The public health vaccination mandate remains in place as some push for an end

LOWRY CITY, Mon. — At Truman Lake Manor in rural Missouri, every day begins the same way for every employee who walks through the nursing home’s doors — with a swab up their nose, a squirt of test solution, and a quick wait to see if a thin one red line appears indicating a positive COVID-19 case.

Only the healthy are allowed in to ensure virus-free residents.

Despite these precautions, a coronavirus outbreak swept through the facility late last year. An inspector then cited it for violating the federal government’s COVID-19 vaccination requirement for healthcare facilities.

Truman Lake Manor is one of about 750 nursing homes and 110 hospitals nationwide charged with violating federal staff vaccination requirements last year, according to an Associated Press analysis of data from the Centers for Medicare & Medicaid Services. Most received a bureaucratic push to do better – although some care homes also received fines, particularly if they had several other problems.

A year after its nationwide enforcement began on February 20, 2022, mandatory vaccination, which will affect an estimated 10 million healthcare workers, is the last remaining major mandate from President Joe Biden’s sweeping attempt to increase national immunization rates. Similar requirements for big employers, military members And federal contractor all were struck down, canceled or partially blocked.

The healthcare mandate to vaccinate is scheduled to run until November 2024. However, some claim it is time to stop now, citing less severe COVID-19 cases, health care workforce shortages and the upcoming expiry on May 11th of a national health emergency that has been in effect since January 2020.

“Their regulations are making them harder to look after – not easier,” said Tim Corbin, Truman Lake Manor’s administrator, who also serves as a nurse, adding that “mandates must end.”

CMS said in a statement to the AP that “requiring staff to be fully vaccinated was a critical step in the response to the pandemic” and “saved Americans from countless infections, hospitalizations and death.”

The policy requires workers, contractors, and volunteers at facilities receiving Medicare or Medicaid payments to receive the full primary dose of an original COVID-19 vaccine, with exceptions for medical or religious reasons. Although nursing homes can be fined for violators, CMS has generally given violating facilities additional time to update their policies and comply with regulations.

The Republican-led US House of Representatives recently passed laws that would halt the mandate, but the bill is unlikely to pass the Democrat-led Senate.

Meanwhile, the request continues with mixed results and – in some cases – widespread exceptions.

When a state inspector visited Truman Lake Manor in December, a coronavirus outbreak in recent weeks had infected 26 of the 60 residents and about a quarter of the staff. Corbin said the outbreak originated from an unvaccinated worker on a religious exemption who tested negative for COVID-19 and wore a mask before working shifts. 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 vaccination. However, the federal Centers for Medicare & Medicaid Services do not review the rationale for such exceptions. The reason the facility was cited for a vaccine shortage was that three staff members had not received their second dose of the vaccine and no exemption was on record. After the subpoena, they each got a second chance, and regulators admitted to the fixes in January.

It’s difficult to find workers willing to get vaccinated, Corbin said, because many local residents continue to oppose the vaccine or doubt its effectiveness. Just 42% of adults in St. Clair County are vaccinated against COVID-19 — a rate barely half the national average.

The 120-bed facility is at half capacity and turning away potential residents “because I can’t hire enough people to take care of them,” said Corbin, who has run ads showing a $5,000 signing bonus touted for nurses.

Rhonda Martin, a nurse educator at the facility, said she understands people’s reluctance to get vaccinated. Despite getting the first shots and a booster shot, Martin still got sick from COVID-19 last fall and missed a few weeks of work.

“At first I was all for the vaccine because I felt like we, as healthcare workers, need to protect ourselves and the patients we care for,” she said. “The longer it goes on, the more the vaccines don’t seem to be helping.”

At a facility in Greenwood, South Carolina, the vaccination order caused a drain of nursing staff that took a while to replenish.

“People were like, ‘You know what? I’ll just stop working,” said David Buckshorn, CEO of Wesley Commons in Greenwood. “Having a requirement that someone has a strong feeling they don’t want to fulfill really limits our ability to get people involved.”

