Nursing homes should require flu shots for all staff and patients, most older adults say

High unvaccinated rate might even affect decisions about where to seek long-term care, U-M/AARP National Poll on Healthy Aging shows

ANN ARBOR, MI – As flu season swings into high gear, a new poll suggests that nursing homes and other long-term care facilities should be doing more to get their staff and patients vaccinated before it’s too late.

Nearly three-quarters of people over age 50 surveyed in a new poll say that all staff in such facilities should definitely be required to get the flu vaccine. More than 60 percent also say that all patients in nursing homes and assisted living should definitely get vaccinated too.

In fact, poll respondents felt so strongly about flu vaccination that 70 percent said that if they found out that one-third of a nursing home’s staff wasn’t vaccinated, they would be less likely to choose it for themselves or loved ones.

The new results, from the National Poll on Healthy Aging, come at a time when nursing homes and assisted living facilities lag behind hospitals and other healthcare settings in the rate of flu vaccination among staff.

The poll was conducted in a nationally representative sample of 2,007 Americans between the ages of 50 and 80 by the University of Michigan Institute for Healthcare Policy and Innovation. It was sponsored by AARP and Michigan Medicine, U-M’s academic medical center.

Lack of vaccination

Older people, and those with chronic health conditions of any age, are especially vulnerable to the influenza virus, and at an increased risk of developing flu-related complications such as pneumonia. Widespread vaccination helps create “herd immunity” that makes it harder for the virus to spread between people.

The Centers for Disease Control and Prevention recommends that everyone over the age of six months should be vaccinated against the flu every year, with few exceptions. But the CDC has reported that only 68 percent of workers in long-term care settings such as nursing homes get vaccinated against the flu, compared with more than 92 percent of hospital workers.

“We’ve finally gotten to the point in the last few years where most inpatient hospitals require their staff to get vaccinated against the flu, or at least strongly promote it,” says Preeti Malani, M.D., the director of the poll and a professor of internal medicine at the U-M Medical School who specializes in infectious diseases and geriatrics.

“These results suggest that other types of care facilities should do the same to protect vulnerable patients – or potentially risk losing business,” she adds. “I encourage everyone to ask nursing homes and other long-term care facilities about their vaccination policies.”

“Flu and pneumonia are a critical health concern, and in recent years have resulted in over 50,000 deaths annually, making it the 8th leading cause of death just behind diabetes,” says Alison Bryant, Ph.D., senior vice president of research for AARP. “Over 80 percent of these deaths were among older adults ages 65 and older. Increasing vaccination rates to increase herd immunity is imperative to the health and lives of our most vulnerable.”

Influence on facility choice

It’s up to nursing homes and other long-term care facilities to disclose to their patients, visitors and prospective patients what their flu vaccination policies and practices are. But the new poll asked respondents to react to a hypothetical scenario in which a nursing home had a vaccination rate about the current national average.

Forty percent of poll respondents said if they found out that 1 in 3 staff at a particular nursing home weren’t vaccinated against the flu, it would make them much less likely to choose that facility. Another 30 percent said this knowledge would make them slightly less likely to choose it.

Such data about staff vaccination is actually publicly available for some types of facilities, though many people may not know it.  In inpatient rehabilitation facilities, 91 percent of patients and 84 percent of staff have had theirs, according to the federal site that tracks them. The site for long-term care hospitals shows that 77 percent of staff have been vaccinated.

However, the site that tracks nursing home data doesn’t yet show nursing home staff flu vaccination rates, though it does show resident flu shot percentages for each facility.

CDC makes a special recommendation that healthcare workers be vaccinated, and offers a special toolkit for long-term care facilities.

Impact on employment and visiting

In all, 73 percent of respondents felt that nursing home medical staff should definitely get vaccinated, and 71 percent felt that non-medical staff should too. An additional 20 percent of respondents felt that staff should possibly be required to be vaccinated.

The vast majority of respondents also thought that nursing homes should offer the vaccine to staff at work, at no charge, and should require unvaccinated staff to stay home if they get sick. But a lower percentage – 55 percent – thought that the flu vaccine should be mandatory for staff to keep their jobs. In contrast, many hospitals require staff vaccination but allow some staff to opt out and instead wear masks around patients during flu season.

When it came to nursing home visitors, respondents were less strong in their opinions. Only 25 percent said visitors should be required to be vaccinated before visiting their loved ones. Another 45 percent said they possibly should be required to get the vaccine, and 30 percent believed visitors should not be required to get the vaccine.

The poll results are based on answers from a nationally representative sample of 2,007 people ages 50 to 80. The poll respondents answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it. A full report of the findings and methodology is available at www.healthyagingpoll.org