INCREASING UNDERSTANDING OF ENHANCED INFLUENZA VACCINE PRODUCTS IN LONG-TERM CARE SETTINGS
Practical Strategies for Increasing Use of Enhanced In uenza Vaccine Products Among LTCF Residents and Sta
Practice standards and clinical recommendations are available to guide best practices for adult vaccinations, including in uenza vaccines.
Facilities can use practical strategies for improving immunization rates among nursing home sta and residents, including having leaders commit to vaccine education, implementing universal vaccination policies, making vaccines easily accessible, and documenting vaccination e orts.
Families admitting their loved ones to long-term care facilities (LTCFs) need to know that infection prevention and control are priorities. For post–acute care patients on their way to LTCF beds, respiratory viruses are a key concern. To attract quali ed sta who are concerned with their own health, LTCF managers need to be able to demonstrate e ectiveness of vaccination policies and infection control practices. These goals can be reached by educating sta about vaccines and vaccinations, strongly recommending or requiring vaccinations, administering vaccines or working to make these easy for sta and residents to get, and documenting vaccinations as responsible members of the immunization community.1,2
Having Leaders Commit to Education at All Levels 1
The rst step in strengthening vaccine policies in LTCFs is through sta education. This begins with making sure facility managers and clinical leaders are all on board with vaccination policies and procedures. A variety of practical, clinical, and nancial challenges can come up in this process. Information is available to counter concerns about reimbursement issues, the true cost to facilities when residents are ill or must be transferred for acute care, and the expense of bringing in replacement workers if sta become sick and cannot work. For vaccine policies to be e ective, commitment of LTCF leaders is necessary.3
As education moves to the sta level, everyone employed by LTCFs should learn about practice standards for all health professionals as developed by the National Vaccine Advisory Committee and recommendations for adult vaccinations developed by the Advisory Committee on Immunization Practices, a component of the Centers for Disease Control and Prevention.1,2
By learning about these standards and their importance to resident health, facility sta develop greater awareness of their personal responsibility to be fully vaccinated. The advantages of using enhanced in uenza vaccines in older adults can be emphasized during sta education sessions. Nursing sta , other clinical workers, social workers, and consultant pharmacists must all be conversant about the value and e ectiveness of vaccines for these e orts to produce the highest possible vaccination rates. Nonmedical sta — including employees in housekeeping, dietary services, and maintenance — should also be educated about the importance of immunizations and encouraged or required to stay current with vaccines that can help protect residents.3
Implementing Universal LTCF Vaccination Policies 2
LTCF administrators and clinical leaders can adopt established best practices to increase both sta vaccinations and resident vaccinations, as identi ed in a 2016 stakeholder summit convened by The Gerontological Society of America3:
Emphasize mandatory vaccination policies during the hiring process and vaccinate new employees within 48 hours.
Obtain renewable informed consent from employees, contractors, and health professions students and residents in the facility.
3
Obtain a general consent for vaccinations and include vaccines in standing orders.
Use gami cation, etc… quizzes, and puzzles to increase awareness of in uenza and its impact on health.
Making Vaccines Accessible and Easy to Get
Cost and convenience are key factors in raising vaccination rates in all settings, including LTCFs. Facilities should identify ways of o ering vaccinations with no or minimal out-of-pocket costs to sta and residents. This can be accomplished by training sta to administer and bill Medicare/Medicaid for residents and employee insurance for sta vaccinations. If sta ng for vaccinations is not feasible, facilities can turn to partners in the aging and pharmacy communities. These entities specialize in setting up vaccination clinics within the facility and billing for services separately. If sta cannot be vaccinated within the facility, paid time o should be arranged so they can receive the in uenza vaccine elsewhere. When needed, incentives for getting immunized can be o ered, such as an additional paid day o . Another strategy of minimizing communicable diseases in LTCFs is to provide paid time o for illnesses so that sta do not come to work when sick.
4
Documenting Vaccination E orts
Even before COVID-19, consumer surveys showed that people expect LTCFs to have high or universal in uenza vaccination rates. People 50 to 80 years of age told surveyors they expected sta and residents in LTCFs to be vaccinated, and 70% of respondents would be less likely to choose an LTCF if they knew that one-third of sta members were not vaccinated.4 Thus, in addition to ful lling professional responsibilities to document vaccinations in medical records and state immunization information systems, LTCFs should trumpet their vaccination e orts to the community and potential residents.
Resources
1. Centers for Disease Control and Prevention. Standards for adult immunization practice. May 2, 2016. Available at: https://www.cdc.gov/vaccines/hcp/adults/for-practice/standards/index.html. Accessed May 18, 2020.
70% of respondents would be less likely to choose a LTCF
2. National Vaccine Advisory Committee. Update on the National Vaccine Advisory Committee Standards for Adult Immunization Practice. September 10, 2013. Available at: https://www.hhs.gov/sites/default/files/nvpo/nvac/meetings/pastmeetings/2013/adult_immunization_update-sept2013.pdf. Accessed May 18, 2020.
3. Gerontological Society of America. Charting a Path to Increase Immunization Rates in the Post-Acute and Long-Term Care Settings. 2018. Available at: https://www.geron.org/images/navp/pdfs/ImmunizRatesWP_FNL.pdf. Accessed May 18, 2020.
4. University of Michigan Institute for Healthcare Policy and Innovation. Nursing homes should require flu shots for all staff and patients, most older adults say. January 3, 2018. Available at: https://ihpi.umich.edu/news/nursing-homes-should-require-flu-shots-all-staff-patients-most-older-adults-say. Accessed May 18, 2020.
© 2020 by The Gerontological Society of America. All rights reserved. August 2020.