COVID-19 Vaccine Mandate Boosted Nursing Home Staff Vaccination Rates

May 18, 2022 - Following the COVID-19 vaccine mandate for nursing home staff, the vaccination rate among facility workers increased across the country by 25 percentage points, according to an issue brief from the Kaiser Family Foundation (KFF).

In August 2021, the Biden Administration announced that nursing home staff must get vaccinated against COVID-19 or risk losing Medicare and Medicaid funding. Due to legal pushback, different states had different deadlines for compliance.

Twenty-five states and the District of Columbia had to have completed their vaccinations or have a pending or approved exemption by February 28, 24 states had a March 15 deadline, and the remaining state of Texas had a March 21 deadline.

The KFF analysis reflects data from 14,700 nursing facilities reported by the federal government between August 2021 and March 27, 2022.

Nursing home staff vaccination rates rose from 63 percent in August 2021 to 88 percent in March 2022—after all deadlines for vaccine mandate compliance had passed. Researchers noted that several factors may have contributed to this increase, but it was likely the vaccine mandate that had the most significant impact.

The report found that vaccination rates varied among states, though all states reported an increase in staff vaccination by March 2022.

By March, vaccination rates ranged from 77 percent in Montana and Ohio to 99 percent in Washington DC, Massachusetts, Maine, New York, and Rhode Island.

Following the vaccination deadlines, 12 percent of facilities had staff vaccination rates of 100 percent and 39 percent of nursing homes reported rates over 90 percent but less than 100 percent. Nearly a quarter (24 percent) reported rates between 81 percent and 90 percent, while the remaining 25 percent had vaccination rates of 80 percent or below.

The changes in vaccination rates also varied across states. For example, Hawaii saw a 9 percentage point increase while Georgia saw a 37 percentage point increase.

Nursing homes in ten states had a 30 percentage point or greater increase from August 2021 to March 2022. Meanwhile, facilities in five states reported a 15 percentage point increase or less. This may be because some states already had high vaccination rates in August, while others had low baseline vaccination rates, the report noted.

The issue brief also included booster rates at nursing homes, though the CMS mandate does not require staff to receive booster shots.

As of March 2022, the national booster rate for nursing home staff was 44 percent, rising 17 percentage points from 27 percent in mid-January 2022. The CDC began recommending booster shots for nursing home residents in September 2021 to protect from waning initial vaccine efficacy.

One-third of nursing facilities reported staff booster rates over 50 percent, while another third had rates between 25 and 50 percent, and the remaining third reported rates below 25 percent.

Booster rates for nursing home staff were higher in some states, with Massachusetts reporting a 93 percent booster rate and Florida, Missouri, and Mississippi reporting a 24 percent rate. Eight states had booster rates above 60 percent, while 13 states had rates below 30 percent.

Certain states—including Connecticut, Massachusetts, New Jersey, New York, and California—had booster mandates, contributing to percentage point increases greater than 30 between January and March.

When hospitals and healthcare facilities started mandating staff to receive the COVID-19 vaccine, leaders were concerned that it would exacerbate workforce shortages.

After the vaccine mandate deadlines passed, 28 percent of nursing facilities reported staffing shortages, ranging from 63 percent of facilities in Alaska to 3 percent in California. However, researchers noted that these staffing shortages are not necessarily attributed to the vaccine mandate.

“Data suggest that the vaccine mandate has not exacerbated staffing shortages to the extent initially hypothesized since shortages have actually fallen nationally since January 2022,” the brief stated. “There are likely a multitude of factors that impact staffing shortages beyond the vaccine mandate.”

While nursing homes continue to face staffing shortages, KFF researchers determined that the COVID-19 vaccination mandate likely did not exacerbate shortages and played a role in boosting the vaccination rate among staff.