Order-of-the-State-Public-Health-Officer-Adult-Care-Facilities-and-Direct-Care-Worker-Vaccine-Requirement-FAQ Public Health Order Questions & Answers: Adult Care Facilities and Direct Care Worker Vaccine Requirement

This Q&A is out of date and is for historical purposes only. 

Public Health Order Questions & Answers: Adult Care Facilities and Direct Care Worker Vaccine Requirement

​Updates as of September 13, 2022:

  • Rescinds testing requirement (except as specifically noted to comply with federal requirements) for workers exempt due to medical reasons or religious beliefs. 
  • Facilities should maintain testing capacity at their worksite and have the ability to ramp up testing at their worksite, in the event of outbreaks or if it is required again at a future date. 
  • Updates timing of required booster doses consistent with current CDC recommendations.  

Why are testing requirements for exempt covered workers being rescinded?  

California has seen a dramatic increase in the percentage of Californians that are fully vaccinated and boosted. Vaccine coverage is high among workers in high-risk settings and the proportion of unvaccinated workers is low. As we’ve also seen, the Omicron subvariants have shown immune escape and increased transmissibility and while unvaccinated individuals still have higher risk of infection, previously infected, vaccinated, and boosted persons have also been infected. Consequently, mandated testing of the small number of unvaccinated workers is not effectively preventing disease transmission as with the original COVID-19 virus and prior variants earlier in the pandemic. 

Accordingly, amendments to the State Public Health Officer Order of February 22, 2022 regarding required testing for exempt covered workers are needed at this time, to reflect recent CDC recommendations, the current science of the Omicron subvariants, the increase in community immunity from vaccination and infection, and increases in vaccine coverage of our healthcare workforce. 

When does this amended order go into effect? 

This amended order is effective September 17th, 2022. 


Are adult care facilities and other covered facilities still recommended to test workers?  

Covered facilities should maintain capacity at their worksite, to continue to test as recommended during outbreaks, and in the event it is required again at a future date. Facilities may also still consider various screening testing strategies (point in time testing, serial testing, etc.) and based on concerning levels of transmission locally. Workers may also consider routine diagnostic screening testing if they have underlying immunocompromising conditions (e.g., organ transplantation, cancer treatment), due to the greater risks such individuals face if they contract COVID-19. 

Vaccination and Boosters 

Are the requirements for vaccination and booster for covered workers still in effect? 

Current requirements regarding vaccination and booster for covered workers remains in effect. Additionally, facilities must continue to track worker’s vaccination or exemption status. Effective February 22, 2022 workers who provide documentation of previous infection (after having received their full primary series of COVID-19 vaccine) may defer their booster dose for up to 90 days from date of infection. Workers with a deferral due to a proven COVID-19 infection must be in compliance no later than 15 days after the expiration of their deferral. 

Why are there new changes regarding the timing of when to get a booster dose?  

California has always made decisions based on science. As we have continued to learn more about post-Omicron infection immunity, waning immunity in general, and what new variants may evolve, changes to timing of booster doses have been updated to reflect this new science and recent CDC recommendations.   

Why are we requiring booster doses? 

Current vaccine requirements of staff in health care settings did not prove sufficient to prevent transmission of the more transmissible Omicron variant. Although COVID-19 vaccination remains effective in preventing severe disease, data suggest vaccination becomes less effective over time at preventing infection or milder illness with symptoms, especially in people aged 65 years and older. Boosters have been available in California since September 2021. 

Accordingly, making boosters mandatory are necessary. 

How does the vaccination and booster requirement affect new covered workers coming into compliance? Will current covered workers be required to receive the bivalent booster?

CDPH continues to urge all individuals to remain up-to-date on the COVID-19 vaccines (including the bivalent booster when due) to protect themselves and reduce the spread of the virus.

For covered workers who are already in compliance with  receiving the primary series and at least one booster, there is not a new requirement to receive the  additional bivalent booster.

For covered workers who are newly coming into compliance with the COVID-19 vaccination requirement including a booster, receipt of the bivalent booster will be required, based on the timing included in Table A of the order, since it is the only currently authorized booster.

Why are we allowing those that had an infection after completion of their primary series to defer their booster dose? 

There has been a growing body of evidence suggesting that a combination of history of SarsCoV2 vaccination and infection can lead to a strong "hybrid" immunity after recovery from infection. Additionally, there is immunological data suggesting that allowing an adequate interval between an infection and a COVID-19 vaccination dose may be important to allow quality immune memory. Thus, CDPH updated its order requiring health care workers to be fully vaccinated and boosted by March 1, 2022 to allow delay of the March 1, 2022 deadline for receiving a booster for covered workers with proof of a recent infection for up to 90 days from date of infection. This update reflected the current science and understanding as it relates to hybrid immunity in those who are fully vaccinated and then become infected. 

If a worker is not eligible for a booster dose by March 1st, can they still defer any future booster doses by 90 days if they become infected with COVID-19? 

Yes, if a covered worker is not currently eligible for a booster dose, but becomes infected with COVID before the recommended timeframe indicated in Table A in the order, they may still defer their booster dose by 90 days from the date of infection. 

Workers with a deferral due to a proven COVID-19 infection must be in compliance with the booster requirement no later than 15 days after the expiration of their deferral. 

How can a worker provide proof of prior infection?  

Workers must provide documentation (including date of infection) of previous diagnosis from a healthcare provider or confirmed laboratory results to provide proof of COVID-19 infection. 

Are there any exemptions to the vaccination mandate?

 The Order allows for two exemptions: (1) the worker is declining vaccination based on sincerely held religious beliefs or (2) the worker is excused from receiving any COVID-19 vaccine due to Qualifying Medical Reasons. To receive an exemption, a worker must participate in their employer's interactive process.

