Biden Administration to Withhold Medicare and Medicaid $ from Nursing Homes Not Having Fully Vaxxed Staff

The Biden Adminstration’s latest gambit to combat Covid by increasing vaccination levels among nursing homes’ staffers via coercion shows a lack of appreciation of what is at stake. If this works at all, it will be in the nature of “Burn the village to save it” in too many instances.

As I wrote to or Covid brain trust:

Oh, this is going to work well. All stick no carrot.

94% of facilities already have staff shortages.

Of the 40% not vaccinated, not a hard guesstimate that at least 10% will quit. Can they take another 4% staff loss?

IM Doc replied: “Put simply – no”

Now let’s go through this situation in more detail. First, the Biden policy, according to the Associated Press:

President Joe Biden on Wednesday announced that his administration will require that nursing home staff be vaccinated against COVID-19 as a condition for those facilities to continue receiving federal Medicare and Medicaid funding.

Biden unveiled the new policy Wednesday afternoon in a White House address as the administration continues to look for ways to use mandates to encourage vaccine holdouts to get shots.

“If you visit, live or work in a nursing home, you should not be at a high risk for contracting COVID from unvaccinated employees,” Biden said.

Let us put aside for the moment that Biden is not “following the science” in the framing of this policy. The reason to get vaccinated is to lower the odds of getting a bad case of Covid. It would be perfectly reasonable to push for higher levels of vaccination in any workplace where employees are in close physical proximity with each other and with patients/customers, to keep them from getting sick and overloading hospitals. Covid-jammed hospitals have all sorts of bad knock-on effects, like delays in administering ER care, staff Covid cases, burnout and resignations, postponement of elective surgeries, and higher medical system costs due to all of us indirectly paying for Covid care costs via medical system costs (the piper has to be paid somehow).

The evidence is not as strong as vaccine proponents would like to believe that the current vaccines prevent the transmission of the Delta variant, as a new UK study suggests, confirming the CDC finding in Provincetown of similar levels of Covid virus in the nasal passages of the vaxxed and unvaxxed in Provincetown:

In other words, “We can’t afford to have you wind up in the hospital and your patients can’t afford to have you in the hospital either” is a more honest sales pitch, and also appeals to self interest. But weirdly the officialdom has been consistently unwilling to go there.

The Associated Press makes clear that this new policy is intended to be coercive:

It comes as the Biden administration seeks to raise the costs for those who have yet to get vaccinated, after months of incentives and giveaways proved to be insufficient to drive tens of millions of Americans to roll up their sleeves.

But the coercion is applied to the wrong party. This use of the Medicare/Medicaid funding stick is what is called an unfunded mandate. Nursing homes are supposed to behave differently, as in find out who is unvaccinated among their workers (and not just nurses and other attendants, but also kitchen staff, cleaners, and clerks) and fire them. As we indicated at the top of the post, just shy of 60% of nursing home personnel are vaccinated, which is just about on par with the overall level of vaccination in the US. That contrasts with the 80% vaccination level of the residents.

Moreover, these nursing homes collectively have only that 60%ish vaccination level despite many having tried hard to get more workers to take the jab. They have extremely strong incentives to do so. Nursing home residency fell during Covid due to the (correct) perception that being around a lot of other people isn’t terribly safe. Being able to say you have a high vaccination rate among residents and staff would reassure some fence-sitters, or sway them to pick your facility over a competitor’s. Nursing home occupancy fell 10% from December 31 to end of May 2020 alone due to deaths and a big drop in new admissions. It continued to fall in 2020 to a national occupancy rate of 69.2% at the end of January, down from the pre-Covid level of 84.6%, and was starting to recover.

And even with shrinking populations, the workforce had also fallen, in no small measure due to Covid concerns. From Skilled Nursing News as of this June:

Of 616 nursing homes surveyed by the American Health Care Association and National Center for Assisted Living (AHCA/NCAL), 94% said they are experiencing a staffing shortage.

Nearly three-fourths of respondents indicated that their workforce situation has worsened compared to 2020, largely due to higher turnover associated with the COVID-19 pandemic. Facilities are actively trying to hire across the board, including registered nurses, licensed practical nurses (LPNs), certified nursing assistants (CNAs), dietary staff and housekeeping.

While operators could make headway on these shortages if they offered better pay and benefits as incentives, 81% said that higher reimbursement from payers is necessary to support those actions.

Do not assume these nursing homes are poor mouthing without justification. From another article in Skilled Nursing: “”So the question is: do we get back to our baseline (pre-COVID) operational reality; median operating margin of 0.0%..'”

So again, the Biden Administration only thinks it is coercing those refusnik staffers. It’s actually coercing the nursing homes, who are already having trouble attracting and keeping staff. And nowhere do I see any plan to increase Medicare/Medicaid reimbursement rates, which would allow these facilities to pay more and hire more staff, both to fill the gaps they now have plus the ones that will result when they tell employees, “No jab, no job”.

Let’s look at a few of the cohorts that are on the vaccine hesitant to anti-vax spectrum that have good odds of quitting:

Reproductive age women who’ve heard of cases menstrual period disruption post vaccination. The CDC has simply ignored this issue, which doesn’t engender confidence in women who’ve heard about these problems. The lack of interest reeks of gender and class bias. Well off women could store their eggs before getting a shot and then get IVF later. Or they could afford a fertility doctor if they had issues, whether or not due to the vaccination. Lower income women don’t have these fallbacks.

