The nursing home vaccination mandate

This just seems obvious to me.

President Joe Biden announced on Wednesday that he is directing all nursing homes to require their staff be vaccinated against Covid-19 in order to continue receiving Medicare and Medicaid funding.

Biden said he is directing the Department of Health and Human Services to draw up new regulations making employee vaccination a condition for nursing homes to participate in Medicare and Medicaid. The decision on nursing home staff represents a significant escalation in Biden’s campaign to get Americans vaccinated and the tools he is willing to use, marking the first time he has threatened to withhold federal funds in order to get people vaccinated.

“Now, if you visit, live or work at a nursing home, you should not be at a high risk of contracting Covid from unvaccinated employees. While I’m mindful that my authority at the federal government is limited, I’m going to continue to look for ways to keep people safe and increase vaccination rates,” the President said during a speech at the White House.


The move comes as the more transmissible Delta variant now accounts for 99% of Covid-19 cases in the United States and as data shows a link between low vaccination rates in certain nursing homes and rising coronavirus cases among residents.

The Delta variant has spurred a jump in daily new cases from a low of 319 on June 27 to nearly 2,700 on August 8, according to Centers for Medicare & Medicaid Services. Many are in facilities in areas with the lowest staff vaccination rates.

In the seven states in which less than half of nursing home staff is vaccinated, weekly cases were 7.9 times higher in the week ending August 1 than they were in the week ending June 27. Meanwhile, in states that have vaccinated a larger share of staff than average (more than 60%), cases reported in the week ending August 1 were only three times higher than cases reported in the last week of June.

The new regulations could go into effect as early as next month, but Johnson said the CMS will work with nursing homes, employees and their unions to ramp up staff vaccinations before the regulations go into effect.

About 1.3 million people are employed by the more than 15,000 nursing homes that participate in Medicare and Medicaid. Some 62% of those workers are vaccinated nationwide, according to CMS data, but the figure ranges from 44% to 88% depending on the state.

“We have seen tremendous progress with low Covid rates within the nursing home population and I think we’re seeing signs that it is starting to tip the other direction. We don’t want to go backwards,” said Jonathan Blum, CMS’ principal deputy administrator.

Blum said CMS officials are “confident we have the legal authority” to implement the new regulation, noting that the law allows CMS to take action as it relates to the health and safety of nursing home residents.

As the story notes, this came a day after Biden directed the Education Department to get involved in the mask mandate fight. You would think, given how devastating the first wave of COVID was to the residents of nursing homes, that their staffers would be highly vaccinated as well, but you would be wrong.

Nationwide, most of the elderly and vulnerable in long-term care facilities have taken the coronavirus vaccine, but many of the staff caring for them have refused it. The federal program responsible for bringing vaccines to the vast majority of nursing homes and similar settings inoculated roughly half of long-term-care workers in the nation, and in some states a much slimmer percentage, as of March 15, according to new data from the Centers for Disease Control and Prevention provided to the Center for Public Integrity.

In seven states and the District of Columbia, the program vaccinated less than a third of staff members.

Now the federal program is winding down in the coming days, leaving states and facilities to figure out how to vaccinate the remainder of workers in settings where COVID-19 has already taken a heavy toll.

Though they represent a tiny fraction of the American population, long-term-care residents made up 34% of the nation’s COVID-19 deaths as of March 4, according to the Covid Tracking Project. Low vaccination rates among staff at these facilities mean that workers continue to have greater risk of contracting COVID-19 themselves or passing the virus to their patients, including residents who can’t be inoculated for medical reasons. Low staff uptake can also complicate nursing homes’ attempt to reopen their doors to visitors like Caldwell, who are striving for some sense of normalcy.

“Going into it, we knew it was going to be a problem,” said Ruth Link-Gelles, who led the team at CDC working on the federal initiative that’s now closing up shop, the Federal Pharmacy Partnership for Long-Term Care Program.

She cited past years’ low vaccination rates among long-term-care workers for diseases such as the flu. “We were disappointed, but I don’t think anyone was shocked to see the low uptake. … There is a stubbornly large portion of the population that really doesn’t want to get vaccinated, and we have a lot of work to do generally and in this community in particular.”

Federal agencies and states have poured resources into a #GetVaccinated educational campaign, hosting listening sessions, live chats and virtual town halls for long-term-care staff to get their questions answered.

In spite of all these efforts, many workers are reluctant to take the shots because they don’t trust information about the vaccines’ safety or they don’t wish to be among the first to take them, experts said.

“There are many reasons to blame nursing homes and the federal government,” said David Grabowski, a professor of health care policy at Harvard Medical School who studies long-term care. “We knew this coming in — that this was a group that was not very trusting of leadership and frankly not very trusting of the vaccine so it was going to take some work in terms of building that trust.”

That story was from late March, so things may be better by now. According to the map embedded in this story, as of that time about 54% of the long-term care workers in Texas who have been vaccinated got their shots through this federal program. But as usual, the overall story in Texas is not great.

The number of nursing homes across the state with at least one active COVID-19 case has shot up nearly 800% in the past month — while nearly half of nursing home employees in Texas remain unvaccinated.

