Providers are raising concerns that federal vaccine mandates for healthcare facilities upheld by the Supreme Court on Thursday could exacerbate serious staffing shortages across the U.S., threatening care in regions with low vaccination rates.
In a separate ruling, the Supreme Court on Thursday blocked the Biden administration’s vaccine mandate for large employers, voting 6-3 on ideological lines to strike down the rule. The decision is a serious blow to the administration’s pandemic response efforts, and one public health experts noted would set the nation back in its fight against COVID-19, now stretching into a third year.
Cities, states and businesses can still impose their own vaccination requirements, though a number of U.S. states prohibit employers from enacting vaccine mandates and only a handful of large companies have required the jab for their workers.
However, the nation’s highest court, on a 5-4 vote, upheld a vaccination requirement for staff working in facilities that accept Medicare and Medicaid funding. The decision requires the providers to vaccinate their staffs or risk losing federal funding, and applies to about 10.4 million workers in the U.S., according to CMS.
The mandate is supported by major provider organizations as a valuable tool to stop viral spread in healthcare facilities that could extend into the community. Powerful trade groups including the American Medical Association and American Hospital Association applauded the decision on Thursday to keep the mandate.
However, providers also noted requiring immunizations could exacerbate the nation’s worsening staffing crisis, especially in facilities and regions with particularly acute need like nursing homes and in rural areas.
“The AHA has consistently urged all health care workers to be vaccinated and supports hospitals and health systems that require them for their workforce to better protect them, their patients and the communities they care for,” CEO Rick Pollack said in a statement on the ruling. “We also recognize that a vaccine requirement has the potential to create additional workforce staffing issues, at a time when our workforce is already exhausted by the many demands of COVID-19.”
Staffing shortages at long-term care facilities are already at crisis levels, according to nursing home trade group the American Health Care Association and National Center for Assisted Living.
Worker shortages at nursing homes predated the pandemic, but COVID-19 burnout and alternative jobs offering better wages are causing long-term care facilities to bleed nurses and support staff.
“We respect the ruling of the U.S. Supreme Court but remain concerned that the repercussions of the vaccine mandate among health care workers will be devastating to an already decimated long term care workforce,” AHCA CEO Mark Parkinson said in a statement.
The profession has lost more than 230,000 caregivers — almost 15% of the total workforce — since the pandemic began, according to AHCA, which represents some 14,000 nursing homes and assisted living communities in the U.S.
The omicron variant is also contributing to a record number of new staff cases in nursing homes, requiring workers to follow isolation protocols when they test positive. That further winnows available staff.
Vaccine holdouts have pointed to numerous reasons for their hesitancy, but Parkinson cited rampant misinformation as the root cause among the minority of frontline workers who have not yet received a shot.
On average, 80% of staff per nursing home are already vaccinated, according to CMS. But AHCA’s Parkinson urged CMS to consider a regular testing option for unvaccinated staff members, to try and prevent worsening shortages.
“When we are in the midst of another COVID surge, caregivers in vaccine hesitant communities may walk off the job because of this policy, further threatening access to care for thousands of our nation’s seniors,” Parkinson said.
Early signs suggest the omicron wave is plateauing in parts of the Northeast, which was hit earliest by the infectious variant. But nursing homes aren’t the only facilities being slammed by the repercussions of omicron.
Some hospitals have started limiting admissions due to a lack of workers, while others are cutting back on nonemergent services as COVID-19 hospitalizations reach new highs. According to HHS, 19 states currently have less than 15% capacity remaining in their intensive care units as of Thursday.
Several states have sent National Guard members to help fill staffing gaps, including at nursing homes. In Wisconsin, for example, National Guard members are being trained as certified nursing assistants to support hospitals and nursing homes.
Hospitals that have implemented a vaccination mandate before the ruling faced initial backlash from workers, and some had to fire staff. However, most health systems that require vaccination have said the move had widespread compliance and was successful in cutting down on COVID-19 spread (and sick leaves) in their facilities.
The AHA has said it will work to help hospitals comply with the new mandate, while balancing workforce challenges.
Under CMS guidance, currently unvaccinated employees at Medicare- and Medicaid-certified facilities must now get their first vaccine dose by Jan. 27, and be fully vaccinated or receive a valid exemption by Feb. 28.