And these changes are frequent enough to not be “rare” (like the roughly one in a million J&J blood clots) even if not common. And they are in many case alarming. From WBRC last month:

Katharine Lee noticed changes in her menstrual cycle not long after getting her COVID-19 vaccine….

“When we were going through ethics approval, Katie and I had a discussion about how many people we anticipated would participate and the number we put in was 500 and that was being optimistic,” said Kate Clancy, PhD, Director of Graduate Studies, Associate Professor of Anthropology, University of Illinois. “We hit 500 I think in the first couple of hours and in fact, were in the thousands within 24 hours.”

Their research survey launched a few weeks ago and has nearly 130,000 replies from women sharing their menstrual experiences after vaccination…

Among those people, just broadly what we can say, is for the most part their experience is that their period is heavier, but we do also see some people with lighter periods, and really the most important finding for us, is not just looking at the experiences of people who are currently menstruating, but looking at people who are not currently menstruating.”

Clancy said women who are on-long active contraceptives or women who are postmenopausal are reporting breakthrough bleeding.

Some experts (of course men!) have tried to depict these results as stress-driven, but stress if anything leads to late and/or light periods, not early and heavy ones. And since when do post menopausal women have heavy breakthrough periods?

Even some of our male readers have heard about this syndrome. From Isotope_C14:

With the quality of data being collected by CDC and VAERS I don’t know how any person could hang a flag to either side…

Anecdotally, all the girls that run the bar that I shouldn’t go to have incredibly whacked long-term symptoms. All of them are under 30. Most of them are having bizzare menstrual problems. One, who is utterly adorable and reminds me of a young Terry Farrell hasn’t had her time of the month in 55 days.

He also mentioned how odd it was to have women who were just a bit over half his age tell him about their periods, which he took as an indicator of how much it was on their minds.

An MD (yes confirmed as an MD), sent his examples via e-mail:

I have 2 young women in my practice – both robustly healthy late 20s. Both were vaccinated in the spring and have not had a period since. Multiple OB GYN evals and hormonal evals. Absolutely nothing showing up wrong. OB GYN is really concerned – never seen this before. Now that it has been 4 missing cycles – both will be having hysteroscopy this next week. Both of these young women really want to be mothers – and are OUT & LOUD with all their friends and coworkers about this issue. And they wonder why there is hesitancy? Most people who want to have kids will gladly tell the boss to take the job and shove it – and they are.

Religious objectors. Even though nearly all national church leaders are urging members to get the shot, there are still congregations and individuals that don’t buy in. Some still believe the debunked idea that the vaccines were made with stem cells. Some particularly hard-core evangelicals see the vaccine requirements such as vaccine passports as the Mark of the Beast, so for them getting a shot would condemn them to hell.

Anti-vaxxers or serious vaccine doubters. Despite the stereotypes, these are not all or even mainly Bubbas. As we’ve described, the ground zero for the anti-vax movement was Northern California, and it has significant funding from individuals in the private equity industry who believe in it. Similarly, I know a top professional, highly paid, better traveled and cultured than I am who is getting out of New York as quickly as possible because there’s nothing for him to do there any more in light of the requirement to be vaccinated to go to museums and restaurants and shows (a mere same day clean test won’t do).

And of our four aides, who are the closest demographically to nursing home workers of all the people I know, only one has been vaccinated, and that’s because we dragged her to Publix. One of the non-vaccinated CNAs is 30, had Covid, and might get a vaccine but is nervous about all of the people she knows who’ve had side effects. Odds are 50/50 she’ll get a shot. One CNA is in her early 40s, very religious, and keeps her views to herself, so I don’t know her reasoning. The third, a 67 year old retired hospital tech, is PMC in her presentation (extremely well spoken and put together, and a vegan). She is highly resistant but I don’t understand exactly why. It seems to boil down to mistrust of the testing and the messaging.

It’s not hard to imagine that these groups could easily account for 10%, if not more, of the vaccine non-takers at nursing homes. It’s not hard to imagine that those those who have or can create other employment or survival options will avail themselves of them.

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  1. zagonostra

    This is very troubling. How long before receiving SocSec benefits are tied to whether you are CV vaxed or not? Can I sue the gov’t for the money I’ve put into, and continue to put into, the system for the last 45 years back, adjusted for inflation?

    Along with talk of a Central Bank Digital Currency, we are slipping into an authoritarian hell-hole if we continue along this trajectory.

    1. Tom Doak

      That’s a very good argument. You have been paying into Medicare all those years, too, and now they’re going to deny you care? Surely there will be lawsuits over that.

      1. Patrick

        It costs the government a lot of money to cover treatment of severe covid cases. Requiring vaccination strikes me as common sense if you want the government to pay your medical bills

        1. tegnost

          Did you notice the part from Tom Doaks regarding paying into medicare? Do you feel the same way about social security. Adding it probably doesn’t cost that much in real terms to take care of covid patients…would you rather have them out in the wild infecting people?

        2. Yves Smith Post author

          This argument is nonsensical. This policy is not addressed at getting Medicare or Medicaid recipients to vax up.

