Association of State COVID-19 Vaccine Mandates With Staff Vaccination Coverage and Staffing Shortages in US Nursing Homes.

Importance: Several states implemented COVID-19 vaccine mandates for nursing home employees, which may have improved vaccine coverage but may have had the unintended consequence of staff departures.
Objective: To assess whether state vaccine mandates for US nursing home employees are associated with staff vaccination rates and reported staff shortages.
Design Setting and Participants: This cohort study performed event study analyses using National Healthcare Safety Network data from June 6, 2021, through November 14, 2021. Changes in weekly staff vaccination rates and reported staffing shortages were evaluated for nursing homes in states with mandates after the mandate announcement compared with changes in facilities in nonmandate states. An interaction between the mandates and county political leaning was considered. Data analysis was performed from February to March 2022.
Exposures: Weeks after announcement of a state's COVID-19 vaccine mandate.
Main Outcomes and Measures: Weekly percentage of all health care staff at a nursing home who received at least 1 COVID-19 vaccine dose, and a weekly indicator of whether a nursing home reported a staffing shortage.
Results: Among 38 study-eligible states, 26 had no COVID-19 vaccine mandate for nursing home employees, 4 had a mandate with a test-out option, and 8 had a mandate with no test-out option. Ten weeks or more after mandate announcement, nursing homes in states with a mandate and no test-out option experienced a 6.9 percentage point (pp) increase in staff vaccination coverage (95% CI, -0.1 to 13.9); nursing homes in mandate states with a test-out option experienced a 3.1 pp increase (95% CI, 0.5 to 5.7) compared with facilities in nonmandate states. No significant increases were detected in the frequency of reported staffing shortages after a mandate announcement in mandate states with or without test-out options. Increases in vaccination rates in states with mandates were larger in Republican-leaning counties (14.3 pp if no test-out option; 4.3 pp with option), and there was no evidence of increased staffing shortages.
Conclusions and Relevance: The findings of this cohort study suggest that state-level vaccine mandates were associated with increased staff vaccination coverage without increases in reported staffing shortages. Vaccination increases were largest when mandates had no test-out option and were also larger in Republican-leaning counties, which had lower mean baseline vaccination rates. These findings support the use of state mandates for booster doses for nursing home employees because they may improve vaccine coverage, even in areas with greater vaccine hesitancy.
Competing Interests: Conflict of Interest Disclosures: Dr McGarry reports grants from the National Institutes on Aging (NIA) and AHRQ during the conduct of the study. Dr Gandhi reported grants from the NIA (predoctoral fellowship through the National Bureau of Economics Research), the National Institute for Health Care Management, the Washington Center for Equitable Growth, and the University of California Los Angeles, and from the following internal sources: the Society of Hellman Fellows, Price Center for Entrepreneurship & Innovation, the Fink Center for Finance & Investment, the Morrison Center for Marketing & Data Analytics, and the Ziman Center for Real Estate, all outside the submitted work. Dr Syme reported grants from the NIA during the conduct of the study. Dr White reported grants from the NIA during the conduct of the study. Dr Grabowski reported personal fees from Analysis Group, the AARP, GRAIL, RTI International, Medicare Payment Advisory Commission, and Health Care Lawyers PLC, all outside the submitted work. No other disclosures were reported.
(Copyright 2022 McGarry BE et al. JAMA Health Forum.)