Nursing Homes Prep for Staff Vaccine Mandate, Booster Shots

The nursing home industry is dealing with the familiar and the unknown as it prepares for the dual challenge of providing Covid-19 booster shots for residents and mandatory vaccinations for staff.

The nation’s long-term care pharmacies have been providing shots for new residents and staff since Walgreens and CVS completed their on-site nursing home vaccination clinics under the federal Pharmacy Partnership for Long-Term Care Program.

“It appears they’re going to keep that supply chain intact, and facilities will just reach out to their pharmacy” for the booster shots, Chad Worz, chief executive of the American Society of Consultant Pharmacists, said. “The vaccine’s a lot easier to get right now.”

But it won’t be nearly as easy to comply with a new Biden administration mandate that all nursing home employees get fully vaccinated for Covid in order to participate in the Medicaid and Medicare programs.

Wednesday’s announcement of the mandate by the Centers for Medicare & Medicaid Services has unsettled the industry as it struggles to rebound from nearly 187,000 Covid deaths, continued staffing shortages, and increasing community spread due to the Delta variant.

“If this mandate is not expanded to all health care settings, nursing home staff may leave to work in other sectors. This could have devastating consequences on access to care for residents,” the industry’s leading trade group, the American Health Care Association, said in a statement Thursday.

“The exact impact remains to be seen, but we’ve already heard stories of nursing homes having to refuse new admissions because they don’t have the number of staff necessary to take on new patients,” the group said. “Further workforce shortages could cause facilities to close.”

The AHCA wants the Biden administration to expand this mandate to all health-care settings and release more provider relief funds to help struggling facilities.

Spike in Infections

The highly transmissible delta variant has caused nursing home resident infections to spike from 319 cases in late June to 2,696 cases on Aug. 8, according to the CMS. Many of the outbreaks are occurring in facilities with very low staff vaccination rates, the agency said. Nationally only 60% of nursing home workers have been vaccinated, despite an industry effort to reach 75% by July.

Nationally, nursing home employees are a low-paid workforce with high rates of minority, female, and immigrant representation. Their turnover rate is high because many lack health insurance and paid sick days.

Their low vaccine take-up rates reflect a combination of misinformation about the vaccines, cultural distrust, and a growing anti-vaccine sentiment throughout the nation.

The Service Employees International Union represents certified nursing assistants at nursing homes, along with dietary, housekeeping, maintenance, and laundry workers. The union didn’t respond to a request for comment about the new mandate. Their website urges members to get vaccinated, but adds “the best approach to encouraging universal vaccination is through education and outreach, not through making vaccination mandatory.”

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‘Peer Influencers’

To break through, nursing homes will double down on what has worked, said Dee Pekruhn, director for life plan communities services and policy at LeadingAge, which represents nonprofit nursing homes and similar aging services providers.

That includes posting pictures of staff being vaccinated and identifying and utilizing “peer influencers,” or trusted colleagues, to hold “small huddles” that help sway the most vaccine-resistant staffers, Pekruhn told participants during a Wednesday conference call.

“So have those ongoing conversations with trusted peers who can listen to where you’re coming from, acknowledge the concerns that are valid, and, quite slowly, perhaps, but chip away at outstanding concerns people might have. This appears to work well,” Pekruhn said.

The CMS hasn’t issued regulations for how the mandate will be enforced and how penalties for noncompliance will be applied.

Boosters and Flu Shots

As for the booster shots, Worz said long-term care pharmacies expect to provide those alongside seasonal flu shots this fall.

“Obviously, boosters and flu gives you a lot more reason to send a team out because you’re going to be administering hundreds of doses again and you’re not going to be in that scenario where you’re just trying to pick off one or two,” Worz said.

“We kind of anticipated that we might see a better flu-shot acceptance rate this year because of Covid,” he said. “But this really gives us an opportunity to do two things at once and really up the flu protection as well as the Covid protection.”

Worz’s group represents about 6,000 pharmacists who work in long-term care, along with 80% of the estimated 1,800 long-term care pharmacies that provided Covid-19 vaccinations.

While no research has been conducted on the safety and efficacy of providing the two vaccines together, “We have no reason to believe that these two cannot be given at the same time, or within a week from each other,” said Ali Mokdad, a professor of health metric science at the University of Washington who tracks Covid cases and deaths. “We don’t have a lot of data on that yet. It’s something that we’re looking at,” Mokdad told participants during the LeadingAge call on Wednesday.

In that same call, Ruth Katz, senior vice president of public policy at LeadingAge, said it will be easier for larger facilities with many residents to arrange on-site vaccination clinics. But smaller and rural providers may find it better to rely on their staff and contracted pharmacies for the shots.

“Housing, assisted living, memory care, life plan communities—all aging services providers need to begin now to make plans,” Katz told call participants.

She urged providers to figure out how many doses will be needed and reach out to “retail partners” and the Centers for Disease Control and Prevention to discuss how to bring them into clinics, “or, if absolutely necessary, arrange to bring people to the retail provider.”