          We pointed out that the CDC and the UK have confirmed that Covid cases among the vaxxed and unvaxxed under Delta have similar viral loads. Their data also showed as of early July (4-6 months after the original vaccination), infections were proportional among vaxxed and unvaxxed, even stratified by age. That means as of then Pfizer was not keeping people from getting Delta. Not clear how much this was due to vaccine efficacy waning and how much to Delta.

          The way to keep nursing home residents from getting infected would be frequent testing and required quarantine, and not the vaccine.

          Did you miss that this article is about nursing home workers? They are not on Medicare, they are of working age. And hopefully they are being paid enough so as not to be on Medicaid.

          So by (almost certainly) forcing resignations of employees in Medicare/Medicaid institution, they will degrade the quality of care and not reduce contagion risk.

          1. Patrick

            “We pointed out that the CDC and the UK have confirmed that Covid cases among the vaxxed and unvaxxed under Delta have similar viral loads.”
            Probability of getting infected in the first place is much lower. “Breakthrough cases”

            But yes I would argue that they should use Medicare and Medicaid to force vaccination much more wildly than just nursing homes. But at least the most vulnerable are getting some protection.

  2. Tom Stone

    Joe Biden:
    The Delaware Version of a Texas a$$hole, “All stick and no carrot” instead of “All hat and no cattle”..
    He still owe those Nursing home staff $600 and most of them know it.

    1. PHLDenizen

      He’s from DE! Land of the Plastic Fantastic Debt Instruments!

      We’re owed the principal, interest (let’s say 21% since he’s at the default rate, and several months of late fees at say $39.00 a pop. It’s the principle of the thing.

  3. Arizona Slim

    Watch for more protests like this one:

    Note the location of this protest — outside one of Tucson’s largest hospitals. It also attracted many healthcare workers.

    In addition, the intersection where the protest was held has a traffic light. If you get the red light, you’re going to be at that intersection for a while because that light takes its sweet ole time.

    Those protestors chose the right location. And I don’t think that this recent protest was a one-off.

  4. Stillfeelinthebern

    There has been a worker shortage for years in nursing homes. Raise the workers wages.

    1. Yves Smith Post author

      Did you miss that the average operating margin in the industry is zero? Pre Covid? And that’s with generally thin staffing levels?

      Taking care of old people is costly. My mother pays for her own food, electricity, cable, heat, and housing. Her aides run to over $80,000 a year, and that’s only for 13 hours a day. How many people can afford that?

      1. Andrew Watts

        It wasn’t that way at my previous employer where their budget indicated they spent around 60% on labor-related items and where they were banking millions of dollars into their capital fund every year after hefty administrative fees. I don’t buy the assisted living / licensed nursing home plea of poverty at the higher end of the industry. It seems like another effort to feed at the government trough.

        Although it was a non-profit so the same taxes and rules might not apply.

        1. Yves Smith Post author

          I’m not unsympathetic with your argument, but I suggest you bone up on your accounting.

          Capital charges/expenses are not included in the computation of operating margin.

          As I said, this is an unfunded mandate. If you want workers paid better, Medicare has to improve reimbursement rates, better yet based on improving staffing ratios.

          And the higher end of the industry is not large in terms of the number of total beds. For them, the profit-making independent and assisted living pay for the costly nursing home care. They still lose money on nursing home.

          On top of that, despite their high tickets, just about none of the fancy facilities are set up to handle Alzheimers patients. Alzheimers patients need a totally different set-up that other nursing home patients, since familiarity and routine are paramount in keeping them from getting agitated. They often wind up being transferred out of the fancy places. Down here, only one of the about 10 nursing homes we looked at has an Alzheimers wing. That one happens to be the one nearest to us, so the ratio if we had cast a broader geographic net may be even worse.

          They can also get away with crap pay because the immediate alternative for a CNA, home health care, pays $10 an hour here through an agency and they can’t assure you regular hours. Clients die, go in the hospital, visit relatives.

      2. Michael Mck

        We had a big kerfuffle out here with Brius Heathcare, who own several care homes locally. They were claiming to be unable to afford an ethical wage because reimbursements were so bad yet had total ripoff contracts with other companies also owned by Brius’s owner, Shlomo Rechnitz, providing supplies, owning the real estate etc. He was pulling in many millions in profits.
        Oooh! They have fans. from them: “But holding Brius accountable is no easy task. The corporation, which owns as many as 81 California facilities and controls one of every 14 nursing home beds in the state, goes to great lengths to conceal its identity from consumers and the public. Brius does not brand its facilities with its corporate name; neither Bruis nor Shlomo Rechnitz appear in the California Department of Public Health’s database of skilled nursing facilities. Instead, Brius manages its operations through a complex web of more than 130 companies, each with a different name, that buy and sell products and services from one other.”

  5. Objective Ace

    >“We can’t afford to have you wind up in the hospital and your patients can’t afford to have you in the hospital either”

    Sure, but we also can’t afford staff to get infected – not realize it – and continue to spread the disease. That’s arguably worse when your working with seniors all day. This argument would require some sort of weekly testing as well to ensure those that get infected quarantine.

