As COVID-19 cases trend upward again in the US, there are calls for mandatory vaccinations for nursing-home caregivers to protect the vulnerable population that suffered the highest fatality rate during the pandemic.

Overall, vaccine rates are lower among the staff compared with nursing home residents. Nationwide, 82.4 percent of nursing home residents and 60 percent of staff are vaccinated, according to the Centers for Medicare and Medicaid Services (CMMS). Eight states reported an average rate of less than half, and 23 individual facilities had vaccination rates of under 1 percent, the CMS data updated in July showed.

In Florida, a recent coronavirus outbreak at Life Care Center of Palm Bay resulted in 34 residents and 17 staff members testing positive. Personal visitation and group activities were suspended during the outbreak.

In Texas, where nursing home staff's vaccination rate of 56 percent lags the national average, the number of nursing homes with at least one active coronavirus case has shot up nearly 800 percent in the past month, the Texas Tribune reported.

From mid-July to Aug 11, the number of nursing homes with active cases went from 56 to 489 across Texas. Deaths also increased from seven to 84. Seventy-six percent of nursing home residents have been fully vaccinated.   

In Grand Junction, Colorado, a cluster of outbreaks at nursing homes led to an investigation by the US Centers for Disease Control and Prevention last month.  

In Kokomo, Indiana, seven senior residents died in a coronavirus outbreak in July. Only 35 percent of the staff at the facility was vaccinated at the time. 

While the rising cases at nursing homes have led to stricter visitation guidelines across the country, there are more calls for vaccine mandates for nursing home staff. 

The American Association of Retired Persons (AARP) called for mandatory vaccines for nursing home caregivers. 

In the US, COVID-19 killed more than 133,000 residents and nearly 2,000 staff members of nursing homes and other long-term care facilities, between May 31, 2020, and July 4, 2021, according to CMMS.

"The high COVID death rates of residents and staff in nursing homes have been a national disgrace. As the new variants are emerging, facilities cannot let preventable problems be repeated. The key is to increase vaccinations, and do it now," Nancy LeaMond, AARP's executive vice-president, said in a statement last week.

Some local governments and private companies have adopted vaccine mandates recently as COVID cases surge. 

On Monday, New York Governor Andrew Cuomo, who said last week that he would step down later this month amid a sexual harassment scandal, said that all healthcare workers in the state, including staff at nursing homes and other adult care facilities, must get at least one dose of coronavirus vaccine by Sept 27.

Large nursing home company Genesis HealthCare announced Aug 2 that it is adopting "a universal COVID-19 vaccination requirement for employees, care partners, and onsite vendors across the company". 

Denver, Colorado, recently announced a vaccine mandate covering private-sector workers in high-risk places like nursing homes.

On Aug 4, Massachusetts issued a vaccine mandate for all long-term care staff, which requires them to be vaccinated by Oct 10 "to strengthen infection control and protect vulnerable residents".

California issued a vaccine mandate for all medical workers including nursing home staff the next day. It requires them to have at least one shot by Sept 30. State health officials said if workers don't want to get vaccinated because of their religious beliefs or a medical reason, they will need to provide their employer with formal documentation.

Healthcare workers in California and other states have staged rallies in protest, calling such mandates a violation of their constitutional rights.

Nikki Strong, executive director of the Missouri Health Care Association, which represents more than 65 percent of the state's licensed nursing care facilities, told the Joplin Globe newspaper that she is afraid the mandates may drive away workers who are already in shortage across the country. 

"I think we need to let each employer make the best decision for their specific circumstance," she said. "At this point, given the workforce challenges that our long-term care providers face, the vaccination mandates would probably further challenge them, and make it difficult for them not only to keep their staff and retain the staff, but also recruit staff."

In June, the American Health Care Association and National Center for Assisted Living conducted a survey of 616 nursing homes and 122 assisted-living communities across the US on workforce issues. It found that close to three-fourths of nursing homes and more than half of assisted-living communities face more staffing challenges this year than in 2020. 

About 94 percent of nursing homes and 81 percent of assisted-living communities have faced a shortage of certified nursing assistants, licensed practical nurses, registered nurses, dietary staff and housekeeping, according to the survey. Overtime was often used to make up for the shortage.