Vaccination Reminder for Nursing Home Residents
Critical Action Required
All nursing home residents must receive influenza vaccination immediately, and RSV vaccination should be offered to eligible residents, as vaccination is the single most effective intervention to reduce mortality and severe complications in this highly vulnerable population. 1
Why This Matters: The Evidence
Mortality Impact
- Influenza vaccination reduces all-cause mortality by 44% in nursing home residents (from 17% to 10% mortality rate), making it one of the most impactful interventions we can provide. 2
- Among nursing home residents specifically, influenza vaccine is 80% effective in preventing death and 50-60% effective in preventing hospitalization or pneumonia. 3
- More than 90% of influenza deaths occur in adults ≥65 years, with 20,000-40,000 deaths during severe epidemic years. 3
Current Coverage Gaps
- As of November 2024, only 58.4% of nursing home residents had received influenza vaccination and just 17.9% had received RSV vaccination early in the season—leaving nearly half our residents unprotected. 4
- COVID-19 vaccination coverage stands at only 29.7% among nursing home residents. 4
Required Vaccinations for Nursing Home Residents
1. Influenza Vaccine (Annual - MANDATORY)
- All residents must be vaccinated unless medically contraindicated or the resident/legal representative refuses. 1
- Vaccination should commence immediately when vaccine becomes available (typically October-November) and continue through March for new admissions. 1
- CMS requires nursing homes participating in Medicare/Medicaid to offer influenza vaccine to all residents and document results. 1
- Benefits and risks should be discussed at admission, but signed consent is not required to implement standing orders. 1
2. RSV Vaccine (Recommended)
- All residents ≥75 years should receive a single lifetime dose of RSV vaccine. 5
- Residents aged 60-74 years at increased risk for severe RSV should also receive vaccination. 5
- Current coverage is critically low at 17.9%, representing a major gap in protection. 4
3. COVID-19 Vaccine (Annual - Updated Formulation)
- All residents should receive the updated 2024-2025 COVID-19 vaccine. 4
- Current coverage of 29.7% is unacceptably low and leaves residents vulnerable to severe outcomes. 4
4. Pneumococcal Vaccine
- CMS requires nursing homes to offer pneumococcal vaccine to all residents and document results. 1
Implementation Strategy
Timing and Logistics
- Vaccinate all residents at one time before influenza season begins, ideally in October-November when vaccine arrives. 1
- New admissions: Vaccinate at time of admission if they arrive after the facility's vaccination program is complete, continuing through March for influenza. 1
- Standing orders should be implemented to streamline vaccination without requiring individual physician orders for each resident. 1
Documentation Requirements
- Each resident must be vaccinated unless: (1) medically contraindicated, (2) resident/legal representative refuses, or (3) vaccine unavailable due to shortage. 1
- Document vaccination status in the CMS Minimum Data Set as required. 1
- Informed consent is required but does not necessitate a signed document to proceed with standing orders. 1
Staff Vaccination
- Healthcare workers must also be vaccinated to protect residents—vaccination of staff reduces resident mortality by 44%. 2
- Staff vaccination should be offered on-site, free of charge, with convenient access including night and weekend shifts. 1
Common Pitfalls to Avoid
Don't Wait for Individual Orders
- Standing orders are recommended and effective—do not delay vaccination waiting for individual physician orders for each resident. 1
Don't Assume Signed Consent is Required
- While informed consent is necessary, a signed document is not required to implement standing orders for vaccination. 1
Don't Forget New Admissions
- Residents admitted after the initial vaccination campaign must be vaccinated at admission (through March for influenza). 1
Don't Overlook Staff Vaccination
- Staff vaccination is equally critical—unvaccinated staff serve as vectors for transmission to vulnerable residents. 2
Key Talking Points for Residents/Families
- Influenza vaccine reduces death risk by 80% in nursing home residents. 3
- Vaccination prevents hospitalization in 50-60% of cases. 3
- RSV causes severe respiratory illness in older adults, and vaccination provides important protection. 5, 4
- COVID-19 continues to circulate and updated vaccines protect against current variants. 4
- Staff vaccination protects residents—when healthcare workers are vaccinated, resident mortality drops significantly. 2
Action Items for Providers
- Review vaccination status of all current residents immediately
- Implement standing orders for influenza, RSV, and COVID-19 vaccines
- Vaccinate all eligible residents who have not yet received 2024-2025 vaccines
- Ensure staff vaccination is complete
- Document all vaccinations in CMS Minimum Data Set
- Establish protocol for vaccinating new admissions at time of admission