| Dear readers: As The Post's beloved editor Ben Bradlee said, "It changes your life, the pursuit of truth." It has certainly changed mine as I've written The Health 202 over the past 4½ years. I've composed at least 800 editions of the newsletter since we first launched it, exploring a wide range of topics inside the wild (and sometimes bewildering) world of health policy. It's been an immense privilege to follow these stories wherever they lead and share them with you. Thank you from the bottom of my heart for staying with me through it all — and please stick around, because we're not going anywhere! While this is my last edition of The Health 202 as full-time author (I'll now be editing the newsletter), I leave you in excellent hands with the superlative Rachel Roubein, who brings a wealth of experience, insight and, most importantly, curiosity to the job. Rachel joins us from Politico, where she has reported on health care for nearly a decade. Watch for her byline — and more about her — on Tuesday. The Biden administration will require nursing home workers to get vaccinated against the coronavirus, and there's a possibility hospital staffers could be next. The reasoning is clear: Medical workers should be protected from passing the virus to the most vulnerable Americans — particularly as the delta variant refuels the pandemic. And the nation's largest network of nursing homes has already instituted its own vaccine requirement for staff. Yet the major nursing home associations are pushing back, saying they shouldn't be singled out and raising concerns about worsening staff shortages over the mandate. The Department of Health and Human Services will use its funding leverage over long-term care facilities.The administration said yesterday it will develop rules requiring nursing homes to mandate that all of their workers be vaccinated as a condition for those facilities to receive federal funds, The Post's Tyler Pager and Annie Linskey report. HHS, which is developing the new regulations, will enforce them with the threat of withholding Medicare and Medicaid dollars — the major source of funding for more than 15,000 nursing home facilities, which employ roughly 1.3 million workers. | Larry Levitt, senior vice president at the Kaiser Family Foundation, noted it's not the first time the government has taken this tactic: |  | | | "If you visit, live or work in a nursing home, you should not be at a high risk of contracting covid from unvaccinated employees," Biden said. As my colleagues previously noted, the effort "is part of a far more muscular approach by the Biden administration to increase vaccinations amid spiking cases due to the highly contagious delta variant." Indeed, coronavirus cases have shot up in parts of the country in recent weeks, while deaths — albeit rising more slowly — are back to levels seen in May, about 620 per day. Nursing homes said they want their staff vaccinated – but they also don't want to be singled out. - LeadingAge, which represents nonprofit providers of aging services, said penalizing nursing homes "is not the right way to increase vaccination rates."
- The leading group representing long-term care providers complained that the administration was singling out nursing homes and should have instead applied the mandate more broadly to other health providers. "Unfortunately, this action does not go far enough," Mark Parkinson, president of the American Health Care Association and National Center for Assisted Living, said in a statement. "Vaccination mandates for health care personnel should be applied to all health care settings. Without this, nursing homes face a disastrous workforce challenge."
The fear Parkinson was articulating is that health-care workers — whose vaccine hesitancy rates are similar to those among the general public — might choose to leave their job rather than get the shots. And that could intensify personnel shortages that are already a problem across the country. Ninety-four percent of nursing homes surveyed by AHCA said they are experiencing a staffing shortage. Hospitals are experiencing nursing shortages — and lately those have been particularly apparent in areas where the coronavirus is especially surging, as our colleague Amy Goldstein recently reported. "They've got PPE and other supplies," Chip Kahn, president of the Federation of American Hospitals, told me. "The big problem is staffing, and so the question is: does this get in the way of staffing?"  A health care worker is injected with the Pfizer vaccine at a hospital in Providence, R.I. (AP Photo/David Goldman, File) | There are some examples of this happening in hospitals.Earlier in the summer, more than 150 health-care workers were fired or resigned from the Houston Methodist hospital system for refusing to comply with its vaccination requirement. New Jersey's largest hospital system fired a half-dozen workers who also refused to get vaccinated. Nursing homes are starting to shift in the direction of mandates, too. A few weeks ago, Genesis Healthcare told workers they need to get the shots in order to keep their jobs. The decision was a major shift for the industry, given that Genesis has 400,000 employees in nearly 400 nursing homes and senior communities. Of course, these examples don't prove that a federal vaccine requirement would lead to widespread hospital staff losses. The Associated Press recently interviewed operators of 10 smaller nursing homes, who said that fears of a massive staff exodus seem to be overblown. But it's a fair question to ask, considering long-standing concerns in the United States over lacking enough medical workers as the population ages. Medical workers are (surprisingly?) hesitant to get vaccinated.One might guess they would be more willing than the general public to get the shots, but that doesn't seem to be the case, especially when it comes to lower-wage workers such as medical aides and assistants. Medscape Medical News found 1 in 4 hospital workers who have direct patient contact hadn't received a single coronavirus vaccine dose by the end of May, when it analyzed government data from 2,500 hospitals around the country. In a March poll conducted by The Post and the Kaiser Family Foundation, 30 percent of front-line medical workers said they either wouldn't get a vaccine or hadn't yet decided whether to get one. The poll found vaccination rates were higher among doctors and nurses compared with those who perform administrative duties or assist with patient care. And hundreds of thousands of nursing home workers still aren't vaccinated. Only about 62 percent of nursing home staff members in the United States were vaccinated as of Aug. 8, ranging at the state level from a low of 44 percent to a high of 88 percent, according to data from the Centers for Medicare and Medicaid Services. | Christina Jewett, investigative reporter for Kaiser Health News: |  | | | A similar mandate could be on the way for hospitals.Yesterday's new vaccination requirement doesn't include hospitals, but health-care lobbyists said the administration has been toying with the idea of extending similar requirements to them. A CMS spokeswoman declined to comment on the matter. Many hospitals have decided on their own to press forward on vaccine mandates. About one-third of hospitals have announced mandatory vaccination policies for their workers so far, a spokesman for the American Hospital Association told me. When asked for a response to the nursing home requirements, AHA emphasized its support for hospitals making their own decisions. "The AHA supports hospitals and health systems that choose, based on local factors, to mandate covid-19 vaccines for their workforce," the statement said. | 
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