    It’s also probably part of why its not being pitched. It would be an acknowledgment that public health policy has been wrong this entire time with respect to vaccines. Better to double down and compound the problem

    1. Yves Smith Post author

      Yes, agreed that I probably should have unpacked what the better remedies are, since it’s now questionable with Delta that the vaccines are doing much to reduce transmission.

      But we still have a problem. As GM pointed out, you can’t ask people to quarantine with no income support. But that is the US position. These nursing homes can’t afford to pay staff to stay home.

      IM Doc points out in his part of the world that young people don’t get tested for Covid unless they are so sick they have to go to the hospital, since positive test = quarantine = they can’t pay their rent.

  6. Glossolalia

    I was having a conversation with a friend yesterday about the announcement that all school employees in Washington State will need to be vaccinated or they’ll be fired. He is a dyed in the wool PMC Democrat with a pedigree in academia and the NIH. I wondered out loud about how schools would deal with a certain percentage of staff just quitting right before school starts because we’re in a hot job market. His answer was pretty much just fire as many as you need to, you don’t want those people working for you anyway.

    1. tegnost

      He is a dyed in the wool PMC Democrat

      It’s distressing how intellectually incurious this group is (observed from both personal conversations as well as news reports and anacdotes such as this one). Mansplaining writ large…coercion, TINA, debasement (can you say bubba?), blind faith, no citations, no evidence. There’s going to be a shock. If only that harley that brough covid over the pacific had gotten a flat and sank…oh well, here we are…

      1. chris

        I’ll refer you to the expert of these situations, Mr. Douglas Adam’s, who first described the SEP in the seminal text describing modern life, The Hitchhiker’s Guide to the Galaxy. He wrote about the “Somebody Else’s Problem” field. Our PMC doesn’t see these issues because they don’t affect them and they’re not, “their problem.”

        Being only a little facetious… All the issues that have been laid bare by the damage COVID has done to our society are cloaked by an SEP field. So none of our leadership class can see them.

        Like the people who talk about how great it is to support artisans through Etsy while using Amazon so much they’ve driven local businesses into the ground, they don’t see how their attitudes and actions are creating these problems. Like the people of the Amazon who can’t imagine there’s an end to the rain forest, the PMC cannot conceive of a time when there won’t be population willing to be exploited for a reasonable fee. These people are largely parasites who have sucked on our society so long they think they’re the hosts now.

    2. Brunches with Cats

      A friend who works for Washington State Ferries told me week before last that several sailings were canceled due to crew calling in sick with COVID. Neither masks nor vaccines had been required. Finally, last week, management issued a bulletin requiring a return to masks, regardless of vaccination status, and established some additional social distancing procedures. There also was a reminder that, to comply with the mandate for state employees to be fully vaccinated by mid-October, the first dose must be received by the first or second week in September, depending on the maker. As of yesterday, he already knew of one resignation and said there are likely to be more, as there’s a sizeable contingent of anti-vaxxers among the crew. Despite union wages and benefits for crew, WSF has a hard enough time as it is filling vacancies due to the rigorous physical testing and punishing shifts for new hires.

      Meanwhile, a family connection told me last week that 70 people just walked off the job at her BOCES facility (educational programs allied with school districts) in our rural county in Upstate New York. When I asked why, her husband jumped in, “Because the superintendent is a liberal asshole!” She didn’t specifically cite COVID restrictions as an issue, but launched into a rant about masks and vaccines, using the “my body, my choice” trope; “like abortion.” If I hadn’t already read on NC about libertarian nut jobs using this false equivalency, I’d have been flabbergasted. I asked what the facility was going to do, so close to the start of the school year. “They’ll just have to cut back,” she said. I mentioned my ferry worker friend, to which she replied, “They’ll have to cut back like everybody else.” Didn’t matter to her that the ferries are part of the highway system and that thousands of people rely on them to get to work, medical care, etc. She just kept repeating, “They’ll have to cut back.”

      It’s hard — heart-breaking — to stare someone you know in the eye and see such a cold lack of empathy, of basic human caring for others.

  7. The Rev Kev

    Excuse me a minute while I switch into evil mode. Right. On the surface it seems that Biden does not understand how a market works and, like those oft abused & underpaid restaurant workers, those staff are more than capable of voting with their feet. And if the operating margins are razor thin in this industry like Yves says, then this will push more than than a few of them into bankruptcy. And at that point, they can be individually or as a group be snapped up by private equity firms as parts of a mega-chain of nursing homes. You will see the same when people are finally kicked out of their hoes and these are snapped by them. So this may be part of a Wall Street plan to consolidate this industry with the help of the White House. Tough luck if you have family members living in one of these places. This could be one possible explanation why such a bone-headed move. Otherwise, I got nuffin’ as an explanation.

    1. Glen

      Given that the govenator of NY state passed a law shielding nursing home executives from legal liability to CV deaths, I don’t think evil mode is required. I think you are discussion “normal business” at this point. PE is going to swoop in and buy up all sorts of businesses and proceed to run them into the ground to maximize profit in very short order.

      1. Brunches with Cats

        The nursing home liability shield was repealed by the NYS legislature. The new law was effective immediately upon signing by Cuomo in early April.

