Covid-19 Facilities News Resolution

Resolution – Mandate Vax for Nursing Homes Employees

Download the full resolution Calling on Nursing Home Providers and Caregivers to Mandate COVID-19 Vaccinations to Protect All In their Care.docx. The download includes extensive resource links.


Dignity Alliance commends the Biden Administration for its 8/18/21 announcement that all nursing home staff must be fully vaccinated against COVID-19 as a condition of participating in the Medicare and Medicaid programs. Providers could be expected to meet the mandate as soon as next month, and details are still being worked out.  These new regulations would apply to nearly 15,000 nursing home facilities, which employ approximately 1.6 million workers and serve approximately 1.3 million nursing home residents. Nationally, about 60% of all nursing home care is paid for by Medicaid, with about 20% more by Medicare.

Dignity Alliance also greatly appreciates Governor Baker’s 8/4/21 initiative that mandates COVID-19 vaccinations for all personnel of the Commonwealth’s 378 skilled nursing facilities (Level I-III), as well as the two Soldiers’ Homes, (collectively “nursing homes”).  Personnel includes members of the medical staff, employees, contractors, volunteers, and students.  This initiative precedes the above federal mandate and currently remains in effect.

The new MA initiative requires nursing homes to ensure that all personnel are fully vaccinated against COVID-19 by 10/10/21, with at least one vaccine dose by 9/1/21 for a two-dose vaccine.  There are exceptions if such administration is medically contraindicated or if the individual objects to vaccination based on a sincerely held religious belief.  These exceptions require that the individual is also able to perform essential job functions, with a reasonable accommodation by the nursing home.

A nursing home that fails to comply with this MA initiative will be subject to the following sanctions: $50 for failure to report by 10/10/21; a $50/day penalty for each personnel member not fully vaccinated by 10/10/21; and if a facility fails to ensure that 75% or more of personnel are vaccinated as of 10/10/21, the facility may be ordered to stop accepting new admissions until it achieves or exceeds the 75% vaccination threshold.

We respectfully submit the following resolutions to support nursing home residents and personnel: 

Whereas, complications from COVID-19 are more common among older adults, who typically suffer from other chronic conditions and comorbidities; and

Whereas, the number of Coronavirus deaths among residents and staff of nursing homes took a devastating toll nationally, and, in Massachusetts:

  • Over the course of the pandemic, as of 7/30/21, 5,613 MA nursing home residents and staff died from COVID-19, accounting for over 30% of the 17,714 COVID-19 deaths in the Commonwealth. 
  • There has been a 5-fold increase in MA resident and staff COVID-19 cases and an observed increase in COVID-related resident deaths during July, 2021; and
  • Conditions have always been challenging in nursing homes, but this has been magnified during the pandemic. Across the US, as of 8/8/21, about 602,000 staff have had confirmed Covid cases, and more than 2,000 staff have died from Covid, making nursing home caregiver the most dangerous job in America.

Whereas, immunization is the most effective method for preventing and mitigating infection from COVID-19, including possible hospitalization or death; and

  • COVID-19 vaccines are being held to the same safety standards as all other vaccines. After a review of all the available information, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices agree that the lifesaving benefits of vaccinating long-term care facility residents against COVID-19 outweigh the possible risks.
  • When the COVID-19 vaccines were first made available to the public: Based on an independent panel of medical and public health experts, the CDC recommended that both healthcare personnel and residents of long-term care facilities be included among those offered the first supply of COVID-19 vaccines.

Whereas, according to the CDC per a 7/30/21 CNBC report, the Delta variant (now in at least 132 countries and already the dominant form of COVID-19 in the United States) is more transmissible than the common cold, the 1918 Spanish flu, smallpox, Ebola, MERS, and SARS; and

Per the CDC in the same report:

  • Federal and state leaders should communicate to the public the benefits of getting vaccinated, adding the Covid vaccine shots reduce the risk of severe disease and death “10-fold or greater” and reduce the risk of infection “3-fold.”
  • Vaccines prevent more than 90% of severe disease but may be less effective at preventing infection making community spread among the vaccinated more likely. As of this 7/30/21 report, 35,000 symptomatic infections are occurring per week among 162 million vaccinated Americans.

Whereas, as of 8/2/21, 155 (or 41%) MA nursing homes had less than 75% of their staff fully vaccinated.; and

  • The majority of the nursing home workforce are certified nursing assistants — predominantly women and many are people of color and recent immigrants.
  • A March, 2021study by the CDC (released in July 2021) found that those with the most resident contact – nurses and nurse aides – had the lowest vaccination coverage. Furthermore, it concluded that the disparities in vaccination rates among staff in long-term care facilities likely mirror social disparities that are found in the surrounding communities.

