Clarification on Survey Issues Related to Vaccination Status

Nursing homes are being cited for failing to develop and implement policies and procedures (P&P) to ensure the implementation of additional precautions intended to mitigate the transmission and spread of COVID-19 for all staff who are not fully vaccinated against COVID-19. Facilities are also being cited erroneously for allowing staff to work with just one dose of the COVID-19 vaccine. LeadingAge NY would like to provide two points of clarification related to these areas:

1. Staff can begin working with just one dose of the primary series, while waiting to be eligible for the second dose. However, facilities must track the status and timing of the recommended doses, and both doses are required when the staff member becomes eligible to receive the second dose. The Centers for Medicare and Medicaid Services (CMS) QSO Skilled Nursing Facility (SNF) Attachment requires facilities to have a process for tracking the date of the staff member’s next required dose. The facility must track and securely document each staff member’s vaccination status (this should include the specific vaccine received, and the dates of each dose received, or the date of the next scheduled dose for a multi-dose vaccine). This should be reflected in P&P.
2. If staff are working with just one dose or with a medical exemption, the facility must put in place additional precautions to mitigate the spread of COVID-19. The CMS QSO SNF Attachment provides a variety of actions or job modifications that a facility can implement to potentially reduce the risk of COVID-19 transmission, including, but not limited to:

• Reassigning staff who have not completed their primary vaccination series to non-patient care areas, to duties that can be performed remotely (i.e., telework), or to duties that limit exposure to those most at risk (e.g., assigning to residents who are not immunocompromised, unvaccinated).
• Requiring staff who have not completed their primary vaccination series to follow additional Centers for Disease Control and Prevention (CDC)-recommended precautions, such as adhering to universal source control and physical distancing measures in areas that are restricted from patient access (e.g., staff meeting rooms, kitchen), even if the facility or service site is located in a county with low to moderate community transmission.
• Requiring at least weekly testing for exempted staff and staff who have not completed their primary vaccination series until the regulatory requirement is met, regardless of whether the facility or service site is located in a county with low to moderate community transmission, in addition to following CDC recommendations for testing unvaccinated staff in facilities located in counties with substantial to high community transmission.
• Requiring staff who have not completed their primary vaccination series to use a National Institute for Occupational Safety and Health (NIOSH)-approved N95 or equivalent or higher-level respirator for source control, regardless of whether they are providing direct care to or otherwise interacting with patients.

Please note that the QSO does not specify which actions must be taken. The examples above are not all inclusive and represent actions that can be implemented. Facilities can choose other precautions.

Facilities should have policies in place regarding the additional precautions for staff who are not fully vaccinated. These additional precautions can be added to an existing policy for infection control or vaccination status, but they must be spelled out as it pertains to these individuals.

If you have further questions, please feel free to contact any member of the Policy team.

Contact: Amy Nelson, anelson@leadingageny.org, 518-867-8383 ext. 146