Healthcare Safety Network. Nursing homes must report COVID-19 cases and related deaths to federal health authorities.

Such deaths were much higher before the vaccine mandate took effect. In the week ending December 20, 2020 — a little more than a year before the March 2022 deadline of the vaccine mandate — there were 6,127 COVID-19 deaths of nursing home residents, a rate of 5.5 deaths per 1,000 residents, according to the chart. In contrast, in the week ending October 2, 2022, there were 223 resident deaths in nursing homes, a rate of 0.2 deaths per 1,000 residents, according to the CDC’s Nursing Home COVID Dashboard.

The vaccine mandate does not apply to residents, although nursing homes are obligated to make it available to them, says Jacqueline Voronov, a partner at Hall Booth Smith, a law firm that provides counsel on aging services as well as other areas of the law. The firm represents a “significant number” of nursing homes and skilled nursing facilities. She’s based in Paramus, New Jersey.

[READ: Medicare Mistakes to Avoid.]

What Is a Nursing Home?

There are 15,600 nursing homes in the country with 1.7 million licensed beds, according to the CDC.

Nursing homes are also known as skilled nursing facilities. As that name suggests, these places offer a higher level of daily care than assisted living settings. For example, nursing homes can provide medical care that assisted living facilities aren’t equipped to handle.

Nursing homes would be appropriate for seniors who need round-the-clock medical care for conditions such as dementia, or the effects of a major stroke.

These are some of the services a nursing home can offer:

Skilled nursing care. This would include medically-necessary care that can only be provided by skilled or licensed medical personnel. Examples include: intravenous injections, wound care and catheter care.

Rehabilitation services, such as physical, occupational and speech therapy. These services are needed by people who’ve suffered a stroke, broken bones or had a traumatic brain injury; and individuals who have undergone back surgery, open-heart surgery or have had a hip or knee replacement.

Assistance with daily tasks. This includes aid getting dressed, or moving in and out of bed.

Memory care. Some, but not all, skilled nursing facilities also offer memory care for patients suffering from Alzheimer’s disease or other forms of dementia.

[READ: How to Stay Connected to Your Loved One in a Nursing Home.]

What Consumers Should Ask

If you are considering a nursing home for yourself or a loved one and are worried about COVID-19, you should ask these questions, Kapur says:

What percentage of the staff is vaccinated? The more vaccinated staff members, the safer residents are from COVID-19. A vaccination rate below 75% might be worrisome, Kapur says.

How often does the facility offer the COVID-19 vaccine or booster to residents? “You want to make sure the facility has vaccine supplies available for new residents who are coming in,” she says. Offering the vaccine on a weekly or bi-weekly basis would give every resident the opportunity to be well-protected.

How often are unvaccinated staff members tested? If the facility has staff members who are unvaccinated for religious or medical reasons, they should be tested at least on a bi-weekly basis, in order to quickly detect possible infections and assure that employees who are infected don’t interact with residents.

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Understanding Covid Vaccine Mandates in Nursing Homes originally appeared on usnews.com

Correction 10/25/22: A previous version of this story had the wrong data for nursing home deaths.

Update 12/01/22: This story was previously published at an earlier date and has been updated with new information.

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