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After President Joe Biden announced Thursday a new, six-pronged approach to his administration’s COVID-19 strategy that requires most home health workers to be vaccinated against the virus, many questions and concerns remain.
More clarity is likely to come to light as specific agencies deal with the next steps following the mandate’s release, like the Department of Labor (DOL) and the U.S. Centers for Medicare & Medicaid Services (CMS).
“Ensuring that all frontline health care staff are vaccinated just makes sense,” Katie Smith Sloan, the president and CEO of the aging services advocacy organization LeadingAge, said in a statement. “This action not only shores up protection for older adults who move across care settings, but also levels the playing field among providers competing for in-demand health care workers.”
The National Association for Home Care & Hospice (NAHC) immediately had questions for CMS after the announcement, one of which has already been answered. Its president, William A. Dombi, asked who exactly the vaccination requirement would apply to in home health.
The CMS answer to that question was shared with Home Health Care News.
“The staff vaccination requirement would only apply to Medicare and Medicaid-certified provider and supplier types that are regulated under the Conditions of Participation,” the agency said. “If an entity is not regulated under the CoPs, then this requirement would not apply.”
Other questions still remain though, including when the interim final rule would be published, what the deadline for employees to get vaccinated would be, what exemptions would exist and how vaccination status would be monitored, among others.
While the announcement will certainly send some agencies with lower vaccination rates scrambling, it may be welcomed guidance for others.
“I think for many providers this is welcome news, especially those in the home-based care industry, who are looking for consistency and a significant measure by the federal government,” Matt Wolfe, a partner at law firm Parker Poe, told HHCN. “At the same time, providers within the home-based care space are going to have to wait and see exactly how CMS rolls this out, … how it will be implemented, exactly who it would apply to and when they’d be required to comply by.”
For providers that have been teetering the line between making sure they can safely provide care to patients while also not fully mandating vaccines for their employees, the move by the Biden administration is a cause for some relief.
“I think it does provide some relief for those providers who were considering mandates of their own or were looking at states to move forward with one,” Wolfe said. “But, again, we have to keep in mind that there’s still a lot of information we are expecting to see from CMS as we move forward with this.”
The news is also welcome for those providers in states that have already mandated vaccines for home health care workers, like in New York state.
“Without a major national mandate like this, providers had the threat of losing their employees to other industries where vaccinations will not be mandated,” Emina Poricanin, managing attorney of Poricanin Law, told HHCN. “But if other large private employers will require a vaccine also, then the employees’ options are somewhat limited and those home care aides may feel more pressure to become vaccinated and stay employed with their New York home care provider that is requiring the vaccine.”
The penalties for non-compliance are also not yet completely clear, outside of a $14,000 penalty that would likely be enforced by the DOL’s Occupational Safety and Health Administration (OSHA).
The effect on home care providers
An additional part of the announcement was a provision that would require all private-sector businesses with more than 100 employees to require that their workforces be fully vaccinated, or otherwise be subjected to weekly testing. Those employers will also be required to give paid time off to employees to get vaccinated.
A recent study from Caring.com of 2,000 caregivers found that just 50% of them were fully vaccinated. Of those that weren’t, 27% had at least started the vaccination process, while the remaining 23% had not.
The survey also found that vaccine hesitancy was not actually curbed after a full approval from the U.S. Food and Drug Administration (FDA).
While private-pay home-based care providers are not yet subject to mandated vaccine requirements on a federal level, it will still affect many of them considerably.
The first reason is that many of these providers also care for patients through Medicaid, which is obviously a federal payer source. The second is the aforementioned 100-plus-employee provision, with the caveat being that unvaccinated workers can still be tested weekly in lieu of getting the vaccine.
One question for these providers is whether part-time employees will be counted — this could make or break whether a provider is considered to have more or less than 100 employees.
Just 14% of direct care workers in the home-based care field work 40 or more hours per week, with many opting for more flexible schedules due to non-economic obligations like child care, according to a recent report from advocacy group PHI.
Additionally, it’s unclear for franchise organizations whether each franchise will be considered its own entity or if the network will be viewed as one.
Some home care operators in places like Los Angeles County have already been mandated by the regulators to comply with mandates, including 24 Hour Home Care.
“We’re in this testing phase right now,” Ryan Iwamoto, the president and co-founder of 24 Hour Home Care, recently told HHCN. “We’re probably at about 50% vaccinated, in terms of caregivers who’ve told us they’ve gotten the shot. With the other 50%, we’re wondering, ‘Are they on the fence? Or are they just going to leave the industry?’ It’s all a bit unknown. We hope most will get [the vaccine], but you never know. And I think that’s what we’re sort of facing right now.”
Other providers still remain in limbo, however. With vaccine hesitancy high and looming federal and state mandates still sometimes unclear, they are in a precarious position.
A sigh of relief
Nursing home operators were among the loudest supporters of a vaccine mandate from the federal government that stretched across the continuum of care. CMS announced on Aug. 19 that all nursing home staff must be vaccinated against the COVID-19 virus, or risk losing Medicare or Medicaid reimbursement.
“It needs to be broadcast to all health care settings, because it will decimate the industry as a whole,” Carespring CEO Chris Chirumbolo said during the Skilled Nursing News Rethink conference in Chicago.
Essentially, nursing home executives feared that a mandate in one setting would simply cause workers to migrate into less-regulated corners of the health care world.
“The problem is singling us out,” Ignite Medical Resorts CEO Tim Fields said at Rethink. “I think that you’ll force some people who just don’t want to get [the vaccine] to go to home health, hospice, hospitals, assisted living and other settings.”
Companies featured in this article:
Caring.com, LeadingAge, National Association for Home Care & Hospice, Parker Poe, Poricanin Law
