Words cannot do justice to the valor of nursing home workers throughout the COVID-19 pandemic.  And in New Hampshire, they have stepped up to get vaccinated, with a 76 percent vaccination rate among the nation’s highest. That, combined with a 92 percent vaccination rate among residents, has made New Hampshire nursing homes the safest places to work and for the elderly and frail to reside.

With the delta variant on the march, our state’s largest nursing home operator had issued a staff vaccination mandate, effective August 23, and a county nursing home and some private facilities had also issued mandates. My association had adopted a policy that urged members “to mandate the vaccination of staff if the circumstances of a facility’s staffing make such a mandate practicable without the disruption of quality care.”

And that was the key concern. Nursing homes faced a staffing crisis that predated the pandemic, and it has only grown worse since. When you see a labor shortage so acute that even a restaurant impresario like Tom Boucher must limit hours at his popular restaurants, and close Mondays, you feel despair, because nursing homes, unlike other businesses, cannot limit hours in the face of staffing challenges. To lose even one vaccine-hesitant worker, let alone several, could imperil care. The combination of Medicaid underfunding, despite appreciated legislative efforts to improve funding, and exorbitant pandemic costs is a perfect storm.

On August 18, this storm converged with Hurricane Biden, as the president announced nursing homes, alone among all the health care providers that participate in the Medicaid and Medicare programs, must impose staff vaccination mandates as a condition of that participation.

Effectively, by singling out nursing homes for his edict, Biden may accomplish two unintended aims. First, vaccine-hesitant nursing home workers can flee to the refuges of Biden’s favored care settings that do not require vaccination, debilitating the nursing home sector – with New Hampshire facilities already turning away prospective residents where they cannot responsibly staff to serve their needs.  Second, the aims of broader vaccination will not be achieved if mandate-free health care settings exist for vaccine-hesitant workers. Why not a level playing field?

It might be that nursing home workers would have a bit more faith in the administration had it kept a key promise.

On Biden’s campaign website, one today still finds the exhortation that “all frontline workers putting their lives on the line should receive premium pay for their work.  The Trump administration should immediately work with Congress to pass a bold premium pay initiative.”

No action has taken place on this promise, which was to be facilitated with federal funding, even though it could very easily have fit within the American Rescue Plan Act (ARPA). Nursing home workers can be forgiven for feeling abandoned.

The Biden administration has also let the federal Provider Relief Fund sit untapped this whole calendar year even as delta rages and more is asked of health care providers. As the federal government’s website states: “The Provider Relief Fund supports American families, workers, and the heroic healthcare providers in the battle against the COVID-19 outbreak.” Well, it hasn’t this year, despite much-appreciated efforts of members of Congress like Sen. Jeanne Shaheen to free up the funding they worked hard to appropriate.

In the face of federal indifference, and the piling on of new unfunded federal expectations, nursing home providers can only hope their states will save their sector through ARPA funds, just as governors like Chris Sununu stepped up with Coronavirus Aid, Relief, and Economic Security Act funding to keep long-term care afloat in 2020.