Different vaccine mandates for long term care workers

The Biden administration recently rolled out several steps toward getting more Americans vaccinated with two different new rules covering more than 100 million workers and specific guidelines for nursing homes and assisted living facilities.

The first rule, issued by the Occupational Safety and Health Administration (OSHA) covers companies with 100 or more employees, applying to an estimated 84 million workers. It requires companies to ensure that their workers are either fully vaccinated against the coronavirus by January 4, 2022, or that they test negative at least once a week.

But it was temporarily blocked when a three-judge panel for the Louisiana-based Fifth

Circuit Court of Appeals, rejected a Justice Department request. That court said the Biden administration's order exposes companies to "severe financial risk" if they refuse or failed to comply and that might "decimate" their workforces.

A group of companies and individuals, including churches and grocers, filed the suit, seeking a permanent injunction. The groups argued that OSHA usurped its authority by issuing a sweeping mandate. The OSHA mandate will take months to work its way through the court system. But the second rule, which applies to nearly 17 million workers in nursing homes, hospitals, dialysis centers, ambulatory surgical settings and home-health agencies and other Medicare and Medicaid-funded facilities, requires them to be fully vaccinated by Jan. 4. The medical workers rules are tougher than overall OSHA rules. It gives these health care workers no option to instead get tested for the virus. They can, however, still seek exemptions on medical or religious grounds.

The Centers for Medicare and Medicaid (CMS) told healthcare providers that it would tie COVID-19 vaccinations to Medicare and Medicaid funding in September. That prompted nursing home workers to increase vaccination rates by about nine percentage points from 62% to 71%. The latest emergency regulation aims to boost vaccination rates among the general health care worker population and create a more consistent standard within Medicare and Medicaid.

The nursing home rules immediately drew concern from the largest association of senior living providers. While they said they support the overall intention of getting everyone vaccinated, Mark Parkinson, president and CEO of the American Health Care Association and National Center for Assisted Living, warned the rules would "exacerbate" the already "dire workforce crisis in long term care."

Roughly 75% of nursing home employees nationally are already vaccinated, Parkinson said. But imposing a hard deadline, will likely "push too many (workers) out the door, forcing a staffing crisis at facilities nationwide that revolve around around-the clock care," he warned.

The vast majority of employees fired due to vaccine refusal this year (5,939 out of 6,843 workers fired since June) worked in the health care sector, according to a report by staffing firm Challenger, Gray and Christmas Inc.

Around the country, state nursing care associations report that they continue to struggle to hire enough nurses and that problem has grown during the coronavirus.

The Centers for Medicaid & Medicare Services (CMS) said it concluded that nursing home settings facilitated the spread of COVID-19 in the U.S. and established the specific rules to create a consistent standard to assure patients safety from those providing care for them.

According to CMS numbers, as of September, almost 140,000 residents and 2,100 staff members died at nursing and assisted living facilities in the United States, out of the 750,000 Americans who died due to coronavirus.

The OSHA rules that were sidetracked would cover 100 million employees, about two-thirds of the U.S. workforce, requiring employers to give workers time off to get vaccinated and provide sick leave for workers to recover from any side effects.

In an effort to push workers to choose vaccinations over testing, the rule does not require employers to pay for or provide testing for workers who decline the vaccine. In some cases, though, collective bargaining agreements may dictate otherwise. Some 41% of hospitals across the country have some sort of vaccination mandate in place, according to data from the American Hospital Association.

Medical debt crisis

Do you have emergency money saved to cover medical expenses? A new survey finds that nearly half (46%) of individuals age 65 or older are concerned that a major health situation in their household could lead to medical debt or bankruptcy, even though most are covered by Medicare.

The survey, from MedicareGuide.com, which was released recently, found that 27% of nearly 1,200 adults aged 65 or older, have less than $500 in savings to pay for medical bills. Roughly 25% carry medical debt and more than a third said they found it either difficult or very difficult to pay for health care. More than 28% said they would have to use non-medical savings to pay for a severe illness, including dipping into their retirement accounts.

The survey also found that to pay for medical treatments or severe illness, some 22% of seniors said they would turn to credit cards, while another 15% said they would tap into their retirement savings and 13% said they would draw on other savings.

Surprisingly, however, one third of those interviewed, said they had more than $6,000 set aside in medical savings, which demonstrates the divergent financial circumstances many seniors are dealing with.

The survey had some other disturbing results. Those without medical savings continue to face tough choices over their health care. Roughly 25% of the seniors surveyed said they have deferred treatment for dental, hearing or vision issues because of lack of funds. Nearly one-third (29%) have had to put off other expenses, such as home repair, to afford health care, while nearly two-thirds (65%) have tried to save on prescription drugs by buying in bulk or using generic versions.

A recent Gallup/West Health poll continues to point to the stresses people are dealing with over high health care costs and mounting drug costs. An estimated 18 million Americans – or 7% of U.S. adults – said that within the previous three months they had been unable to pay for at least one doctor-prescribed medication. The situation is even worse for low-income households with annual income of less than $24,000, with almost 20% unable to pay for at least one prescription medication in the prior three months. The survey, of almost 5,000 adults, also found that about 1 in 10 adults say they've skipped a pill in the prior year as a way to save money.

The high cost of medical care in the U.S. has also led to huge increases in medical debts, which skyrocketed during the pandemic and now stands as the largest source of debt collection, a recent study published in the Journal of the American Medical Association said.

Also contributing to this column were: NPR, CBS, CNBC, Kaiser Health News and Gobankingrates.com.