Following an announcement from President Biden this week that all nursing home staff will be required to be fully vaccinated against COVID-19 in a forthcoming regulation, the nursing home industry warned about the potential impact on the profession’s already challenging workforce situation. Industry leaders are deeply concerned that it may cause a mass exodus from the nursing home profession, leaving frail seniors without the caregivers and access to care they need.

The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) should use a thoughtful approach in developing the policy—one that focuses on retaining current staff members, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) said in a letter to HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure.

The association encouraged the administration to strengthen the policy by including all health care settings and provide resources to support providers in their efforts.

In the letter, AHCA/NCAL offered key solutions for federal officials to ensure success:

1. The president’s order should include a vaccine mandate for all health care workers in all Medicare- and Medicaid-certified settings. This is the only way to prevent nursing facility employees from leaving to work in other settings such as hospitals or home health.

2. More education must take place to provide information to vaccine-hesitant staff. “We worked with the CDC on a digital media campaign that targeted facilities,  and we had success in increasing vaccination rates,” the letter said. “Individuals who saw our advertising reported they were more likely to get vaccinated after watching or reading the ads. Unfortunately, there was only $1 million allocated for that campaign, and we quickly exhausted the funds. We ask that the administration, either with us or on its own, dedicate $25 million to restart and expand this effort.”

3. There should be a federally funded daily testing alternative for staff who won’t take the vaccine. This will give the education efforts time to work and prevent a sudden departure of large numbers of staff. “We realize and would support this option being time limited,” the letter said. Currently 16 states and the District of Columbia have implemented vaccine mandates for some or all health care workers. Of these, eight (Delaware, D.C, Hawaii, Maryland, Mississippi, Oregon, Pennsylvania, and Rhode Island) include regular testing for unvaccinated staff as a provision of their mandate.

4. Providers will incur significant expense in agency staff once this policy goes into effect. “We encourage the Administration to set aside $3 billion from the Provider Relief Fund to cover the cost of implementing this program, including use of agency staff [and] recruiting replacement staff, as well as the cost of testing staff,” the letter said. This could either be in the form of a direct payment on a per bed basis at the start of the program, or an application process with funds set aside to cover these costs.

5. “We continue to urge HRSA [Health Resources and Services Administration] to open the portal for the additional Provider Relief Funds, both in the general fund and the rural fund,” the letter said. “The sector is in crisis, and the time to open these funds is now.”

6. CMS should modify its visitation guidance to allow providers to ask visitors about their vaccination and test results and require vaccination or negative tests prior to visits. This should also apply to federal and state survey inspectors and ombudsman.

“Nursing home providers are committed to increasing vaccination rates, but we can’t do it alone,” the letter said. “COVID-19 has exacerbated longstanding workforce challenges in nursing homes, and a vaccine mandate focused solely on this sector would push too many caregivers out of their jobs and facilities to their breaking point.

“Our nation’s most vulnerable deserve full protection from the virus, but they also deserve access to the long term care they need. Federal officials must take a comprehensive and supportive approach.”