Two nursing home workers distribute pasta to two residents in the dining area of a nursing home.
Residents are served in the dining room at Emerald Court in Anaheim, Calif., on March 8, 2021. (Paul Bersebach/MediaNews Group/Orange County Register via Getty Images)
Reading Time: 3 minutes

Federal deadlines to vaccinate all health-care workers against COVID-19 are just weeks away, but the most recent federal data show that roughly a fifth of nursing-home employees are not yet fully vaccinated.

The Supreme Court in January upheld the mandate that covers 76,000 health care facilities and their 10.4 million employees. Now medical employers have until late February or mid-March, depending on what state they’re in, to vaccinate their staffers, or risk losing federal Medicare and Medicaid payments.

What percentage of long-term care workers have been vaccinated varies by state, from 99% in Rhode Island to 68% in Missouri as of Jan. 16, according to data from the Centers for Medicare and Medicaid Services

Some industry leaders worry that nursing homes, which have struggled with staffing issues for years, won’t have enough workers to care for residents if employees quit over vaccination. Whether nursing homes can do a good job caring for residents and avoid horrors like bedsores and medication mix-ups has a lot to do with whether they have enough staff, experts say.

We “remain concerned that the repercussions of the vaccine mandate among health care workers will be devastating to an already decimated long-term care workforce,” said Mark Perkinson, president of the American Health Care Association, which represents nursing homes. “When we are in the midst of another COVID surge, caregivers in vaccine hesitant communities may walk off the job because of this policy, further threatening access to care for thousands of our nation's seniors.”

The lobbying organization pointed to Bureau of Labor Statistics data showing that the industry lost more than 234,000 employees over the course of the pandemic. 

Nursing homes have long struggled to recruit and retain workers. The jobs involve heavy physical labor, and sometimes long hours, for low pay. The median wage for nursing assistants in 2020 was $14.82 per hour, according to federal data.

Julia Liu, a certified nursing assistant in Portland, Oregon, said almost all of her colleagues are vaccinated but that the nursing home where she works part-time still has trouble retaining staff since nursing assistants can make about the same amount of money working retail jobs.

Vaccine hesitancy has persisted among nursing-home workers. As the coronavirus vaccines rolled out in late 2020, the federal government sponsored an effort to inoculate nursing-home residents and workers, but the Center for Public Integrity revealed it succeeded in vaccinating only half of the nation’s long-term care workers by the time it wrapped up its work in early 2021. 

Regulatory agencies must stand by the federal vaccine mandates, said Martha Deaver, an advocate for nursing-home residents and their families in Arkansas, even if it means calling in the National Guard to help out understaffed facilities.

“These are our most frail and vulnerable citizens,” Deaver said. “We are obligated to make sure they’re cared for.”  

Not every facility is struggling to comply with the upcoming mandates. At Tieszen Memorial Home in Marion, South Dakota, where a third of residents died of COVID-19 in the space of five weeks in 2020, all but three of roughly 80 employees are fully vaccinated, said administrator Laura Wilson. The three unvaccinated workers have religious exemptions, approved by a committee at the facility. 

Wilson offered her employees $500 bonuses if they were vaccinated in the first few months it was available and still offers $250 to those who get the shots now. She said she didn’t lose any full-time workers to the upcoming mandate.

“When they were first talking about vaccinations in the fall of 2020, I distinctly remember saying I did not want to be a guinea pig,” Wilson said. “Then we had the outbreak hit, and I honestly could not get a vaccination fast enough because I saw something that could potentially have avoided all the pain and death that I saw in October and November.”

Your support is crucial!

Our newsroom needs to raise $121,000 by end of the year so we can hold the power accountable and strengthen our democracy in 2024. Public Integrity doesn’t have paywalls and doesn’t accept advertising. We depend on individuals like you to sustain quality journalism.

Liz Essley Whyte is a senior reporter covering health inequality at the Center for Public Integrity,...