Nursing home residents were among the hardest hit by COVID-19 last year as the virus tore through facilities at an alarming rate. More than 400 Texas nursing home residents died during a single week in August 2020; since the pandemic began, 9,095 have died after contracting COVID-19, according to the Texas Health and Human Services Commission. As of Aug. 11, that’s 17% of the state’s COVID-19 deaths.

To slow the virus’s spread, Gov. Greg Abbott shut down nursing home visitation in March 2020, then eased those restrictions five months later for facilities that didn’t have active cases in the previous two weeks. HHSC’s current visitation guidelines for nursing homes require visitors to wear a mask at all times and limits visitation to no more than two “essential caregivers” per resident.

But after seeing infections remain relatively low in recent months, the state’s more than 1,200 nursing homes are seeing a new wave of infections as COVID-19 cases explode around the state, driven by the highly contagious delta variant:

  • The number of Texas nursing homes with active COVID-19 cases has risen by 773% in the past month, from 56 in mid-July to 489 on Aug. 11. That’s still well below the peak in January, when more than 900 facilities had at least one active case.
  • Deaths are increasing as well. From July 21 to Aug. 11, 84 nursing home residents died from COVID-19, compared to seven deaths during the four-week period before.
  • Roughly 76% of nursing home residents in Texas have been fully vaccinated, putting the state 46th nationally. The national average is 82%.

But the current surge in nursing home cases hasn’t triggered renewed restrictions by the state.

“We continually assess what actions are necessary to keep people safe in the facilities we regulate,” HHSC spokesperson Helena Wright-Jones said in a written statement.

Meanwhile, just over half — 56% — of nursing home staff have been fully vaccinated, below the national average of 59%, which puts Texas 33rd nationally for nursing home staff vaccination rates.

In other words, the usual indifference from state government and general mediocrity, which puts a whole lot of people at risk. What do the nursing homes have to say for themselves?

Kevin Warren, the president and CEO of the Texas Health Care Association, whose members include both for-profit and nonprofit long-term health care facilities, said nursing homes are hesitant to require staff to be vaccinated because they are fearful of losing employees who might look for other jobs that don’t require vaccinations.

“Right now, we have a severely stretched workforce,” Warren said. “And when we see this surge occurring again, the stress and the emotional toll it places on staff and others that are in the building, the concern is: ‘If I put this vaccine mandate on, am I potentially going to lose staff?’”

The percentage of nursing home staffers who are unvaccinated is similar to the general population, Warren added, “so let’s not set them out to the side.”

Except they’re in close contact with the most vulnerable people in the state, and not enough of them are vaccinated, either. The DMN has a whole story on that, and while I can believe it to some extent, there’s a quote from a nursing home operator whose staff is 70% vaxxed, and I cannot see how this is any less urgent than getting hospital staff vaccinated. We’ve tried the carrot, now there needs to be a stick. There’s plenty of polling data to suggest that a non-trivial number of people who are vaccine hesitant will give in and get the shot if their workplace mandates it. Let’s put that to the test.

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12 Responses to The nursing home vaccination mandate

  1. Bill Daniels says:

    This proposed diktat is both racist AND sexist.

    Disparate impact, anyone? Black women are over represented in the nursing home workforce, yet blacks are under represented when it comes to those injected. So guess who will disproportionately lose their jobs over this? Yes, it will be black women.

    I don’t understand why there aren’t lawsuits being launched against this clearly racist policy right now. This is Jab Crow! Where is the NAACP? Where is the ACLU? ADL?

    And this, from the article:

    “….nursing homes are hesitant to require staff to be vaccinated because they are fearful of losing employees who might look for other jobs that don’t require vaccinations.”

    Um, hello? Clue phone? That is EXACTLY what will happen with this diktat. You will just push people out of their jobs, and then there will be NO ONE who will be willing to do the work. I mean, Joe Biden will still get HIS butt wiped, but what about your loved one?

  2. Ross says:

    So, Bill, you are totally OK with nursing home workers killing patients? OK, it’s clear now. Bill hates old people, and considers them a waste of space and vital resources.

    To be clear, there will be no requirement to vaccinate nursing home workers, the nursing home will just not get paid by the Feds.

  3. Bill Daniels says:


    Get real. The wealthy will be OK, because they can send their infirm elderly to nice places that don’t take Medicaid/Medicare, or can spend whatever is necessary to poach injected staff from other places. For the rest, without taxpayer dollars propping up the places, they’d shut down tomorrow if federal funds were cut off. The wealthy can afford to pay out of pocket for their loved one to rehab at a SNF, when their facility drops their federal contracts, for example. Can the average Joe drop ten grand plus a month for decent SNF rehab?

    So here’s the Hobson’s Choice: Either the place shuts down because of lack of funding, or there is not enough staff to take care of people. Who is going to step in to take care of them? You?