        PE-backed chains could hardly be worse than the chains currently owned by members of a certain hyper-ethnic group, and their lock on the industry in this state (I don’t know about others) makes it unlikely IMHO that outsiders will come in and swoop them up. I did extensive research on one of these operators two years ago for a friend whose mother kept landing in the hospital with horrific bruises all over her body that nursing home staff couldn’t/wouldn’t explain. Its MO was to buy up financially distressed nursing homes (including one that was being run by the state while languishing without a buyer), submit a plan to the state for rehabilitation into a top-ranked, profitable facility, and then run it into the ground physically and financially. So, BTDT.

        Based on what my friend was telling me, I suspected routine Medicare and Medicaid fraud — a perfect setup for it, as residents in rundown nursing homes often are left there to die, with no family to monitor their care or review claims to make sure they actually got the services billed to Medicare. I also had a gut feeling that this was a perfect front for money laundering. The owners had a shell corporation, with an address in what appeared to be an empty building, with a multitude of mailing addresses — admittedly, a common business practice and not proof of anything. There were a few other clues. Still, it’s just a hunch.

        NY Dept of Health inspections are a joke. They’re supposed to be unannounced, but somehow staff know when they’re coming. DOH gives operators a chance to correct violations — and accepts their word that they’ve done so. As long as the record shows there are no uncorrected violations, a facility can maintain a decent Medicare score, and unscrupulous operators like the aforementioned then use it for marketing spin. In short, the nursing home industry in NYS is a racket, and it was a racket before Cuomo came along.

        FWIW, the money Cuomo got from the nursing home industry that supposedly “paid” for the liability shield was chump change, and anyway, they already were getting away with murder. If anything, Cuomo is guilty of not doing something about it when he was AG, and then adopting the penchant of previous governors to look the other way — undoubtedly in exchange for campaign contributions and in-kind graft not directly traceable to the nursing home industry.

        1. bernard j karpf

          The experience i had at a private Nursing Home, in upstate NY, was somewhat different then what you are describing.

          I worked for over 30yrs, as a clerical worker for the most part, but dealt with all different depts.

          Dept of Health inspections were not a joke, by any means. Large fines could be levied. The admin and nrsg depts were always nervous annual inspections. They attempted to inservice the staff not allow the informal rules prevail and follow strict guidelines. And a nursing homes evaluation was important to it for future families looking to place their relatives.

          The Dept of Health gives a ‘time frame’ in which they will go to the nursing home, could be as much as 3 months as i recall. Doesn’t matter, because no one is ever prepared for the scrutinizing eyes of these inspectors. They walk into a bldg, display their badges, and are given carte blanche to observe everything. And they are good!. At least when i worked there – they were professional and sharp sherlock holmes looking for clues. they knew their business.

          This was certainly no shell operation. Totally legit.

          It is true that the staffing levels were a source of constant complaint both by the relatives and the staff. That was the way it was at all the nursing homes in the vicinity. Its even worse now i believe, because of dearth of workers.

          And i don’t mean to let these owners off the hook. They could have afforded the nursing depts more money and staff. They charge an awful lot of money to live there. Whether the margins, as Yves mentioned are razor thin, profit is covered via taxes, i dunno. I believe the owners are making out rather well – but thats my guess.

          You might be right about all else you said – i don’t know. I will say this:

          During Covid, it sure seems like the nursing home industry got liability protection via political connections. And maybe that is what happened.
          But its also true that w/out some immunity, one can we just guess, the amount of litigation these nursing home owners would have underwent with uncaged lawyers?

          1. Brunches with Cats

            Bernard, thank you for the alternative point of view, and apologies if it seemed like I was demeaning staff. That was not my intent. Ultimately, my friend did get good staff help in caring for her mother (although it was only after intervention by her state elected representatives).

            I don’t doubt that staff where you worked were intimidated by state inspectors and that it didn’t seem like a “joke” from your perspective. Again, apologies for being imprecise. Nor was I impugning the inspectors’ competence. The travesty, as I see it, is in the outcome: Violations can be dismissed simply by a facility stating it has corrected them. There are nursing homes still in operation that have the same violations year after year. It takes a call from a state senator to stop attacks on a frail, defenseless, old woman (turned out it was another resident, and staff didn’t take adequate measures to control him).

            According to a 2019 report by a New York community activist organization, for-profit nursing homes in the state had a higher number of serious violations than non-profit and government-operated facilities and thus were assessed with the higher fines — but even then, they can avoid paying them simply by correcting the violation within the grace period allowed. Given your experience in admin, you surely must have seen a few instances of that. Even if they do end up having to pay, many companies, regardless of size (and not just nursing homes), consider fines an irritating cost of doing business rather than an incentive to change.

            Incidentally, the same report (link below) also discusses the sweeping changes that have taken place in the long term care industry in the past decade or so. Please do correct me if I’m wrong, but it sounds like maybe most of your employment time was under the “old model,” which, like everything else related to healthcare these days, was a kinder, gentler environment.

            In doing research for my friend, I read dozens, possibly hundreds, of inspection reports, not just for the nursing home where her mom was staying, but for others under the same ownership, as well as many unrelated facilities in the state, just for comparison. And, as best as I can recall, there were others that were worse than this particular group. BTW, inspection reports are available on the CMS website, although there might be a lag of many months. ProPublica also has a repository of information about nursing homes nationwide (and they did a series of exposes, some in New York State, as I recall, and more horrific than my friend’s experience).

