Nursing home staff vaccination rates vary widely by state

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Vaccination rates among nursing home staff in the U.S. varies from state to state, with some pretty wide swings, with some states reporting 99% vaccination rates and some states reporting vaccinations of only about 70%.

Data compiled by the Kaiser Family Foundation shows that Massachusetts, Maine, New York and Rhode Island rank at the top of the list with 99% nursing home staff vaccination rates. Washington D.C. also demonstrated a high rate, at 98%.

Ohio showed the lowest rate of vaccination at 70%, followed by Oklahoma (71%), Missouri (71%), Wyoming (75%) and Montana (75%).

Nationally, the nursing home staff vaccination rate is about 84%. Twenty-three states reported staff vaccination rates higher than the national average. Of these 23 states, 14 states plus Washington D.C. reported staff vaccination rates of more than 90%.

Twenty-six states reported staff vaccination rates lower than the national average. All 16 of these states are located in the South, Midwest, and Rocky Mountain regions of the U.S.

WHAT'S THE IMPACT?

Nearly one in four COVID-19 deaths has been in a long-term care facility since the start of the pandemic, according to KFF. Due to the disproportionate impact of COVID-19 on this population, nursing home residents and staff were prioritized to receive the vaccine when the vaccine rollout began in winter 2020-2021. 

Since then, CMS has implemented a healthcare worker vaccination mandate for providers that participate in Medicare and/or Medicaid. Although some states have sued to challenge this rule, it was recently allowed to take effect by the Supreme Court.

In part due to the litigation, facilities in different states have different deadlines to comply with the new rule. CMS guidance required staff to have received their first vaccine dose or have a pending or approved exemption by January 27 in 26 states (25 states plus D.C.), including 25 that did not sue to challenge the rule, and Florida, where courts refused to block the rule. 

Additional CMS guidance set a February 14 deadline for staff to have received their first vaccine dose, or have a pending or approved exemption request, after the Supreme Court allowed the rule to take effect in 24 other states that challenged the rule. 

Finally, CMS guidance set a February 21 deadline for Texas, where a lawsuit was dismissed after the Supreme Court's decision. All guidance specifies that if a facility is above 80% by the first-dose deadline, and has a plan to achieve a 100% single-dose staff vaccination rate within 60 days of the deadline, they will not be subject to additional enforcement action.

While the new CMS rule does not require staff to receive booster shots, nursing home staff booster rates also vary across states, ranging from 17% in three states (Louisiana, Missouri and Mississippi) to 56% in California. Nationally, booster rates among nursing home staff are about 28%.

THE LARGER TREND

In the aftermath of the Supreme Court's decision allowing the rule to take effect, litigation challenging the rule continues in Louisiana, where 14 states challenging the rule are seeking to add new claims to their lawsuit, and Tennessee and Virginia are seeking to join the challengers' case against the federal government.

As the various deadlines pass, nursing homes could be subject to enforcement of the rule through a number of mechanisms, including civil monetary penalties, denial of payments, and termination of participation from the Medicare and Medicaid programs. CMS guidance emphasizes that their "primary goal is to bring health care facilities into compliance," and termination would likely occur "only after providing a facility with an opportunity to make corrections and come into compliance."

When issuing the rule, CMS acknowledged that some staff people may leave their jobs because they don't want to receive the vaccine – but cited examples of vaccine mandates adopted by health systems in Texas and Detroit, a long-term care parent corporation with 250 facilities, and the New York state healthcare worker mandate, all of which resulted in high rates of compliance and few employee resignations.

As with other Medicare and Medicaid federal provider requirements, state surveyors will have primary responsibility for enforcing the rule as part of routine inspections. But CMS has notified states that it may reduce the amount of federal money they receive to support facility oversight and redirect those funds to support federal oversight activities if states don't include facility compliance with all federal requirements in their oversight.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com