According to the American Health Care Association, which represents long-term care facilities, labor shortages are prompting more than half of nursing homes across the country to limit occupancy of residents. Although most other healthcare sectors have recovered, nursing home employment fell 13% in 2022 comparedto pre-pandemic levels and reached lows not seen since the 1990s.

LeadingAge, a coalition of nonprofit nursing homes and other aging service providers, originally supported the mandate and still promotes vaccination. But it is now said that a federal requirement is no longer needed.

“Our country is in a very different place now than it was in the summer of 2021, when the mandate was originally proposed,” said Katie Smith Sloan, President and CEO of LeadingAge.

Although the deaths are well below theirs Peak in January 2021, older adults and those with underlying health conditions remain more vulnerable to severe cases of COVID-19. Because of this, some medical professionals believe the vaccination 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. “It not only protects the medical staff themselves, but also the patients.”

Some patient advocates continue to support the vaccination mandate.

“The more we lower the requirements in general, the more dangerous it becomes for nursing home residents,” said Marjorie Moore, executive director of St. Louis-based nonprofit VOYCE, which advocates for long-term care residents.

According to the AP analysis, about 5% of the more than 15,000 nursing homes serving Medicare or Medicaid patients nationwide have been charged with COVID-19 immunization violations and about 2% of the 4,900 hospitals. However, these citations were not evenly distributed across the states and occurred less frequently in the second half of 2022.

24 states did not name hospitals for COVID-19 vaccination violations.

Nearly 1 in 5 nursing homes in Louisiana and nearly 1 in 7 in Michigan received vaccination quotes from staff, the highest rates nationwide. In contrast, two or fewer facilities were named in 14 states and the District of Columbia. In Texas, where most nursing homes participate in Medicare or Medicaid statewide, only one nursing home was reported for violating the vaccination rule.

Kansas, Florida and Texas each declined to search for vaccination violations, instead leaving that process to CMS, which hired contractors. As a result, CMS said Texas was docked more than $2.5 million in federal funding, Florida more than $1.2 million, and Kansas nearly $350,000.

Kansas Governor Laura Kelly, a Democrat facing re-election in a Republican state, said last year that the vaccination mandate conflicted with state law and could exacerbate labor shortages.

Like Kansas, Kentucky has a Democratic governor with a Republican-led legislature. But Gov. Andy Beshear’s administration said state inspectors had found no vaccination deficiencies because all hospitals and nursing homes met federal guidelines in accounting for exemptions.

“We were pioneers in promoting vaccines,” said Betsy Johnson, president of the Kentucky Association of Health Care Facilities and the Kentucky Center for Assisted Living. “We understand that vaccines save lives.”

Nationwide, the number of nursing homes cited for immunization violations fell noticeably after CMS last June stopped requiring state inspectors to review compliance when responding to complaints about unrelated allegations such as patient neglect. CMS cites significantly Compliance with vaccination requirements while making the change.

Previously, Gil-Mor Manor in rural Morgan, Minnesota, was one of only three facilities named for the worst deficiencies category, indicating a widespread “imminent danger” to residents.

A May inspection report said the facility for 15 unvaccinated staff with religious exceptions lacked policies to curb the spread of COVID-19 — such as restricting the spread of COVID-19. B. the requirement for N95 masks. Three other employees who look after patients are neither vaccinated nor released.

The “outages resulted in 7 out of 27 residents contracting COVID-19,” the report said.

The nursing home responded by approving exceptions for the unvaccinated staff, updating its policies and hiring a consultant to provide additional training for its infection control nurse, facility administrator Terrie Rothmeier said. Inspectors removed the imminent threat designation within three weeks. The institution was not penalized.

“We have solved the problem,” said Rothmeier.


Harjai reported from Los Angeles and is a corps member of the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that brings journalists into local newsrooms to cover undercover topics.

Copyright 2023 The Associated Press. All rights reserved. This material may not be published, broadcast, transcribed or redistributed without permission. The public health vaccination mandate remains in place as some push for an end

Sarah Y. Kim

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