With the vaccination rate for staffers in New York state's long-term care facilities jumping from 70% to 92% following a state mandate last week, nursing home advocates are urging the Biden administration to launch a similar mandate for long-term care facilities nationwide -- but the federal agency that oversees nursing home standards has yet to provide guidance on the matter.
Biden administration officials announced in August that long-term care staffers would soon have to get vaccinated, but the Centers for Medicare & Medicaid Services (CMS) has yet to implement the policy. In the meantime, the vaccination rate among long-term care employees nationwide is languishing at just over 65%.
"The federal mandate was welcomed, but the lack of guidance is concerning," said Michael Wasserman, the past president of the California Association for Long Term Care Medicine and a member of California's Vaccine Advisory Committee. "Having unvaccinated staff caring for residents will result in the transmission of the virus and therefore deaths."
"We cannot implement this soon enough," Wasserman said. "Every day that goes by without guidance will inevitably lead to more deaths."
CMS officials said in a press release last month that they intend to release emergency vaccine regulations in mid to late October. In the meantime, CMS officials told ABC News, the agency is encouraging staff across all health care settings to get vaccinated, and are encouraging all facilities to "take advantage of the resources available from CMS" to promote the benefits of the COVID-19 vaccine.
Back in August, John Knox Village in Missouri was among the providers that were waiting to get additional guidance from CMS before taking further action, so they could fully understand exactly what the mandate entails. Two months later, they're still waiting for further guidance.
John Knox Village spokesperson Emily Banyas told ABC News that in the meantime, the facility is continuing with its voluntary biweekly vaccination clinics. The staff vaccination rate at the facility is up 5% over last month -- but is still only around 65%.
Overall, only about half the staff in Missouri's long-term care facilities had been fully vaccinated as of Sept. 19, according to the latest data available from CMS, making Missouri one of the lowest-vaccinated states in the country.
In Oklahoma, where the staff vaccination rate is 51.7%, a long-term care executive told ABC News she's hopeful the federal mandate will increase staff vaccination rates -- especially in rural areas. Mary Brinkley, executive director of the Oklahoma chapter of the elder advocacy group LeadingAge, said that in the meantime, providers in rural areas are making a concerted effort to increase their voluntary vaccination rates, with some nursing home operators achieving rates of 80% to 95%.
But in Montana, where the staff vaccination rate is 59.8%, the federal mandate could be the only way the state will see a big increase in employee vaccinations. Due to a state law that bans employers from requiring vaccinations, Montana Health Care Association Executive Director Rose Hughes said that unless a federal mandate is implemented to create an exception for long-term care providers, there's "nothing else they can do" other than to "continuously try to convince staff to get vaccinated through education and information."
However Hughes also told ABC News that she expects a "significant number" of staff to resign when the federal mandate takes effect. Some facilities have already reported losing staff amid the looming order, Hughes said.
In Kentucky, where the vaccination rate among long-term care staff is just 56.2%, a spokesperson for the Kentucky Association of Health Care Facilities said that despite concerns about possible staff resignations, the organization supports employer vaccine mandates and is hopeful that Biden's mandate will result in a significant increase in COVID-19 vaccinations among staff.
As of Sept. 19, about a month after the Biden administration announced plans to require long-term care facilities to vaccinate their staffs or lose Medicare and Medicaid benefits, the national staff vaccination rate had only risen 4.3%, from 61.1% to 65.4%, according to CMS data. The previous month, it had risen by 2.5%.
Eric Carlson, a long-term care expert with the advocacy group Justice in Aging, says that the mandate is needed "in order to prevent deaths and to keep nursing facilities open to visitors."
"The COVID vaccines have been game-changers in nursing facilities," Carlson told ABC News. "We know that COVID is particularly deadly for nursing facility residents, and that broad vaccination can reduce COVID rates to close to zero. No one should be waiting for someone else in order to do the right thing."
Lisa Sanders, a national spokesperson for LeadingAge, says it is "highly likely" that an increase in workplace vaccine mandates will lead to an overall increase in the vaccination rate.
"What's needed now -- urgently -- is both the actual rule and guidance for implementation," she said.
In Tennessee, where the staff vaccination rate is just under 54%, Tennessee Health Care Association spokesperson Jay Moore told ABC News that while a few long-term care facilities have voluntarily imposed their own mandate, many providers are waiting for the national guidance because "the landscape is changing so rapidly, and there will always be unexpected nuances when the CMS rules are finally promulgated."
Moore said it's a "fair assessment" to say that the lack of additional CMS guidance has put providers in limbo, but that the federal agency is just being careful because it knows that the mandate will have a "tremendous impact on individuals working in health care, the facilities, and the patients in need of services."
"CMS hopefully is just trying to get it right," Moore said.