            Of course, it’s the bad ones that get the most media attention, when there are many facilities with deservedly high ratings. The thing is, the bad ones are where the poor and those with no money or family end up, and they need to be protected from owners who put profits above all else.

            Link to report (PDF):

    2. Objective Ace

      Also with a side effect of setting a precedent for withholding medicaid/Medicare payments for reasons the government sets on a whim, not for actual health outcomes. That could prove most useful down the road.

    3. anEnt

      Having been through this ringer with my mom just last year, one expects that nursing homes must conceal profits in a similar manner as grocery stores, but with extra emotional motivations to avoid. Turnover is huge, both from “reorganization” labor cost squeezes and employees who can voting with their feet. Nurse and assistant demographics skew towards imported labor and 1st generation Americans vice hospitals and doc practices which don’t, one imagines due to a communication/racism nutrient gradient which implies lower wages than average in the profession. And that before the fact that wealthy Americans culture has banished death as taboo.

      Even then, it is obvious that within the nursing industry there is another nutrient gradient – Medicare >> private pay >> Medicaid and facilities that can try to cater to the higher end of the trough and game the system to stay that way contra rules in place allegedly preventing shifting off low or negative profit patients. Yet the labor pool remains the same across facilities, if with lower turnover in the higher end facilities. I very much suspect that some facilities make out like bandits and have no motive to pay as much higher than market rates for labor. If they were, they would attract a more diverse workforce.

    4. Quantum Future

      Well Reverend – Your conjecture may or not be true. However, could be state run and just as horrific. Worked in a private home as a dietary aid when young. Nice place and good treatment.

      On the other hand, my great Grandmother in a state run home smelled the air smelled like piss and cigarettes. Food was inedible.

      I just turned 51. Seeing the US become a giant hedge fund and how people were treated in the financial crash where Wall St. Got made whole while the general population ate crap I realized what would happen to me when old.

      I told my two boys in 2010 that when I started crapp8ng myself and needed a nursing home I was going to rent a fast car, head out west, pick up some peyote then drive off the grand canyon. I would YouTube it and sell proceeds to be provided to my boys.

      I read the Bible cover to cover, a few times. Never was it written in there one goes to hell for suicide. Think if their is a God he would understand in any event.

      Now I got married been with a good woman, a nurse for near nine years. I told he my plan when I met as I was serious and she should know my intent at near end of life. She now fully understands but she does want me home at near death. I don’t really think either of us will be alive at old age to state how I really see things moving forward.

      I won’t be made a slave. Now, like most of history you slave and comply or the slaves are killed.

      Yves, so proud of you for taking care of your Mom. I didn’t have to provide that kind of care for my Mom, she had beast cancer and could care for herself until the last three weeks of life. I did bring her to treatments and helped her out a bit financially. Got to spend a lot of quality time with her having fun two years before she passed.

  8. Eustachedesaintpierre

    Similar situation in the UK except that staff cannot be banned from using the NHS, so instead they will be banned from working in care homes. In a situation of already having about 100,000 vacancies with as BBC put it the sector also facing an exodus of staff, it probably wont end well & at the very least it will put more pressure on those left behind whose morale is likely low & unlike nurses they received no pay rise.

  9. Carolinian

    Biden may have been humiliated by the Taliban but he’ll show those nursing home workers. The important thing is for everyone to know who’s in charge.

    Of course logically, if one believes that the vaccine works, it’s the residents who should be vaxxed and most of them now are. As Yves says above, there are legitimate reasons for young people and particularly young women to resist the jab.

    But if you are going to politicize science then might as well go all in. The media will applaud you and go back to asking only softballs.

  10. Glen

    I don’t doubt that there are numerous examples of this scenario being played out right now in small and large companies across America. I think one of the ways we could help the smaller companies is to give access to good healthcare to everybody – Medicare for All. And yes, we absolutely have to improve Medicare, but I also do not doubt that a very large reason why so many lower income people have not gotten vaccinated is because they have spent their whole life avoiding healthcare. They don’t have it, cannot afford it, don’t have a regular doctor, and never have “normal” visits to to a doctor for routine checkups.

  11. Andrew Watts

    Hah, good luck with a vaccine mandate. It’s a little too late for the government to force health care on anybody. They consistently refuse to even provide a universal health care system in case anything goes wrong.

    My former employer couldn’t get people to wear masks properly, or at all, in the middle of a COVID outbreak. By the way it was the CDC’s guidance that caused the original outbreak. As if a virus will respect the sanctity of the ‘no masks in an office environment’ rule’. It couldn’t possibly spread to the licensed nursing area.

    1. TimH

      Also, aren’t all these vaccines under the emergency approval still? So can’t be mandated by law?

      Separately… a question for the expensive seats nearer the front… if a vaccine is approved, will the liability waiver be lifted, or will the drug companies still have it both ways?

      1. Glossolalia

        If the pandemic has taught us anything it’s that anything can be mandated by law if you get the right judge.

  12. Judith

    Interesting discussion (published on August 13) by Marcie Smith Parenti about the menstrual problems women are experiencing after receiving the Covid vaccine.