What are Qualifying Medical Reasons? 

To determine qualifying medical reasons, the physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician should refer to Interim Clinical Considerations for Use of COVID-19 Vaccines from the CDC, specifically, clinical considerations, as well as contraindications and precautions. The identified contraindications include: 

  • Documented history of severe allergic reaction to one or more components of all the COVID-19 vaccines available in the U.S. 
  • Documented history of severe or immediate-type hypersensitivity allergic reaction to a COVID-19 vaccine, along with a reason why you cannot be vaccinated with one of the other available formulations. 

Additionally, the Interim Clinical Considerations for Use of COVID-19 Vaccines provides information on what are neither contraindications nor precautions to COVID-19 vaccination, which includes: 

  • Allergic reactions (including severe allergic reactions) not related to vaccines (COVID-19 or other vaccines) or injectable therapies, such as allergic reactions related to food, pet, venom, or environmental allergies, or allergies to oral medications. 

Who is authorized to provide a Qualified Medical Reason exempting a worker from the COVID-19 vaccine requirements?

Only a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician can provide a Qualified Medical Reasons exemption. In this context, the term "physician" refers specifically to an individual having a valid certificate or license to practice medicine and surgery issued by the Medical Board of California or the Osteopathic Medical Board of California. 

Will the State be providing a template declination / exemption form for use? 

No, the State will not be providing a template declination/exemption form for use. Facilities may use any existing form or process previously used for other mandated vaccines. If an entity does not have a previously used form, they should ensure that the requirements as stated in the Order are met, including written health care provider's statement where applicable, and testing records pursuant to section (8) of the Order. 

How will you verify workers are vaccinated or boosted? 

Each facility, employer, or employer-recipient will be required to verify and keep record of vaccination status or test results. Pursuant to the CDPH Guidance for Vaccine Records Guidelines & Standards, facilities have multiple options to verify vaccine status. 

Is contracting COVID-19 the best way to gain immunity from subsequent infection? 

No. Completing the COVID-19 vaccination series, including a booster, is the safest and more dependable way to build immunity to COVID-19 than getting sick with COVID-19. The level of protection people get from infection may vary widely depending on how mild or severe the illness was, the time since infection, the variant that caused the infection, and the individual's age. Vaccine-derived immunity is much more predictable and dependable.  In addition, people who get COVID-19 are at risk for potentially severe outcomes.  

If I had COVID-19, why do I need the vaccine at all?  

California health officials strongly recommend getting vaccinated even after a COVID-19 infection. Research shows that the vaccine is effective and can further boost your immunity. For example, some people who have had a COVID-19 infection do not produce the same antibody levels as those who got the vaccine. However, not everyone infected will develop the ability to prevent getting infected again. 

Are there health risks if someone receives their booster after completing their vaccine series and recovering from COVID-19 infection? 

There are no known health risks with receiving a booster dose after testing positive or receiving a clinical diagnosis of COVID-19, and information is evolving regarding the development of optimal immune memory for evolving SarsCOV-2 virus variants. 

Covered Setting and Workers 

Are there any requirements for exempt workers while in the facilities? 

Exempt workers must wear a well-fitting respirator approved by the National Institute of Occupational Safety and Health (NIOSH), such as an N95 filtering facepiece respirator, or surgical mask, at all times while in the facility.  

Are Assisted Living Facilities covered by this Order? 

Yes, Assisted Living Facilities are covered by this Order. 

Are Long-Term Care Ombudsmen Who Provide Services in Adult and Senior Care facilities covered by this Order? 

Yes. This Health Order covers all paid or unpaid Long-Term Care Ombudsman representatives who provide services in those Adult and Senior Care Facilities. 

Does the Order apply to California Children's Services (CCS) Medical Therapy Unit program staff or other public health staff who provide intermittent home visits? 

Yes, the Public Health Order applies to all CCS Medical Therapy Unit staff, including those who conduct home visits. 

Does the Order apply to outside vendors that may need to enter a facility or home (for example, those providing durable medical equipment into the home)? 

Outside vendors who do not work in the facility or home for extended periods or on a regular basis are not covered by this Order. It is recommended that facilities set up daily symptom screening and antigen testing sites for vendors not covered by the Order and provide surgical masks and hand hygiene stations. Unvaccinated vendors must wear face coverings and vendors should minimize their time spent in the facility or home, if possible. Within the context of home health or similar services, the client has the right to request proof of vaccination from the vendor prior to entry. 

What is the definition of "family member" as it applies to this Order? 

A "family member" is defined by the agency or program that provides licensing, enforcement, and/or oversight (e.g. IHSS, CDSS, CDDS etc.) for the particular facilities or services being provided. 

Who will be responsible for enforcement of the requirements under this Order? 

Each covered facility will be required to enforce the vaccine mandate of their respective staff (including any staff that may come from a contracted staffing agency). 

To the extent that the covered facilities are subject to state regulation, the state's regulating entities will ensure each facility is meeting the requirements for vaccine verification/exemptions. For example, the California Department of Public Health will enforce this requirement at hospitals, skilled nursing facilities, intermediate care facilities, and the other health care facilities it licenses; and the Department of Health Care Services will enforce this requirement at residential substance use treatment and mental health treatment facilities. Local health jurisdictions may also enforce the orders. 

What should a facility do if they suspect a fraudulent vaccine card is being presented as proof? 

Facilities should work with their counsel and may report suspected cases of healthcare fraud to the U.S. Health and Human Services through their tip line at 1-800-HHS-TIPS or by using other ways to contact the hotline. 

When did the original Order take effect? 

The original Order went into effect September 28, 2021. 

Will the July 26 Public Health Order continue to apply?  

The July 26th Order has been rescinded. 


Originally published on December 22, 2021