Nursing Home Staff Shortages Linger as Vaccine Mandate Looms

The delta variant drove the share of nursing homes reporting staff shortages to the highest level ever in September—and the situation could worsen in coming months, according to new research.

As the Centers for Medicare & Medicaid Services prepares to unveil guidelines requiring all health-care workers to be vaccinated against Covid-19, the data has illuminated lingering concerns that the mandate will further exacerbate the nursing home staffing problem.

“There will be pockets, in parts of the country, where there will have to be some closures of units and possibly entire facilities, because they just aren’t staffed enough to take care of the people safely. But I don’t think that’s widespread,” said Chris Laxton, executive director at AMDA—The Society for Post-Acute and Long-Term Care Medicine. “So far, what we’ve seen is that when push comes to shove, most people are going to get vaccinated.”

But in areas where vaccine hesitancy and labor shortages are already a problem, nursing homes struggling to find workers may find it harder to increase resident occupancy if the looming vaccine mandate spurs an exodus of more nursing home workers.

“If you can’t find aides to help take care of the patients, then you’re not going to allow new admissions into your nursing home. You are basically being constrained from growing the business,” said Bill Kauffman, a senior principal at the National Investment Center for Seniors Housing & Care.

By the end of September, more than 23% of nursing homes reported shortages of certified nursing aides, more than 20% reported nursing staff shortages, and 19% reported shortages of both. Those are the highest levels since the CMS first reported the data in May 2020, according to the new research that Kauffman co-authored with Omar Zahraoui, a data analyst at the investment center.

A recent survey by the industry’s main trade group found that 86% of facilities say their labor situation has worsened in recent months, while 58% have limited new admissions due to staffing challenges. Nursing home occupancy rates, once 85%, have only rebounded to 72%.

“Over time it’s not something that’s going to go away quickly,” Kauffman said of the labor shortages.

Problem Pre-Dates Pandemic

The dearth of direct-care staff at nursing homes pre-dated the pandemic. And the root causes— low pay, high turnover, and limited benefits—haven’t been addressed. In addition, Kauffman said lower labor force participation rates throughout the economy coupled with a wave of aging baby boomers requiring more care will only add to the worker shortfall.

The American Health Care Association and the National Center for Assisted Living have called on the Biden administration to release $3 billion in federal provider relief funds to help pay for additional staff once the new mandate takes effect.

As many as 1.3 million people working in nursing homes would fall under the new requirement, according to estimates by the Biden administration.

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The industry groups also want the federal government to fund ongoing Covid-19 testing for unvaccinated nursing home workers to help avert sudden staffing shortages that could result from workers refusing to abide by the mandate.

But Laxton, of AMDA, which represents medical directors and other providers at nursing homes, said the testing component “defeats the purpose of the mandate” because it would miss asymptomatic cases. In addition, the rapid Covid-19 test has accuracy issues, Laxton said.

Nationally, nearly 71% of nursing home workers were vaccinated as of Oct. 10, federal data shows. That’s up from about 60% on Aug. 12. The nursing home industry had hoped to reach a national 75% staff vaccination rate in July.

But among certified nursing aides who work in nursing homes, only 49.2%, on average, are vaccinated, according to a recent study in JAMA Internal Medicine. And only 61% of registered and licensed practical nurses in the facilities had taken the jab, the study found.

The AHCA and NCAL are backing a several proposals to address the staffing problem, including H.R. 331, the Nurses Certification and Recognition of Experience Act, which expands training opportunities for temporary nurse aides, or TNAs, who served during the pandemic.

Meanwhile, facilities with direct-care staff shortages had higher Covid-19 infection rates than those that didn’t, Kauffman’s research found.

“This suggests that shortages of staff translate into lower staff-to-resident ratios and consequently increase “one-to-many” interactions between available staff and residents,” the research said. “These ‘one-to-many’ interactions could lead to higher virus transmission among residents.”