Nursing home operators still getting used to last Thursday’s announcement that federal regulators are now publicizing more staffing data also can expect greater detail about staff vaccination rates to be openly shared soon.

The Centers for Medicare & Medicaid Services will start showing the depth of booster vaccination rates for both residents and staff on its consumer-facing Medicare Compare website, said Evan Shulman, director of the agency’s nursing home division. 

This was triggered by the Centers for Disease Control and Prevention’s decision to start collecting “up-to-date” COVID booster rates from providers via their regular submissions to CDC’s National Healthcare Safety Network (NHSN) data gathering system a few weeks ago.

“Just as CMS began posting rates of boosters among residents and staff after the CDC began collecting that in NHSN, I think you can assume we’ll also start posting rates of residents and staff who are up to date,” Shulman told attendees at the NADONA annual meeting in New Orleans.

“I don’t have a time frame for you yet, but I think it’s a pretty safe assumption that we would want to do that since this information is being collected and it’s very helpful for the public to know,” he said during a June 28 session conducted by remote video conferencing.

Shulman praised providers for trying to increase staff vaccination rates. He emphasized that even though official guidance has not dictated that healthcare workers must receive a certain number of COVID boosters, they remain vitally important.

“I know it’s challenging. Be creative, be innovative,” he told the nurse managers. “Look at your staff booster rates and the rates in your county, for those over 18. Maybe challenge your staff to double it. Reapproach those who haven’t  gotten it. Get your vaccine champion, your community champion.”

CMS tries to compare nursing home rates to those of the general public. 

“For residents fully vaccinated who have received a booster, it’s at 83%, compared to 70% for those in the community over 65. So you’re doing much better than those in the community,” Shulman said. “For staff, it’s approximately 53% who have a booster, compared to the general community — of those over 18 — at 51%, so it’s slightly better than the general community. What we’d like to see is a closing of the gap for residents and staff.”

He noted the most recent change about vaccination monitoring is the change in the CDC’s definition of “vaccinated.” Until a few weeks ago, he noted, it meant those who had had shots and boosters or those who had initial shots and were not yet eligible for a booster. A few weeks ago, the CDC included people eligible for a second booster: those over 50 or who had compromised defense systems.

“While we certainly encourage all providers to follow CDC guidance, we have not yet given guidance with regard to surveyors as to the definition of what’s up to date, including second boosters. We hope to have more information about that soon, but we’re not surveying for that now.”

He said providers should be encouraging all staff to get up to date with their vaccinations, no matter what dose they’re eligible for. 

“Rates of severe disease, hospitalizations and severe symptoms are clearly lower than for those who are not up to date,” he noted.

As of late June, the weekly number of COVID-19 cases was 8,000 to 9,000 for residents and 9,000 to 10,000 for staff, he said, citing federal figures. That’s about average for the pandemic era, he said, noting that the numbers have gone as high as 50,000 for residents and 70,000 for staff. On the other end, weekly cases have also been in the 400 to 500 range.

Enforcement eased

Shulman said CMS has actually dialed down its punitive reflex for providers who might miss an NHSN reporting period.

“We’re at a very different place than we were early in the pandemic,” he noted. “In the beginning, we had to get 15,000 nursing homes reporting into the NHSN system, and the vast majority were not reporting previously. So we had to be very strict with enforcement.

“So if a provider missed a week, we would fine them. But now, after two years, if a facility has submitted every single week and they miss one but then they pick back up the next week, we may not fine, especially when you consider what the role of enforcement is. The role of enforcement is to remediate, not to fine as quickly as possible. If the facility reports the next week, they’ve remediated on their own, so that’s what we’re doing.” 

He stressed, however, that providers do not have a free pass to become lackadaisical about reporting. 

“You have to keep it up,” he added. “We don’t want to go back to what we were previously doing. This is our early-warning system. It tells us what’s happening, where the hotspots are. It’s not just for us at the federal level; it’s for you and the health of your peers. So please keep it up. We all benefit.”

Shulman also expressed solidarity with providers on an often controversial subject: the revocation of nurse-aide training programs for facilities with certain deficiencies.

“One of most common questions we get is when a facility is fined for a certain penalty, it automatically disapproves their nurse aide training program. We’re asked why do we have to do that? Actually, it is a federal law. We have no discretion over that,” he explained.

“I agree with you,” he added. “Why would we inhibit a facility’s ability to train new staff when they were just cited and they probably need to train staff? But it is a federal law. We have no discretion over the triggering of it.”

He reminded that a CMS waiver is available for certain providers to allow them to continue such training programs, despite a ban. In addition, he said that providers may apply for waivers for temporary nurse aides who can’t be tested in time to meet the agency’s Oct. 6 deadline for sunsetting the pandemic TNA waiver.

“In April we (removed) several regulatory waivers because we thought cases were stable, and we can’t be operating in emergency mode forever,” Shulman explained. “At some point, we have to be able to integrate how we respond to COVID into our normal operations. We believe we’re very close to there.”

Surveyors update

State surveyors are doing “everything they can” to clear a backlog of surveys that occurred during the pandemic when surveys were suspended, or when state surveyors were pulled to help with their state’s response to COVID, the CMS nursing homes division chief said.

Shulman noted that one of the most common complaints CMS has heard from providers is about the consistency of state survey agencies.

“Consistency within the state, consistency between the states,” he noted. “This is something we’re definitely looking at as we clear the backlog.

“Your work is challenging, super challenging,” he concluded at NADONA. “And people have been trying to improve your work, your environment, for years. If it were easy, none of us would be here and it would have been done already. So we know it’s very, very difficult.”

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