In an attempt to get a handle on the persistent Covid-19 pandemic, President Biden yesterday issued a broad executive order mandating vaccines for a large segment of the US economy, including most of the medical and long-term care industries.

His order should give families comfort that most licensed providers, from doctors to home health aides, will be vaccinated. But it does not cover everyone. Thus, consumers still will have to be careful. And ask if their providers and caregivers have received the shot.

Some of us have been urging this for a while. Biden’s proposal is more far-reaching than his initial plan, where only nursing homes that took Medicaid and/or Medicare (effectively all of them) were subject to the vaccine requirement.  Now, the president has ordered that employees of every business that receives Medicare or Medicaid funding and of every federal government contractor must be vaccinated. In addition, all businesses with 100 or more workers must either vaccinate its staff or require weekly testing for those who do not get the shots.

Who is covered?

In practice, that means that employees of all nursing homes, all hospices, many home care and home health agencies, and some assisted living facilities and adult day programs must be vaccinated. But it still may leave out the many assisted living facilities that take only private pay residents, independent living facilities, many home care agencies and even some physician practices that do not take Medicare or Medicaid.

It also will not cover aides who are independent contractors or so-called gray market aides who work off the books. And it leaves unanswered, at least so far, lots of questions.

What about temporary health workers (so-called travelers) or part-timers?

What happens to staff at assisted living facilities? Medicaid will, rarely, pay for the long-term services provided to very poor assisted living residents. Medicare will not pay.

Those facilities that do accept Medicaid residents clearly would be subject to the mandate. But what happens in a facility with no Medicaid patients but which has a pharmacy where drugs are covered by Medicare? Will that be sufficient to require that all staff be vaccinated? What if it contracts with an outside physical therapist to work with its residents? We’ll have to await guidance from the Centers for Medicare and Medicaid Services to know for sure.

The industry approves…mostly

Of course, if facilities are large enough to have 100 employees, their staffs will have to be vaccinated even if they don’t take Medicare or Medicaid. However, they will have the testing option that will be unavailable to medical and long-term care facilities.

The industry generally seems fine with the mandate, though I’m sure some providers will object. Many operators have been convinced for at least the past month or two that mandates are necessary but they didn’t want to be responsible for imposing them. This way, they can blame the federal government.

In addition, a very broad mandate protects facilities that may have feared that staff would leave rather than get jabbed. Now, those reluctant staffers have fewer job alternatives and are more likely to accept the vaccine.

Still, there will be gaps. The bottom line for consumers is: Ask if the staff has been fully vaccinated. If it has not, consider another facility or a different home care agency.