TCU Neeley School of Business/TCU School of Medicine, Texas Christian University, Fort Worth, TX, USA.
TCU Neeley School of Business, Texas Christian University, Fort Worth, TX, USA.
J Am Med Dir Assoc. 2023 Apr;24(4):451-458. doi: 10.1016/j.jamda.2022.12.024. Epub 2023 Jan 6.
To assess the federal COVID-19 vaccine mandate's effects on nursing homes' nurse aide and licensed nurse staffing levels in states both with and without state-level vaccine mandates.
Cross-sectional study using data from Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, and Economic Innovation Group. Including nursing home facility fixed effects provides evidence on the intertemporal effects of the federal vaccine mandate within nursing homes.
The sample contains 15,031 nursing homes, representing all US nursing homes with available data.
On January 13, 2022, the US Supreme Court upheld the federal COVID-19 vaccine mandate for health care workers in Medicare- and Medicaid-eligible facilities, with workers generally required to be vaccinated by March 20, 2022 (ie, the compliance date). We examined actual nursing home staffing levels in 3 time periods: (1) pre-Court decision; (2) precompliance date; and (3) postcompliance date. We separately examined staffing levels for nurse aides and licensed nursing staff. Because 28% of nursing homes were in states with state-imposed vaccine mandates that predated the Supreme Court's ruling, we divided the sample into 2 groups (nursing homes in mandate states vs nonmandate states) and performed all analyses separately.
Staff vaccination rates and staffing levels were higher in mandate states than nonmandate states in all 3 time periods. After the Court's decision, staff vaccination rates increased 5% in nonmandate states and 1% in mandate states (on average). We find little evidence that the Court's vaccine mandate ruling materially affected nurse aide and licensed nurse staffing levels, or that nursing homes in mandate states and nonmandate states were differentially affected by the Court's ruling. Staffing levels over time were generally flat, with some evidence of a modestly greater increase for nurse aide staffing in mandate states than nonmandate states, and a modestly smaller decrease for licensed nurse staffing in mandate states than nonmandate states. Finally, regression results suggest that for both nurse aides and licensed nurses, staffing levels were lower in rural and for-profit nursing homes, and higher in Medicare-only, higher quality, and hospital-based nursing homes.
Results suggest the federal COVID-19 vaccine mandate has not caused clinically material changes in nursing home's nurse aide and licensed nurse staffing levels, which continue to be primarily associated with factors that are well-known to researchers and practitioners.
评估联邦 COVID-19 疫苗授权对有和没有州级疫苗授权的州的养老院护士助理和持照护士人员配备水平的影响。
使用医疗保险和医疗补助服务中心、疾病控制和预防中心以及经济创新集团的数据进行横截面研究。包括养老院设施固定效应，可以提供联邦疫苗授权在养老院内部的时际影响的证据。
样本包含 15031 家养老院，代表所有有可用数据的美国养老院。
2022 年 1 月 13 日，美国最高法院维持了医疗保险和医疗补助合格设施中医疗保健工作者的联邦 COVID-19 疫苗授权，要求工人一般在 2022 年 3 月 20 日（即合规日期）之前接种疫苗。我们检查了 3 个时期的实际养老院人员配备水平：（1）法院裁决前；（2）合规日期前；（3）合规日期后。我们分别检查了护士助理和持照护理人员的人员配备水平。由于 28%的养老院在州级疫苗授权之前，我们将样本分为 2 组（有授权的州的养老院与无授权的州的养老院），并分别进行所有分析。
在所有 3 个时期，授权州的员工疫苗接种率和人员配备水平都高于非授权州。在法院裁决之后，非授权州的员工疫苗接种率增加了 5%，授权州增加了 1%（平均而言）。我们几乎没有发现法院的疫苗授权裁决对护士助理和持照护士人员配备水平有实质性影响的证据，也没有发现授权州和非授权州的养老院受到法院裁决的不同影响。随着时间的推移，人员配备水平基本持平，有一些证据表明，授权州的护士助理人员配备略有增加，而非授权州略有减少，而授权州的持照护士人员配备略有减少，而非授权州则略有增加。最后，回归结果表明，对于护士助理和持照护士，农村和营利性养老院的人员配备水平较低，而仅接受医疗保险、质量较高和以医院为基础的养老院的人员配备水平较高。
结果表明，联邦 COVID-19 疫苗授权并没有导致养老院护士助理和持照护士人员配备水平发生临床显著变化，这些水平仍然主要与研究人员和从业者熟知的因素有关。