    This is JUST LIKE what’s going on in the hospitals. Last year’s health care heroes are now pariahs that must be fired. And then we wonder why there’s no one to take care of people. Where were you last year screaming about muh uninjected are killing people in nursing homes?!?! It’s the same people, Ross. The same people you called essential, front line heroes, last year, are the ones you now stand and accuse of killing grandma. How fickle you are, Ross. If there is any profession that we don’t want workers to be soulless automatons, it’s health care, and if you keep on treating health care workers like shit, don’t be surprised when they leave the field.

    The mass casualties at the nursing homes last year occurred because Cuomo, Whitmer, and the other Yankee governors insisted on putting the infected in nursing homes. Did you notice how Cuomo got poundmetoo’d to get rid of him and bury the fact that his decision decimated the nursing home population? I’m sure the other governors that did the same thing are all breathing a sigh of relief right now.

  4. Jason Hochman says:

    Ross, never before in the history of civilization have we accused people of “killing” others because an illness has spread among people. It is the nature of disease that it exists, and people get it, and this has been since the beginning of history. It is amazing how quickly the Big Lie caught on, and people gleefully blame everyone else for making everyone else sick. Also the way that we now blame people of a different skin color for our problems. The hate based media have propagated what I call the Big Lie, a divide and conquer and bicker amongst yourselfs kind of policy.

    Of course Gov. Cuomo, who, at the time was a hero, and was doing everything a president should do, was the cause of many nursing home deaths, and still hasn’t been imprisoned for that. Then, he got all high on himself and molested 11 women. He flew too close to the sun on wings of fake news.

    The thing about the hospitals, if they are truly short staffed and overwhelmed, you’d think that they would not be firing nurses and forcing them to resign. Right now, in the summer, is the time when experienced nurses are most needed. You see, the medical schools graduate the residents in the summer and they start working in the hospital. They don’t know what they are doing, but a nurse who has been there for ten years or more knows what to do…without the help of experienced nurses, these residents will make errors, and as we know, medical error is in the top five causes of death every year.

  5. Manny says:

    Jason, they executed witches and necromancers because of diseases that killed people.

    Why the fibs or miswriting, Jason?

  6. Ross says:

    So, both Jason and Bill are in favor of allowing medical staff to kill patients by not requiring that medical staff be vaccinated.

    Any nurse, a profession that requires education, who doesn’t want to be vaccinated, and doesn’t have a medical reason not to do so, is too stupid to be allowed to work with patients, and should be relegated to sweeping floors in the morgue or fired. It’s that simple. The staff in nursing homes need to be educated as to why the vaccine is necessary, and then be given the opportunity to get vaccinated.

    The Pfizer vaccine was fully approved today, so there is no excuse.

  7. Bill Daniels says:


    Since Wolf isn’t here to explain it to you, let me help point out your strawman fallacy:

    People who were front line heroes last year didn’t roll out of bed one day and become serial killers with a wanton disregard for human life. You just made that up, Ross. Those front line heroes….you weren’t calling them too stupid to work with patients last year. This is the fatal flaw in your argument.

    Worst of all, a disproportionate number of the people you now call too stupid to work with patients are people of color, in many cases, women of color. Nice.

  8. Bill Daniels says:


    If Jason and I were in favor of allowing medical staff to kill patients, we’d be objecting to the wearing of PPE and other mitigation methods in a nursing home setting, which we are clearly NOT doing. There ARE proper venues for masks, face shields, etc., which include nursing homes. Other places, not so much.

  9. Jason Hochman says:

    Manny, great, thanks for admitting that this is a witch hunt. The “science” should be called the “superstition.”

  10. Manny says:

    No, Jason, just pointing out that you were not telling the truth.

    “Never before in the history of civilization have we accused people of “killing” others because an illness has spread among people.”

  11. Ross says:

    Bill, I never called them heroes. I don’t call entire groups heroes when they are doing their jobs. The NYFD firefighters on 9/11 weren’t heroes either, they were just doing their jobs. Heroes is overused to the point of being useless.

    There were no vaccines for much of last year to mitigate Covid transmission. There are plenty of vaccines now, so there’s no reason not to get one, unless you don’t want to keep your job.

    If I was in the hospital or a nursing home, my first question would be the vaccination status of my caregivers. If they don’t care enough to protect themselves, why should I let them work on me? Being unvaccinated implies stupidity and lack of caring about others, and I won’t tolerate that.

  12. Jason Hochman says:

    Ross, if you are in dire condition, I hope you don’t waste the time asking if they are vaccinated. Keep in mind that medical error is in the top 5 causes of death every year.

    And, by your logic, if a doctor or nurse is fat, smokes, doesn’t exercise, drives over the speed limit, or even has a hobby like rock climbing, you should assume that this person is not safety minded enough to care for you. You should have an emergency questionnaire that you carry, in case you are injured, you can be sure that any doctors, paramedics, nurses, etc. will have met your safe lifestyle requirements.

    Keep in mind that most nursing home staff are low paid housekeepers, nursing aides, cafeteria workers. Many of them are minorities. It is time for the Democrats to rally behind Joe Biden, and tell them, we are putting you back in chains, buddy. The party of hate needs to express its true emotions.

    Manny, good to hear that I have lied, but still we have to admit that returning to burning witches is not progress. It may be progressive, but that’s not the same as progress.

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