key: cord-1016018-wzz69xiw
authors: Bernardo, Michael J.
title: CMS' One-Size-Fits-All Mandate on Vaccines for all Health Care Workers Is a Bad Idea
date: 2021-12-05
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2021.11.014
sha: a1c71017578f6c3fdca1f3954c106bb0697cdd7e
doc_id: 1016018
cord_uid: wzz69xiw

nan

Letter to the Editor CMS' One-Size-Fits-All Mandate on Vaccines for all Health Care Workers Is a Bad Idea Q 1 To the Editor: As a medical director for nursing homes in rural South Carolina, I wanted to give my perspective "from the trenches" regarding the recent editorial in JAMDA "Mandating COVID-19 Vaccine for Nursing Home Staff: An Ethical Obligation" by Dumyati et al. 1 Our nursing homes certainly faced a dire situation in 2020. At that time, staff frequently transmitted COVID-19 infections to residents, with catastrophic results. Sadly, nursing home residents, which make up roughly 0.5% of the US population, accounted for 30% to 40% of all COVID-19 deaths in the United States in 2020. In the 4 facilities where I serve as medical director, we had approximately 280 infections, with 80 deaths. It was undoubtedly the most grim, depressing time of my 30 years as a physiciandand of course equally devastating to nursing home staff, residents, and their families.

What has happened in 2021? This year, staff transmission of COVID-19 infections to residents is no longer the main problem. After vaccinating almost 90% of nursing home residents, and more than 70% of staff, deaths of these residents nationwide have plummeted. 2 And this year in my homes, only 5 residents have become infected, all with mild cases and no deaths. So, what is the major problem facing nursing homes now? Clearly, the problem now is widespread staff shortages, particularly of nurses and certified nursing assistants. In September 2021, the American Health Care Association (AHCA) released "State of the Long-Term Care Industry," a survey that revealed 99% of nursing homes nationwide faced staffing shortages, 99% were asking current staff to work overtime, and nearly 80% concerned that workforce shortages might force them to close. 3 The truth is that COVID-19 infections in the nursing home setting are tremendously reduced this year. Therefore, it seems the government is attempting to "fix" a problem in the nursing home (and I would venture, in other health care settings as well) that has already been fixed by the large number of vaccinations previously administered, and is in the process of making the real, current problemdhealth care staff shortages, especially in the nursing homedmassively worse.

I believe it is a worthy goal to strive for maximum staff vaccination rates, and I was vaccinated earlier this year. But there is no reason we need to attain 100% vaccination rates of staff in our nursing homes. Interestingly, a CDC guideline on Vaccination to Prevent Outbreaks 4 presents data from the National Healthcare Safety Network that shows a reduction in resident infection with increased staff vaccination in skilled nursing facilitiesdup to the third quartile (60%-74% staff vaccine coverage). But it also revealed no significant reduction in resident infection when staff vaccination rates are 75%. If the data show that 60% to 74% staff vaccination rates are effective, and experience on the ground over the last several months would bear that out, why push for 100% vaccination and exacerbate a potential staffing shortage nightmare?

The Biden Administration may have the best of intentions regarding mandating vaccination for 100% of health care workers, and in certain scenarios it may be reasonable to institute. But we face a potentially catastrophic situation if this requirement for 100% vaccination of nursing home staff is enacteddfor some, it may mean closure, forcing their residents to find other places for care, but for others, it will mean greater difficulty providing care in significantly understaffed homes. This mandate will punish the remaining nursing home staff who are already overworked, and ultimately our frailest elders as well. For their sake, it should not be enacted. 8  9  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55 

Mandating COVID-19 vaccine for nursing home staff: an ethical obligation

COVID-19 nursing home data

American Health Care Association. National Center for Assisted Living. State of the long term care industry

Vaccination to prevent COVID-19 outbreaks with current and emergent variants e United States

Geriatrics & Home Care

on behalf of AMDA e The Society for Post-Acute and Long-Term Care Medicine