LOWRY CITY, Mo. — At Truman Lake Manor in rural Missouri, every day begins the same way for every employee who walks through the nursing home doors — with a swab in the nose, a swirl of test solution, and a brief wait to see if a a thin red line appears indicating a positive case of COVID-19.
Only the healthy are allowed in to care for virus-free residents.
Despite these precautions, an outbreak of the coronavirus hit the facility late last year. An inspector later cited him for violating the federal government’s COVID-19 vaccination mandate for healthcare facilities.
Truman Lake Manor is one of approximately 750 nursing homes and 110 hospitals nationwide filed for violating federal staff vaccination rules during the past year, according to an Associated Press analysis of data from the Centers for Medicare & Medicaid Services. . Most have been given a bureaucratic push to do better, although some care homes have also received fines, especially when they have had many other problems.
One year after it began its nationwide enforcement on Feb. 20, 2022, vaccination mandates affecting about 10 million health care workers are the last major mandate left from President Joe Biden’s sweeping bid to boost vaccination rates national. Similar requirements for large employers, military members and federal contractors have all been abolished, repealed or partially blocked.
The health care vaccination mandate is expected to run through November 2024. But some say it’s time to stop now, citing fewer severe COVID-19 cases, a shortage of health care workers, and the impending May 11 deadline of a national public health emergency that has been in place since January 2020.
“Their regulations are making it harder to give care, not easier,” said Tim Corbin, the administrator of Truman Lake Manor who also serves as a nurse, adding that “terms need to end.”
CMS said in a statement to the AP that “the requirement for staff to be fully vaccinated has been a critical step in the response to the pandemic” and “has saved Americans from countless infections, hospitalizations and deaths.”
The policy requires workers, contractors and volunteers at facilities receiving Medicare or Medicaid payments to have the full primary dose of an original COVID-19 vaccine, with exemptions for medical or religious reasons. While nursing homes can be fined for violations, CMS has generally given violating facilities more time to update their policies and comply.
The Republican-led US House recently passed legislation that would end the mandate, but the bill is unlikely to pass the Democrat-led Senate.
Meanwhile, the requirement continues with mixed results and, in some cases, widespread exceptions.
When a state inspector visited Truman Lake Manor in December, an outbreak of the coronavirus had infected 26 of the 60 residents and about a quarter of the staff in the previous weeks. Corbin said the outbreak originated from an unvaccinated employee with a religious exemption who tested negative for COVID-19 before shift work and wore a mask. The employee was not feeling well and tested positive after arriving home.
The inspector found that more than 40% of staff had been granted religious exemptions from being vaccinated. But the federal Centers for Medicare and Medicaid Services are not examining the rationale for those exemptions. The reason the facility was cited for vaccination shortfalls was because three employees had not received their second dose of vaccine and had no exemptions on record. After the subpoena, each got a second strike, and regulators approved the fixes in January.
It’s hard to find workers willing to get vaccinated, Corbin said, because many local residents remain opposed to the vaccine or doubt its effectiveness. Only 42 percent of adults in St. Clair County are vaccinated against COVID-19, a rate just half the national average.
Workforce shortages are forcing more than half of nursing homes nationwide to limit resident admissions, according to the American Health Care Association, which represents long-term care facilities. While most other health care sectors rebounded, nursing home employment fell 13% in 2022 from pre-pandemic levels and reached lows not seen since the 1990s.
LeadingAge, an association of non-profit nursing homes and other aging service providers, initially supported the mandate and still encourages vaccinations. But now he says a federal requirement is no longer needed.
Although deaths have dropped significantly since their January 2021 peak, older adults and people with underlying health issues remain more susceptible to severe cases of COVID-19. For this reason, some medical professionals believe the vaccine mandate should continue in nursing homes and hospitals.
“This is an important requirement,” said Dr. Georges Benjamin, executive director of the American Public Health Association. “Not only does it protect the healthcare worker themselves, but it also protects the patients.”
Nationwide, about 5 percent of the more than 15,000 nursing homes caring for Medicare or Medicaid patients were cited for violating their COVID-19 vaccination mandate, and about 2 percent of 4,900 hospitals, according to the analysis of the AP. But those citations weren’t evenly distributed across states and occurred less often during the second half of 2022.
Twenty-four states have cited no hospitals for COVID-19 vaccination violations.
Texas, which has the most nursing homes nationwide that participate in Medicare or Medicaid, has had just one nursing home cited for violating the vaccination rule.
Kansas, Florida and Texas each declined to check for vaccination violations, instead leaving that process to CMS, which hired contractors. As a result, CMS said Texas received more than $2.5 million in federal funding, Florida more than $1.2 million and Kansas nearly $350,000.
Kansas Gov. Laura Kelly, a Democrat facing reelection in a Republican-leaning state, said last year that the vaccine mandate conflicted with state law and could worsen the workforce shortage.
Nationwide, the number of nursing homes cited for immunization violations dropped sharply after CMS last June stopped requiring state inspectors to check compliance when responding to complaints about unrelated allegations, such as neglect of patients. CMS cited substantial compliance with the vaccination requirement during the change.
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Harjai reported from Los Angeles and is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a non-profit national service program that places reporters on local newsrooms to report on hidden issues.