    This August 11, the US Center for Disease Control (CDC) overhauled its COVID-19 vaccine guidance for pregnant women, now “urging” them to accept their shots.

    Just 23% of pregnant women in the US have received one dose of a COVID-19 vaccine. Only something like 11.1% have been fully vaccinated.

    The CDC is seeking to drive these numbers up, but it is not doing the one thing that would, perhaps more than anything else, assuage the “hesitations” of these so-called “anti-vaxxers”: investigate and explain widespread reports of menstrual disruption post-Covid 19 vaccine – and, if necessary, add a warning about it.


    1. Nick

      My wife is pregnant and only recently got vaccinated, about six months after the other adults in our household and in a current high case state. Reason for delay was fear of (typical) side effects affecting the pregnancy prior to third trimester, but these became outweighed by fear of contracting bad COVID in the hospital and also a desire to produce antibodies for the child. She and I don’t believe the CDC as far as we can throw them (if anything, use their advice as a contraindicator!) but fears and priorities change, and we have been attuned to anecdotal information about pregnant women taking the vaccine and there haven’t seemed to be anything unusual. For what it’s worth, this child would be our final one.

      1. Judith

        I hope all goes well and you can leave the hospital and return home as quickly as possible after your child is born.

    2. antidlc

      EU looking into new possible side-effects of mRNA COVID-19 shots

      Three new conditions reported by a small number of people after vaccination with COVID-19 shots from Pfizer (PFE.N) and Moderna (MRNA.O) are being studied to assess if they may be possible side-effects, Europe’s drugs regulator said on Wednesday.

      Erythema multiforme, a form of allergic skin reaction; glomerulonephritis or kidney inflammation; and nephrotic syndrome, a renal disorder characterised by heavy urinary protein losses, are being studied by the safety committee of the European Medicines Agency (EMA), according to the regulator.

      It disclosed the new assessments as part of routine updates to the safety section of all authorised vaccines’ database and added menstrual disorders as a condition it was studying for vaccines, including those from AstraZeneca (AZN.L) and J&J (JNJ.N), after the EMA’s update last week.

  13. TomFinn

    When ya think this issue is this going to the Supreme Court?
    Will they hear it?

    Two lab rats talking: one says to the other “ you been vaccinated?”. The other one replies “you crazy, they haven’t finished testing it on humans yet”.

    1. Glen

      SCOTUS will protect big pharma and profits at all costs.

      And great joke, reminds me of this one:

      A guy goes to see a doctor. He has a frog growing out if his forehead.

      The doc exclaims, “Oh my, what happened?”

      The frog says, “It started with a little bump on my butt….”

  14. Rory

    I assume that each person who chooses not to be vaccinated has his or her own reasons for the choice, but I also assume that for many a main reason is the currently unknown long term risks of the mRNA technology of the leading vaccines. I think that more people who are now “vaccine hesitant” would go ahead with vaccination if they were given the choice (even if under an EUA) of a more traditional “dead virus” vaccine, such as novavax or maybe a Russian or Cuban vaccine that doesn’t carry mRNA risks. Since the current EUA vaccines seem to be showing only temporary, waning benefit, I don’t see why more traditional vaccines, with less long term risk, made available under an EUA, would create additional risk, and their availability might keep people from being fired from their jobs. Just a thought from someone with no medical background.

  15. Anonymous

    I know someone (early 30’s age wise) who just gave birth to a child a few months ago. She took the Pfizer shots, got the second shot roughly 1 month-ish before the birth date. Major bleeding while giving birth. In hospital for several days, required multiple blood transfusions, Thought she was all clear but started having significant bleeding over the course of next several weeks after birth which has now turned into months. Surgery+medication was required, not sure of exact details, but major pain while recovering, bad enough to require serious painkillers. No way to know for sure if vaccine related but she is certain the vaccines are 100% safe so that possibility is not up for discussion. She is healthy weight, no comorbidity that I am aware of. Baby seems perfectly healthy.


    I understand that the vaccine makers have a liability shield, but what about the social media sites that have been actively removing reports of menstrual issues? Think of all the women who go to reddit/twitter/facebook to get anecdotal reports of side effects unbeknownst that they are actively removing the vast majority of reports in posts, comments, groups dedicated to reporting side effects, etc.

    This is an active manipulation that is putting women of reproductive age at risk with incorrect information. And this time there is no defense of “we’re just a platform” since they’re directly responsible for the content on their sites by choosing what to remove and what to leave.

    This issue has affected my wife and I personally and when trying to join online conversations I’m met with removed posts + shadow bans + lifetime bans when I introduce any perspective that encourages caution, examination or reflection on side effects or even trying to share our anecdotal story.

    1. Yves Smith Post author

      We don’t know if or how often these menstrual disruptions are serious. But the failure of the medical establishment to take them seriously and worse, patronize women who get them as stressed (oh, those hysterical women) is not building confidence.

  17. Peter

    What I’m having troubles wrapping my head around is why our government and PMC – not just in this country but throughout the Western world – are going all in on a vaccine mandate solution that’s obviously going to fail completely in a few months, if not earlier than that.

    We know now that most of the shots out there are only good for a few months. It seems like the protection starts to wane around 4-6 months and will likely be effectively worthless in about 8-10 months, at least in terms of preventing infections. So before you could possibly coerce enough people who aren’t vaccinated yet to get the shot, you’re going to need to get the people who got the shots earlier to get a booster dose.

