Nursing homes lag badly on worker flu shots
Hospitals hit vaccine rate of 83%
Hospital employees recorded the highest-ever rates of influenza immunization in the past flu season, with 83% of hospital-based health care workers reporting they got the shot. But as public health authorities touted that success, they revealed a troubling statistic: Only 59% of health care workers in long-term care received the vaccine.1
That rate was actually worse than the rate of the 2010-2011 season, the year after the H1N1 pandemic, when an Internet-based survey indicated that 64% of health care workers in long-term care facilities received the vaccine.
The health care workers themselves aren’t the only ones to blame. Half of them reported that their long-term care employers did not offer free flu vaccines to workers.
"In the long-term care facilities, where the patients are the most vulnerable, they’re the least likely to be offering vaccine or be offering it for free," said Anne Schuchat, MD, (RADM, USPHS), Assistant Surgeon General for the US Public Health Service and director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. She spoke at a recent news conference sponsored by the National Foundation for Infectious Diseases (NFID).
Yet public health efforts have not always focused on health care workers in long-term care. The Centers for Medicare & Medicaid Services (CMS) requires hospitals to report influenza vaccination rates of health care workers, but long-term care facilities report the vaccination rates of residents.
Some states have filled in the gaps. Rhode Island and New York currently require health care workers — hospital, long-term care and home care — to receive the flu vaccine or wear a mask while influenza is widespread in the state. A Colorado rule requires health care facilities, including nursing homes, to vaccinate 75% or more of their workers by December 31, 2013 (and 90% by Dec. 31, 2014) or adopt a vaccine-or-mask rule.
Nursing homes are aware of the importance of influenza immunization, says Greg Crist, senior vice president of the American Health Care Association in Washington, D.C., a federation of state associations that represent long-term and post-acute care facilities.
"The numbers aren’t where we’d like to see them when it comes to immunizing our staff," he says.
Long-term care providers, which get about 80% of their funds from Medicare or Medicaid, have been struggling with reduced payments and rising costs, he says. They also face a challenge of high turnover of staff, he says.
Nonetheless, long-term care providers are adopting their own vaccine-or-mask policies to protect their residents, he says. "We understand just how vulnerable seniors are," he says.
In nursing homes, vaccination rates are lowest among the lowest paid workers. Some 85% of nurses in long-term care facilities reported having received the flu vaccine, but only 55% of nurses’ aides and technicians said they were vaccinated, CDC reported.
Hospitals almost reach 2020 goal
Meanwhile, pressure on hospitals to boost vaccination rates has produced impressive results. CMS requires reporting of influenza immunization rates for employees, licensed clinical professionals, and volunteers/students/trainees, and those rates will be publicly reported in 2014. (See related article in HEH, October 2013, p. 112.)
Mandatory and vaccine-or-mask policies have become increasingly common in the nation’s hospitals. Hospitals are now just shy of the Healthy People 2020 goal of vaccinating 90% of health care workers against influenza.
Physicians led the way, with a vaccination rate of 92%. About 87% of nurses and 80% of non-clinical personnel in hospitals reported receiving the vaccine.
About 2,000 health care workers participated in the Internet survey, which was conducted in April 2013.
Myths about influenza vaccination persist, despite yearly awareness campaigns, public health authorities say. Some health care workers believe the vaccine will give them the flu, and others believe they don’t need a shot because they never get the flu, said Richard S. Liebowitz, MD, senior vice president and Chief Medical Officer of New York-Presbyterian Hospital in New York City, who spoke at the NFID press conference.
New York-Presbyterian allowed employees to decline vaccination but required them to first view a 25-minute video about influenza vaccination, he said. About 70% to 75% of the hospital’s non-medical staff typically receives the vaccine, he said.
But for this flu season, the hospital will follow the new vaccine-or-mask rule of the New York State Department of Health. "I’m hoping that rather than [having] the stigma of wearing a mask, they will choose to do the right thing," he said.
1. Centers for Disease Control and Prevention. Influenza vaccination coverage among health-care personnel — United States, 201213 influenza season. MMWR 2013; 62:781-786.