New federal rule requires Wisconsin nursing home workers to get COVID-19 vaccine by Jan. 4, but leaves out assisted living
Nursing home workers will be required to be fully vaccinated against COVID-19 by Jan. 4, under a federal rule that took effect Friday, though federal regulators say the rule doesn't apply to assisted living facilities.
The rule requires nursing home workers, as well as workers in other health care settings, such as hospitals and home health agencies, to be fully vaccinated with either two doses of the Pfizer or Moderna vaccine, or one dose of the Johnson & Johnson vaccine by Jan. 4.
Under the rule, nursing home workers will not have the option of undergoing regular testing in lieu of vaccination.
John Sauer, president and CEO of LeadingAge Wisconsin, a statewide association of nursing homes and other long-term care providers, said it would be a challenge to get everyone vaccinated by Jan. 4, calling the time frame "more than ambitious."
"I support the idea ... that everyone should be vaccinated, whether they work in long-term care or not, but our desire to have people vaccinated doesn't create a magic wand," he said. "We're still a long way from achieving 100% vaccination rate."
The rule was issued more than two months after President Joe Biden announced in August that his administration would require the vaccine for all nursing home workers. The Biden administration then decided in September to expand the mandate to hospitals and other facilities that take payments from Medicare and Medicaid, effectively delaying the release of the rule.
More: Federal COVID-19 vaccine mandate aims to boost stagnant rates in nursing home staff, but raises fears of deepening staff shortages
In Wisconsin, nursing home vaccination rates have improved only slightly in the last few months and have remained stubbornly low in certain facilities. Meanwhile, more nursing homes have reported outbreaks of COVID-19 and new cases have ticked up, though case counts have stayed well below levels seen last November at the pandemic's peak.
About 69 nursing home residents in Wisconsin have died with COVID-19 in the last three months reported to the federal government, according to data that the nursing homes are required to submit weekly.
Most nursing home residents - nearly 89% - have been fully vaccinated, but they remain vulnerable to breakthrough infections because so many are older and have underlying medical conditions.
Overall, about 70% of Wisconsin nursing home workers have been fully vaccinated, an improvement of about 8 percentage points from three months ago. However, that percentage obscures large disparities between facilities and between types of workers in nursing homes.
Federal data show that aides, who provide the most direct care to residents, are the least likely of nursing home workers to be fully vaccinated, according to health service researchers and other academics.
In the Wisconsin nursing homes that reported detailed staff vaccination data in the latest week for which the data was available, only about 55% of aides had been fully vaccinated, compared to nearly 70% of nurses and 75% of therapists.
Vaccination rates also vary widely from nursing home to nursing home. In some facilities, as few as a third of workers have been fully vaccinated, ultimately increasing the risk of an outbreak.
At Riverdale Health Care Center in Muscoda, where only about 35% of the workers were fully vaccinated, 14 residents tested positive for COVID-19 in the first few weeks of October. Five of those who had COVID-19 died in a two-week span, making it the deadliest outbreak in a Wisconsin nursing home in months, according to the federal data.
Ashley Kohls, chief director of operations for Bedrock Healthcare facilities in Wisconsin, including Riverdale, said Friday that the outbreak is over, and residents are no longer under quarantine.
She did not answer how the outbreak started. Federal data show a staff member tested positive for COVID-19 the week before residents started getting sick. She did not answer Friday whether the staff member had been vaccinated.
Kohls said nursing home officials would continue to educate staff about the COVID-19 vaccines, and expressed confidence that the facility would be able to comply with the federal requirement by Jan. 4.
Nursing homes that don’t comply with the rule could face fines, penalties or, in more serious cases, loss of Medicare and Medicaid funding. State inspectors will largely be responsible for inspecting the facilities and ensuring they comply with the vaccination requirement. Facilities that don’t meet the vaccine mandate will be given multiple chances to improve vaccination compliance, officials have said.
The federal rule allows exemptions for medical reasons and sincerely held religious beliefs.
Sauer, of LeadingAge Wisconsin, said that at this point, it is unclear how much time facilities will be given to come into compliance if they don't meet 100% vaccination by Jan. 4 or how stringent the penalties for noncompliance will be.
"I’m hoping that as we go through this, we're going to find that there is more time before the heavy hand of enforcement takes over and the line in the sand is drawn and we're going to have to terminate employees," he said.
Mandate doesn't apply to assisted living
Nursing home groups had called for the mandate to apply evenly across health care sectors.
"The fact that it does not apply to assisted living facilities ... in the state creates a tremendous hole in what the administration is attempting to accomplish," said Rick Abrams, president and CEO of the Wisconsin Health Care Association, which represents many nursing homes and assisted living facilities in the state.
He worries that nursing home workers who decline the vaccine could simply switch to jobs in assisted living, further exacerbating staffing shortages at nursing homes.
The federal government does not have much leverage over assisted living facilities, which - unlike nursing homes - do not heavily rely on Medicaid and Medicare funds, said R. Tamara Konetzka, a health sciences professor at the University of Chicago.
"There's no scientific reason that these mandates should not include assisted living," she said, adding that nursing home and assisted living residents are at a similarly high risk of severe illness from COVID-19. "The difference is completely in what authority and leverage the federal government has."
It is unclear how many assisted living workers in Wisconsin have gotten the vaccine. Those facilities are regulated by the state and are not subject to the same reporting requirements that nursing homes are.
In emails to the Wisconsin Department of Health Services, spokespeople did not answer questions about vaccination rates at assisted living facilities in the state.
Some assisted living facilities could still be covered by another federal vaccine requirement for businesses with 100 or more employees. However, those workers have the option to undergo regular testing in lieu of getting the vaccine.
Even before that regulation was issued, some assisted living operators, including Brookdale Senior Living, chose to impose vaccine requirements on their own.
Some states, including Massachusetts and Washington, have chosen to require the vaccine of assisted living workers.
Sarah Volpenhein is a Report for America corps reporter who focuses on news of value to underserved communities for the Milwaukee Journal Sentinel. Email her at firstname.lastname@example.org. Please consider supporting journalism that informs our democracy with a tax-deductible gift to this reporting effort at JSOnline.com/RFA.
This article originally appeared on Milwaukee Journal Sentinel: Wisconsin nursing home workers must get COVID-19 vaccine by Jan. 4