Health care workers in about half the states face a Thursday deadline to get their first dose of the COVID-19 vaccine under a Biden administration mandate that will be rolled out across the rest of the country in the coming weeks.
While the requirement is welcomed by some, others fear it will worsen already serious staff shortages if employees quit rather than comply.
“We would like to see staff vaccinated. We think that it’s the safest option for residents, which is our biggest concern,” said Marjorie Moore, executive director of VOYCE, a St. Louis County, Missouri, nonprofit that works on behalf of nursing home residents. “But not having staff is also a really big concern, because the neglect that happens as a result of that is severe and very scary.”
The mandate affects a wide swath of the health care industry, covering doctors, nurses, technicians, aides and even volunteers at hospitals, nursing homes, home-health agencies and other providers that participate in the federal Medicare or Medicaid programs.
It comes as many places are stretched thin by the omicron surge, which is putting record numbers of people in the hospital with COVID-19 while sickening many health workers.
Nationwide, about 81% of nursing home staff members already were fully vaccinated as of earlier this month, ranging from a high of 98% in Rhode Island to a low of 67% in Missouri, according to the federal Centers for Medicare & Medicaid Services. The data is unclear about the vaccination levels in hospitals and other health care sites.
The mandate ultimately will cover 10.4 million health care workers at 76,000 facilities.
It is taking effect first in jurisdictions that didn’t challenge the requirement in court. Those include some of the biggest states, with some of the largest populations of senior citizens, among them: California, Florida, New York and Pennsylvania.
Some of the states already have their own vaccine requirements for health care workers. In California, for example, they have been required to be fully vaccinated since Sept. 30 and must get a booster by Feb. 1.
The federal mandate is “better late than never,” said Sal Rosselli, president of the National Union of Healthcare Workers, which represents about 15,000 people in California. “But if it happened sooner, we wouldn’t have gone through the surge, and a lot more people would be alive today.”
The government said it will begin enforcing the first-dose vaccine requirement Feb. 14 in two dozen other states where injunctions were lifted when the U.S. Supreme Court upheld the mandate two weeks ago. The requirement will kick in on Feb. 22 in Texas, which had filed suit separately.
In Missouri, one nursing home served notice this week that it intends to take advantage of a state rule that allows facilities to close for up to two years if they are short-staffed because of the vaccine requirement. The state health department would not identify the nursing home, saying it is still notifying families and arranging transfer plans.
“Obviously we are proponents of vaccines,” said department spokeswoman Lisa Cox. But “throughout all of this, we knew that mandating it would be a negative impact really on our health care system … just because of crippling staffing levels.”
The Centers for Medicare & Medicaid Services ultimately could cut off funding to places that fail to comply with the mandate. But it plans to begin enforcement with encouragement rather than a heavy hand.
CMS guidance documents indicate it will grant leniency to places that have at least 80% compliance and an improvement plan in place, and it will seek to prod others.
“The overarching goal is to get providers over that finish line and not be cutting off federal dollars,” said MaryBeth Musumeci, a Medicaid expert with the nonpartisan Kaiser Family Foundation.
The states affected on Thursday are: California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, Washington and Wisconsin, along with the District of Columbia and U.S. territories.