This week’s contributor is Jasmine Travers, an Assistant Professor at New York University Rory Meyers College of Nursing. Her research focuses on mitigating disparities in access and use of in-home and facility-based long-term care for older adults. Jasmine is a member of the 2022 Tradeoffs Research Council.

In the summer of 2021, more than a year into the COVID-19 pandemic, many U.S. states were looking to further protect one of the nation’s most at-risk groups – those living and working in nursing homes – by requiring all staff to be vaccinated. 

But many nursing home administrators were reluctant to adopt such mandates. They worried that a vaccination requirement could harm their staff levels, especially when it came to direct care staff, many of whom had expressed reservations about vaccination and mandates in the past. 

Now, a study led by the University of Rochester’s Brian McGarry, and published in JAMA Health Forum, indicates that nursing home administrators’ fears about vaccine mandates have not played out. The researchers analyzed changes in weekly survey responses about staff vaccination rates and staffing shortages reported by facilities between June and November 2021, comparing data from facilities in states that had mandated vaccination with facilities in states that had not. 

The researchers found:

• By November 2021, nursing homes in states with a COVID vaccine mandate and no test-out option had an average staff vaccination rate of 95% compared to an average vaccination rate near 60% in states without mandates.
• Mandates with test-out options also boosted the average vaccination rate – to 79% by November 2021 – but considerably less than mandates with no test-out options.
• Increases in staff vaccination rates in states with mandates were larger in Republican-leaning counties.
• No significant increases were found in the frequency of reported staffing shortages after state vaccine mandates, with or without test-out options, took effect. 

It is important to consider that this study is based on self-reported data, which can be biased in a variety of ways. The staffing shortage variable also does not allow us to compare how many total staff members left nursing homes in mandate states compared to non-mandate states.

Still, this study clearly concludes that mandates pay off – at little cost to staffing levels. Other work by the Kaiser Family Foundation similarly found staffing shortages to be stable despite vaccine mandates. A 2021 Tradeoffs episode highlighted additional benefits that these vaccine mandates can have, including lower COVID infection rates among staff and residents. 

COVID-19 is not behind us and staffing shortages continue to plague nursing homes across the country. These research findings suggest that strict mandates could be an effective policy tool to help improve staff vaccination rates, including boosters, without exacerbating staffing concerns.