Whereas, LeadingAge, representing more than 5,000 non-profit aging services providers, including non-profit nursing homes, supports mandated vaccinations. According to the LeadingAge CEO, several their members want either a state mandate or a government sanction for a mandate, citing that staff want to work in a safe place.  They are also receiving pressure from residents and family who want to be sure staff are vaccinated.

Whereas, there is precedent for vaccination mandates in the United States and Massachusetts:

  • United States
    1. Public schools (kindergarten – grade 12):  all children (medical or religious exemptions supported by documentation).
    2. Immigrants: vaccinations against vaccine-preventable diseases required for every immigrant entering the United States or every individual seeking adjustment of status to that of a legal permanent resident.

Whereas, there is precedent for vaccination mandates in the United States and Massachusetts:

  • Massachusetts
    1. Camps: children and adult staff.
    2. Colleges: students under 30, with additional meningococcal vaccination for students under 21; all part-time health sciences students, regardless of age.
      • Many colleges now requiring proof of COVID-19 vaccination.
    3. Maternal-newborn hospital units: healthcare workers.
    4. Licensed group and family day-care facilities: all workers.

Whereas, on 8/19/21, Gov. Baker issued one of the nation’s strictest government vaccine mandates as an executive order requiring Executive Department employees, including contract workers, to prove they have been inoculated against COVID-19 by 10/17/21 or risk being fired. Exemptions for medical reasons or closely held religious beliefs are allowed. The mandate applies to about 42,000 Executive Department employees and 2,000 contractors.

Whereas, on 8/23/21, the US Food and Drug Administration (FDA) granted full approval to Pfizer’s COVID-19 vaccine for people 16 and older, a decision that could increase public confidence in the shots and pave the way for more vaccine mandates by employers, schools, and other organizations. It is hoped that the FDA’s approval removes an obstacle that has prevented some from getting vaccinated. A recent poll by the Kaiser Family Foundation found that 3 of every 10 unvaccinated people said that they would be more likely to seek a shot with a fully approved vaccine.


  1. The COVID-19 vaccination be considered as a significant professional and public health responsibility for all who provide care and services to residents of the Commonwealth’s long-term care facilities, in order to protect the lives of nursing home residents, as well as their own lives. 
  2. To mitigate the spread of COVID-19 to protect the health and well-being of nursing home residents and all who provide care and services, Dignity Alliance supports the federal mandate that all personnel receive the COVID-19 vaccination, except for those with valid medical or sincerely held religious doctrinal exemptions, as long as the individual is also able to perform essential job functions (with reasonable accommodation by the nursing home). Those receiving an exemption, as well as any personnel who is not vaccinated or has not completed the second dose of a two-dose vaccine or the 2-week waiting period after full vaccination, must comply with these protection requirements: tested regularly and wear a surgical or higher-level mask or respirator at all times while in the facility.  All such testing and personal protective equipment (PPE) must be provided by the nursing home.
  3. To encourage and assist personnel to obtain the COVID-19 vaccination voluntarily, nursing homes shall continue to provide education on the efficacy and safety of COVID-19 vaccines and to support access to trusted individuals within or outside the facility willing to share their journeys from hesitancy to voluntary vaccination to address concerns preventing vaccinations.
  4. To allow scheduling flexibility and paid time off, as needed, nursing home employers must ensure employees have time to obtain the vaccine and recover from its possible side effects.  It should be noted that some of these expenses may be reimbursable to employers under the Commonwealth’s COVID-19 Temporary Emergency Paid Sick Leave Program and the American Rescue Plan (both programs currently available until 9/30/21).
  5. To expand the COVID-19 vaccination mandate to all health care entities covered by Medicare and/or Medicaid, as well as rest homes, assisted living residences, and other congregate living facilities in order to protect the health and well-being of their residents/patients and personnel. Not only do individuals frequently transition between settings for care, but many also work in multiple settings. Mandating vaccines across all settings will also reduce the likelihood of personnel leaving to take a job in another setting where a vaccination is not required.
  6. To further protect nursing home residents and the residents/patients of all health care entities covered by Medicare and/or Medicaid, as well as rest homes, assisted living residences, and other congregate living facilities: prior to an indoor visit, visitors should be asked to show proof of vaccination status or proof of a negative COVID-19 test within 72 hours of entry to the facility.  If a visitor is unable to show proof of vaccine status or a negative test, the facility must offer a rapid test.  Visitors requesting outdoor visits should not be subject to vaccination and testing requirements.  Visitors to a resident at the end of life should be exempt from the vaccination and testing requirements. All visitors and residents, as they are able, will be required to wear a face mask for the duration of indoor visitations.