The Biden administration's vaccination requirement is putting a squeeze on nursing homes as they try to balance protecting residents and retaining low-wage staff that have been reluctant to get the shot.
Later this month, the administration will outline a policy that requires all staff working at nursing homes to be vaccinated or risk the facilities losing federal funding.
The specifics of the policy are sparse so far, but it would effectively be a mandate for an industry that relies heavily on Medicare and Medicaid funding.
Only about 62 percent of nursing home and long term care facility staff are fully or partially vaccinated nationally, according to federal data compiled by the Centers for Medicare and Medicaid Services (CMS).
More than 602,000 staff members have contracted COVID-19 and more than 2,000 have died from it.
The numbers vary by state, but reflect the nationwide rate for fully vaccinated adults. However, the figures are significantly lower than the nationwide average vaccination rate — nearly 84 percent — for nursing home residents.
Nursing home residents are among the most vulnerable to infection, and despite high levels of vaccination, outbreaks still occur, driven in large part by unvaccinated staff.
Health experts say a vaccine requirement could go a long way towards protecting residents and stopping preventable outbreaks.
The rule "has the potential to really change the narrative that's been ongoing in nursing homes where we've seen staff quite hesitant to get vaccinated. This is an opportunity to really press reset, and actually see high rates of vaccination," said David Grabowski, a professor of health policy at Harvard Medical School.
Some states have already moved forward with mandating vaccines for all health workers. Some nursing homes and health systems have also imposed mandates on their staff, but it's far from an industry standard.
Jewish Home Family, a nonprofit nursing home operator in Rockleigh, N.J., was the first long-term care organization in the state to mandate vaccinations.
Carol Silver-Elliott, the company's President and CEO, said they only lost five out of their 530 employees as a result of the policy.
"It was a small price to pay to keep our elders safe. I think we did well," Silver-Elliott said.
"Do I think everyone can do as well? I think sometimes geography makes a difference ... We're in a part of New Jersey that was hit very hard by the pandemic. It doesn't take much to invoke those images of what horrible experiences we all went through, and all of them suffered losses of friends and colleagues and family members and elders."
Yet industry groups fear the policy will exacerbate what is already a severe staffing crisis, as workers will quit rather than get vaccinated, leaving facilities understaffed and putting residents at risk.
Mark Parkinson, the CEO of the American Health Care Association and National Center for Assisted Living, a nursing home lobby, sent a letter to Health and Human Services Secretary Xavier BecerraXavier BecerraOvernight Health Care — Presented by the National Council for Mental Wellbeing — FDA panel endorses booster shots of Johnson & Johnson vaccine Biden administration to invest 0 million to boost health care, attract workers FDA guidance calls for voluntary salt reduction in food supply MORE warning about the impact of the requirement on the workforce.
"If a significant portion of the approximately 38 percent of unvaccinated nursing home staff leave, the net impact will be worse care for the residents. While the loss of just half of the unvaccinated staff would be devastating to care, the loss of even one or two staff in a nursing home impacts care on certain shifts and units," Parkinson wrote.
Among other issues, AHCA is pressing the administration to broaden the vaccine requirement to all workers in Medicare and Medicaid certified health facilities.
"This is the only way to prevent nursing facility employees from leaving to work in other settings such as hospitals or home health," Parkinson wrote.
Grabowski said the fear about staff loss is reasonable, and while he is in favor of putting a sector-wide mandate in place, he doesn't think that would solve the staffing shortage.
"The biggest group of unvaccinated staff are certified nurse aides. They're making close to minimum wage. They can make that, maybe even more, plus maybe even better benefits out in retail jobs, restaurant jobs. The vast majority of those employers are not imposing mandates," Grabowski said.
"So, yes, the federal government could have done a better job of doing this across the board for health care providers ... But you also still would have this kind of back door where staff might leave for other jobs that are not in healthcare," Grabowski said.
CMS has historically been reluctant to remove nursing home providers from the Medicare program, and it's still unclear what kind of penalties the policy will entail. The details are expected to be released in an emergency rule later this month, though there is no formal deadline.
The agency did not return The Hill’s request for comment.
If vaccine mandates trigger worker shortages, nursing home operators should do more to retain their staff, said Charlene Harrington, professor emeritus at the UCSF School of Nursing.
While some in the industry may plead poverty because of low federal reimbursement rates, Harrington said higher wages for staff are possible to make the job more worthwhile.
"They're entry level workers, and they're underpaid, and their benefits are terrible. The nursing homes have resisted increasing the wages and benefits, because most of the companies are for-profit," Harrington said. "They might have to raise the wages and benefits. They don't want to do it, but it really has to be done."