September 22, 2025
McKnight's Long-Term Care News
Federal vaccination recommendations sparked discontent and unease among senior care stakeholders after an advisory panel on Friday promoted new points of emphasis.
Caregiver reactions ranged from full-throated criticism to pleas for calm, which themselves were punctuated with concerns about staff vaccination administration.
The struggle for clarity and unity may extend beyond this week, when the Centers for Disease Control and Prevention is expected to issue its final recommendations. They figure to be anchored in advice issued late last week after the quarterly meeting of the Advisory Committee on Immunization Practices.
During that meeting, ACIP voted to recommend that patients 65 and older consult closely with a physician before getting vaccinated in what the government is calling either “individual-based decision-making” or “shared clinical decision making.”
In addition, ACIP says that anyone 6 months to 64 years old also should use individual-based decision making — but do so with an emphasis on noting the risks are highest for those at increased risk for severe COVID-19. ACIP also wants the CDC to push language to patients and providers describing perceived risk factors and uncertainties about the vaccine.
A prominent long-term care physician ripped the redirection of responsibility as a blow to patient — and worker — health outcomes.
“The recommendation to ‘consult with your doctor’ doesn’t mesh with the long-term care workflow and falls like a lead balloon in the wake of the 250,000 nursing home residents who died from COVID,” said Michael Wasserman, MD, CMD, a geriatrician who served on the National Academies Committee for “A Framework for Equitable Allocation of Vaccine for the Novel Coronavirus.”
“Avoiding clear direction on the COVID vaccine further diminishes the public’s confidence in the federal government’s public health role and responsibility,” he told McKnight’s Long-Term Care News. “A robust evidence-based public health system that provides clarity is essential to the health and well-being of vulnerable older adults.”
It’s not about just elderly, frail patients, reminded Wasserman, who has been a leading figure with PALTmed, the association of long-term and post-acute care physicians.
“Frontline nursing home staff had one of the most dangerous jobs in the country at the height of the pandemic. Building vaccine confidence is critical to their health and for the safety of the residents they compassionately serve. These recommendations are counterproductive in long-term care,” Wasserman said.
Payment matters
A top long-term care pharmacy leader expressed less concern about guideline shifts for LTC patients. But the payment schema for worker vaccinations are a problem, he said.
“We do worry that the noise around vaccination, particularly in the more contentious areas like pregnant women and children, will distract. … In our space, there is little to no debate on the recommendations for older adults and the medically complex,” said Chad Worz, PharmD, CEO of the American Society of Consultant Pharmacists. “For older adults, the schedule that should be recommended by physicians and pharmacists for older adults has been broadened by the RSV recommendation for 50 to 74 with risk factors.”
There is consensus that older adults need access to high-dose/adjuvanted influenza vaccine, COVID-19 vaccine, pneumococcal and RSV vaccines, he added, emphasizing, “It’s important we cut through the fog to make that clear to people caring for older adults and those over 50 with risk factors.”
Some factors relating to staff vaccinations remain less clear, Worz said.
“Not in terms of the recommendation for shared decision making, but by the continued challenges with reimbursement to pharmacies or nursing homes offering the vaccine,” he said. “This is a payer problem that continues to be unresolved.”
In urging further changes, Worz warned that under current conditions, staff — who should be urged to get the appropriate vaccines — may be forced “to certain providers to get it vs. easily accessing them at their place of employment.”
Next steps
He said a bright spot from recent ACIP talks was the inclusion of a pharmacist on the committee. ASCP-recommended Hillary Blackburn wound up leading the discussion over whether COVID-19 prescriptions should be prescription-only. She successfully argued against the proposal, maintaining that pharmacists should continue to be able to order and administer the shots.
But not everyone is happy with ACIP’s current roster, which was totally swapped out in a controversial move in June.
“Considering that over a million older adults have died from COVID, shouldn’t there be at least one geriatrician on the advisory committee?” Wasserman said.
The American Health Care Association said Friday that it anticipates the CDC to issue its final recommendations “in the coming days.” Providers ultimately will have to check with their state public health agency for additional guidance, the association said.
CMS currently requires nursing homes to offer every resident and staff member the COVID-19 vaccine when it becomes available, unless medically contraindicated or the individual has already been immunized.
An AHCA blog noted that before offering the COVID-19 vaccine, all staff members, residents or their representatives must be provided education pertaining to the “benefits, risks and potential side effects associated with the vaccine.” This can be done by using the CDC VIS, which AHCA said is likely to be updated in light of the new recommendations.
Meanwhile, on Monday, more voices entered the fray, with the president of the largest nurses union in the US condemning the new recommendations, particularly the fobbing off of responsibility to patient-physician talks. About one-third of people in the United States, or about 100 million, do not have a primary care provider, a statement from National Nurses United pointed out.
“It is not clear how this will be implemented and what information will be shared with patients,” said Mary Turner, the president of NNU, which in August called for the firing of Health and Human Services Secretary Robert F. Kennedy Jr. “NNU condemns Kennedy’s deadly anti-vaccine rhetoric and the policies put forward by his appointees: They will lead to an untold number of unnecessary illnesses and deaths.”
Editor’s note: This article has been updated from its original version to clarify the nature of the COVID education process described above.