    There already seems to be a sizeable portion of the population who gets one shot but doesn’t get the second one. I don’t have the numbers in front of me, but my gut feel is it’s roughly 10%. I’d expect that there will be a number of double vaxxed people unwilling to get a third shot because of the side effects from the first two shots or side effects they’ve heard of from their social circle.

    There’s no way you can maintain a vaccine passport system and / or a vaccine mandate if an increasing number of people are refuse to get vaccinated or stay current with their vaccines.

    Our leadership seems to have locked themselves into believing that these vaccines will fix everything and aren’t even considering a Plan B, even when it should be obvious to them that Plan A is already failing.

    1. anEnt

      Plan B: germicidal UV in air handlers in non-homes (places unrelated people gather).

      Plan B also defends against many future diseases by denying them the network effect and preventing superspreader events from being as bad.

  18. Elizabeth

    I have a relative in a nursing home. There has been a staffing shortage for several months, so I don’t think this mandate to be vaxed is going to help alleviate that issue. There was a policy in place that unvaxed staff members had to either be tested weekly or get the vax. To me, that seems to be a more reasonable position v. the mandate. Of course, if one tests positive that person will have to isolate and not be able to work, so that brings up other issues. The aides that work in this nursing home look to be quite young, late 20s early 30s, and I’m sure the pay is low-wage, and other benefits (sick pay, health insurance, etc) are questionable/minimal

    I can certainly understand why young women are hesitant to get vaxed with the issue of messed up menstrual cycles. Women see this as a marker of their fertility, and the vaccine makers need to investigate what is going on – crickets from the CDC, NIH – it’s very disturbing.

    I see the work these aides do, and it is very demanding, stressful and they need better pay/benefits. Most of them are very compassionate when dealing with their patients – better pay and benefits. Medicare/Medicaid payments should also be increased for these patients – actually for all of us.

    1. Yves Smith Post author

      The FDA and CDC burned the J&J vaccine for many women by briefly suspending its use over blood clots…which afflicted women mainly but not entirely using birth control…at a one in one million rate.

  19. Desert Sasquatch

    It would be perfectly reasonable to push for higher levels of vaccination in any workplace where employees are in close physical proximity with each other and with patients/customers, to keep them from getting sick and overloading hospitals.

    I wonder if maybe I’m missing some context here. Was Yves saying that this is a good sales pitch (which it is) but not arguing that it’s decent grounds for coercive medical decision making on behalf of employers or the government?

    Because if not…I fear that the precedent set by such a move would be far from benign. The same logic could be used, say, to force people with high cholesterol to take statins, or people with mild depression to take antidepressants. Really it could enforce the use of almost any pharmaceutical because, as she points out, the logic is not “this protects other people” or even “this protects the workplace in such an important way that it justifies the removal of your medical choice” but “this will prevent you from taxing the medical system needlessly.”

    Which is probably fine logic as far as it goes, except for the terrific level of corruption and incompetence in our medical authorities–a problem which would almost undoubtedly get worse if we gave them the power to coerce particular medical treatment. Is there a new migraine drug? Maybe we should force people to use that instead of something off-label. With the Ivermectin fiasco, this threat isn’t even theoretical, I think we’ve seen it happening. Even ignoring Ivermectin there are a handful of things with much better-defined safety profiles than the vaccine that we could ask people to do in order to decrease their risk of serious covid infection–but giving everyone vitamin D isn’t nearly so profitable or politically polarizing as the vaccines and I’m sure it surprises no one here that we aren’t focusing on it.

    I think if this coercive medical decision-making became normalized as a way to pinch pennies we’ll still have an underfunded medical system. The difference will be that for poor people, they also won’t be able to turn down the Treatment De Jour without losing the job they need.

  20. Mtnwoman

    By end of September 2021 if not vaxed Washington DC Board of Medicine will start disciplinary actions from license suspensions to license revocations.

    A license suspended or revoked will give significant financial and professional dings for the rest of a HCW’s career

  21. Mtnwoman

    So do The Authorities want more vaccines in arms or do they want the population immune?

    Their studious disregard of SCIENCE and the robust and durable immunity of post-covid seems to point to their desire to just put (failing) vaccines in arms. Why isn’t proof of antibodies to covid satisfactory as an alternative to the jab?

    How about Immune Passports, not vaccine passports?

  22. Skip Intro

    Are employers legally allowed to ask for their employees health records? As a basis for employment? What enforcement regime do they imagine the facilities to use to verify their staff, or the administration to verify the facilities’ reports?

  23. LAS

    As I understand it, federal Medicaid reimbursement WAS increased due to the covid-19 emergency, in the Family First Act or something like that name. The higher rates remain in effect even now, as the emergency keeps being extended. However, that money goes to the states administering Medicaid. It was intended to keep states from throwing people off of Medicaid b/c of loss in state revenue and incremental covid pandemic associated costs.

    But — yes — it is generally true that those without power and voice are most coerced by authoritatian pronouncements. It’s an effective way to further generate distrust among the powerless and delusions among the powerful. Powerful people are getting impatient with the powerless people.

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