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Vaccination Requirement for Workers and Regulatory Waivers to End

May 02, 2023

On May 1, 2023, the Biden Administration announced it would be ending the federal requirement that nursing home workers be vaccinated against COVID-19 on May 11, 2023, the end of the Public Health Emergency (PHE). Additionally, the Centers for Medicare & Medicaid Services (CMS) issued new guidance addressing how the end of the PHE would affect certain regulatory waivers that had been issued to nursing homes at the beginning of the PHE.

Consumer Voice opposes lifting the requirement that nursing home workers be vaccinated against COVID-19. COVID-19 vaccinations have proven to be the most effective protection for nursing home residents. For the week ending December 13, 2020, there were 34,101 COVID-19 cases reported in nursing homes, along with 6,077 resident deaths. For workers, those numbers were 29,086 cases and 42 deaths. A month later, for the week ending February 21, 2021, the number of COVID-19 cases for residents had dropped to 2,316 resident cases and 879 resident deaths. For workers, the numbers were 3,018 cases and 25 deaths. These precipitous declines in cases and deaths correspond with the introduction of COVID-19 vaccinations for both residents and workers. Since then, COVID-19 vaccinations have likely saved the lives of tens of thousands of nursing home residents.

Nursing home residents suffered disproportionately during the COVID-19 pandemic. COVID-19 vaccines have been the most effective tool in protecting residents from contracting COVID-19 and dying. Despite the end of the PHE, COVID-19 is still present in nursing homes and in our communities. Fortunately, vaccinations have significantly reduced the likelihood of death from COVID-19. Consumer Voice is concerned that lifting the requirement that staff be vaccinated will put both residents and staff at increased risk for spreading and contracting the virus and experiencing severe illness or even death. Further, it sends the wrong message to both residents and workers that vaccination is not important and could reduce the rates of vaccination in both residents and staff.

Additionally, yesterday, CMS released new guidance regarding regulatory waivers due to expire on May 11, 2023. CMS had issued numerous waivers at the beginning of the COVID-19 pandemic, which were, according to CMS, designed to provide nursing homes “flexibilities” in treating residents during the pandemic. While many of these waivers have been rescinded, several remain in effect, but will now terminate at the end of the PHE. The terminating waivers include:

  • Nursing homes will no longer be able to employ untrained workers: CMS had issued a waiver allowing nursing homes to employ workers as CNAs, who had not met the regulatory training and certification requirements. While this waiver was due to end last year, CMS continued to allow many states to employ untrained workers. When the PHE ends, all workers will need to meet the training and certification requirements within four months. Consumer Voice has strongly opposed this waiver, as we heard from residents, workers, and CMS that these untrained workers were providing substandard care.
  • Three-day hospital stays prior to admission to a nursing home for Medicare residents: CMS had waived the requirement that a Medicare recipient have a three-day hospital stay prior to admission to a nursing home. The three-day requirement will be reinstated at the end of the PHE. Consumer Voice supported this waiver and thinks the three-day hospital stay requirement should be eliminated.
  • Resident Grouping, Cohorting, and Transfer and Discharge: CMS had waived certain resident protections to allow facilities to group residents based on COVID-19 status and to transfer/discharge residents without notice to cohort them with other residents with similar COVID-19 status. All of these waivers will be lifted, and facilities will no longer be able to group or transfer residents, without their consent, based on COVID-19 status. The notice requirement prior to discharge or transfer is reinstated, as well.

Importantly, the result of most of the waivers expiring will reinstate important protections for nursing home residents. We urge the Biden Administration and CMS to reconsider lifting the requirement that nursing home staff be vaccinated. The COVID-19 pandemic may seem over for some, but it is still very real for nursing home residents. We must continue to be vigilant and protect our most vulnerable citizens. 

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