LOCALIZE IT: Health facilities cited for COVID vaccinations

David A. Lieb,Kavish Harjai
Sunday 19 February 2023 05:43 GMT
Virus Outbreak Vaccine Mandate
Virus Outbreak Vaccine Mandate (Copyright 2023 The Associated Press. All rights reserved)


A year has gone by since the federal government began enforcing a requirement in all states that health care workers be vaccinated against COVID-19.

In that time, inspectors have cited about 750 nursing homes and 110 hospitals for violations of the vaccination mandate, according to an Associated Press analysis of federal data.

The Centers for Medicare & Medicaid Services, which issued the mandate, says it has helped prevent countless infections and deaths.

Yet some health care workers say it's time for the mandate to come to an end. They cite a decline in severe COVID-19 cases, a workforce shortage in certain health care professions and the upcoming expiration of the national public health emergency, among other factors.



Health care vaccine mandate remains as some push for an end



The Centers for Medicare & Medicaid Services published a rule in November 2021 mandating that health care facilities receiving Medicare or Medicaid funding require workers to receive at least the initial doses of a COVID-19 vaccine.

The health care vaccination mandate was part of a broader effort by President Joe Biden’s administration to boost vaccination rates nationally. Similar mandates were issued for employers with more than 100 workers, federal contractors and military members — all of which have since been struck down, repealed or partially blocked.

As a result of the court battles, the health care vaccination requirement took effect in some states sooner than others. A U.S. Supreme Court ruling in January 2022 allowed the mandate to go forward nationwide. CMS has been enforcing the requirement in all states since Feb. 20, 2022.

States generally are responsible for documenting compliance with the vaccine mandate as part of process in which inspectors — or surveyors — also verify whether health care facilities are abiding by various other federal guidelines. Facilities can be cited for vaccination violations for a variety of reasons, including for failing to document vaccination exemptions granted for medical or religious reasons and failure to follow their own infection-control protocols, such as requiring unvaccinated staff to wear N95 masks.

Citations, referred to as deficiencies, are reported to CMS. Facilities must come up with plans to address their shortcomings.



Data about CMS “ Quality Certification and Oversight Reports ” is available online. Searches can be conducted for hospitals, nursing homes and other types of health care providers. Basic information about deficiencies can be viewed by selecting a provider type, then running a “survey activity report." The AP focused on hospitals and nursing homes.

Deficiency citations reported to CMS are categorized by code numbers. For nursing homes, violations of the COVID-19 staff vaccination requirements are listed as F0888 deficiencies. For hospitals, those violations are listed as A0792 deficiencies.

Additional information about cited deficiencies for nursing homes is available here, by downloading data at the bottom of the webpage under the link labeled “Full Text of Statements of Deficiencies – Updated January 25, 2023.”

Additional information about cited deficiencies for hospitals is available here, by downloading data near the bottom of the webpage under the link labeled “Full Text Statements of Deficiencies Hospital Surveys - 2022Q4 (ZIP)."

Both datasets include full-text descriptions of problems that surveyors noted during inspections.



— The five states with the highest percentage of nursing homes cited for COVID-19 staff vaccination deficiencies were:

Louisiana, 19%

Michigan, 15%

Nevada, 13%

Wyoming, 11%

Alaska, 10%

— The five states with the greatest number of nursing homes cited for such deficiencies were:

Michigan, 66

Pennsylvania, 64

California, 59

Illinois, 55

Louisiana, 50

— Fourteen states and the District of Columbia had two or fewer nursing homes cited for COVID-19 staff vaccination violations through the end of 2022. They were:











South Dakota



West Virginia

— While the vast majority of states had at least some COVID-19 vaccination deficiencies cited at nursing homes, only about half the states had hospitals that were cited for such deficiencies.

Four states had at least 10 hospitals cited for COVID-19 vaccination deficiencies. They were:







— How many COVID-19 staff vaccination citations were issued for hospitals or nursing homes in your state, region or city? When were these issued? What were the circumstances? The long-text statement of deficiencies typically include information about the reasons why facilities were issued citations.

— Were there facilities in your area that had multiple COVID-19 vaccination citations during the past year? Each citation is supposed to result in a plan to correct the problems. Did facilities develop improvement plans? Did they encounter problems in implementing corrections? Or did new problems arise?

— What do local health care professionals think about the COVID-19 vaccination requirement? Do facility administrators believe it is making it harder or easier to fill jobs? What do nurses and physicians think about the mandate? Has a facility granted a significant number of religious exemptions from the mandate? If so, why?

— What do patients — or advocacy groups for nursing home residents and families — think about whether the COVID-19 vaccination requirement should be continued for health care workers? Do their desires align with — or run contrary to — those of local facility administrators or health care workers?


Localize It is an occasional feature produced by The Associated Press for its customers’ use. Questions can be directed to Katie Oyan at koyan@ap.org.

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