A new study documents that vaccinations of nursing home staff resulted in fewer COVID-19 cases and deaths among residents and fewer COVID-19 cases among staff in the early part of the coronavirus pandemic. The Centers for Medicare & Medicaid Services (CMS) should revise the guidance on staff vaccinations that it issued in October 2022 in order to require that staff receive boosters that are effective against later COVID variants.
Since the beginning of the pandemic, and as of December 18, 2022, CMS data indicate that at least 3,886,999 nursing home residents and staff have been infected with COVID-19 and at least 164,732 of them have died. As early as December 2020, staff and residents began receiving vaccinations.
In May 2021, CMS required facilities to report data on vaccination rates. Through an interim final rule with comment published November 5, 2021, CMS required that staff of Medicare and Medicaid providers and suppliers (including nursing homes) be vaccinated. The Supreme Court upheld the staff vaccination mandate.
A new study of 15,042 nursing facilities finds that between May 30, 2021 and January 30, 2022, “an increase in staff vaccination rates of 10 percentage points was associated with fewer weekly COVID-19 cases among residents, fewer weekly COVID-19 deaths among residents, and fewer weekly COVID-19 cases among staff.” The study also found that staff vaccinations were not effective during the Omicron variant wave (May 30-December 5, 2021). Describing boosters as necessary for later COVID-19 waves, the study’s authors suggest that policy makers consider policy options to increase boosters among staff.
One study co-author told McKnight’s Long-Term Care News that a 10% increase in staff vaccination rates would have resulted in more than 20,000 fewer resident deaths. The other co-author said that high staff vaccination rates would not have been achieved without a federal mandate. Both authors told the on-line newsletter thatCMS policies cannot remain “stagnant” but must evolve “‘in the form of extending mandates for booster doses for staff in nursing homes” in order “‘to prevent a return to the early days of the pandemic when mounting nursing home deaths seemed almost inevitable.’”
To date, CMS is sending a different message. In guidance issued October 26, 2022, CMS minimized the significance of noncompliance with staff vaccination requirements. CMS directed surveyors to cite nursing homes’ noncompliance with staff vaccination mandates at the lowest of four levels of noncompliance, severity level 1 (which is defined as “no actual harm with the potential for no more than minimal harm,” or substantial compliance). Even when surveyors identify “egregious noncompliance” – “a complete disregard” for staff vaccination requirements – CMS said noncompliance should be cited only at level 2 (which is defined as “no actual harm with the potential for more than minimal harm,” or “no harm,” for short). Financial penalties are not usually imposed for level 1 or 2 deficiencies. CMS encourages staff vaccination and continues to require 100% vaccination as the standard of care, but it will apparently not take meaningful enforcement action against facilities’ noncompliance.
Some states are pressuring CMS to go even further in the wrong direction. On November 17, 2022, 22 states, led by Montana Attorney General Austin Knudesen, filed a Petition for Rulemaking, asking CMS to repeal the November 2021 interim final rule requiring health care staff to be vaccinated.
Vaccinations and boosters save lives. CMS policies and guidance must be updated to address current COVID-19 threats.
January 5, 2023 – T. Edelman