Nursing home staffing levels have mostly bounced back to pre-pandemic levels after cratering during the health emergency.

Why it matters: The nursing home industry pointed to staffing shortages and difficulty hiring new workers in its successful fight against the Biden administration's first-ever minimum staffing requirements.

• But aging baby boomers and Trump administration immigration policies could soon reverse the tide and leave the industry dealing with more demand for care than it can handle.

State of play: Nursing and residential care facilities across the country employed about 3.49 million people as of May, according to preliminary federal data, up from 2.96 million at the industry's lowest point in January 2022.

• More granular federal data shows that among nursing homes specifically there are only 1,400 fewer staff employed today than in February 2020.
• Nursing homes lost more staff during the pandemic than any other health sector, and staffing shortages also contributed to the loss of available beds between 2019 and 2024.

Zoom in: The industry has doubled down on developing incentive programs and career ladders to attract people to long-term care work.

• "I'm super excited when I go around the country and see the improvement not only on recruitment but on retention," said Clif Porter, CEO of the nursing home trade group American Health Care Association/National Center for Assisted Living.

Case in point: Arkansas' state nursing home association has opened its own accredited educational programs for nursing home staff to earn higher certifications and degrees that are tuition-free. It's allowing enrollees to work while attending school.

The intrigue: AI's effects on the labor market may also be boosting interest in nursing home jobs. Algorithms can't replace a live caregiver lifting a patient and moving them from the bed to the shower, Porter told Axios.

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FDA scientists are questioning whether Moderna has shown enough evidence that its new mRNA flu shot would be effective against seasonal influenza in certain individuals.

Why it matters: The concerns were raised in a briefing document ahead of a key meeting tomorrow of the FDA's Vaccines and Related Biological Products Advisory Committee, which will review the company's license application.

• The FDA initially refused to evaluate the application, sending shockwaves through the drug industry, before reversing itself in February.

Driving the news: FDA staff scientists wrote that their review of the Moderna shot found "no major deficiencies" but expressed concern that efficacy data were available for only one influenza season.

• They also noted that its effectiveness in immunocompromised individuals and very frail older adults hadn't been established.
• "This gap is significant because these populations face the highest absolute risk of severe influenza-related complications and may respond differently to mRNA-based vaccine platforms," the scientists wrote.

The advisory committee will vote on whether to approve the vaccine for people between the ages of 50 and 64, and whether to grant accelerated approval for individuals 65 and older.

• Most current flu shots are developed in eggs and have an effectiveness of up to 60% under optimal conditions.
• The mRNA platform would eliminate egg-based mutations that could reduce shots' potency and allow for rapid updates to the targeted flu strain, Moderna has said.

More reports of workplace violence in hospitals and clinics are reviving calls for a federal standard to protect nurses, social workers and others in medical settings.

Why it matters: Health care workers have been among the likeliest to experience threats or be assaulted on the job since the onset of the pandemic.

• But there's no nationwide requirement for health systems to keep violence prevention plans, train employees or inform them of their rights.

Driving the news: National Nurses United yesterday renewed calls for a federal OSHA standard for health care and social service employers, as outlined in a pair of bills in Congress.

• The big nurses' union also released a survey of more than 1,200 members in which more than a third said they'd seen an increase in violent incidents in their unit in the previous year.
• 7 in 10 said they had been verbally threatened in the previous year. Nurses also reported frequent occurrences of physical violence, including being pinched, scratched, punched and kicked and having objects thrown at them.

Reality check: OSHA has estimated complying with a standard would cost in excess of $1 billion a year and extend beyond hospitals to home health, residential and behavioral care facilities.

A new pair of HHS reports found considerable inaccuracies in the maternal health data that Medicaid managed care plans provide to patients and states — including instances of "ghost providers" who are not actually in network.

Why it matters: Medicaid pays for more than 40% of U.S. births, and most pregnant Medicaid enrollees are in managed care plans.

• Flawed directories can obscure provider shortages and leave vulnerable Americans unable to get appointments with the doctors listed.

What they found: A review of online provider directories for Centene, Elevance and UnitedHealthcare showed that overall, 9% of listed OB-GYNs, certified nurse-midwives and other providers reported that they were not in network.

• Some practiced in a different state and didn't accept out-of-state Medicaid plans.

A companion report found similar problems with network lists that plans sent to states.

Insurers who collect tens of billions of dollars administering the program have said they conduct regular audits to keep directories updated but depend on providers to keep information current.

🌱 Powerful figures close to President Trump, including Homeland Security Secretary Markwayne Mullin, pushed to downplay health concerns around kratom. (NYT)

🗳️ A Libertarian challenger in a top Iowa congressional battleground says Health Secretary Robert F. Kennedy Jr. privately pressured him to drop out. (Politico)

☣️ A passenger from the hantavirus-stricken cruise ship said she is being held in a Nebraska quarantine unit against her will, despite recommendations of a CDC review. (WashPost)