Bloomberg Law
Free Newsletter Sign Up
Bloomberg Law
Advanced Search Go
Free Newsletter Sign Up

Flu Shot Mandates for Nursing Home Staff Urged as Covid Persists

Aug. 25, 2020, 9:46 AM

The potentially deadly confluence of a raging Covid-19 pandemic and the upcoming flu season is prompting growing calls for states to require influenza vaccinations for all nursing home health-care personnel.

The nation’s 15,000-plus nursing homes are already struggling with rising Covid-19 infections and deaths due to unchecked community spread. The seasonal flu, which has symptoms similar to Covid-19, also poses a deadly threat to older, frail nursing home residents with compromised immune systems.

With no prior experience to predict the way influenza and Covid-19 will interact, some nursing operators and industry experts say mandatory flu shots are needed to boost sagging vaccination rates among nursing home staff—whose interactions with residents have been the principal means of Covid transmission.

“Whether it’s a state or federal mandate, or whether it’s done through best practices or other means, we really don’t care. The truth is that nursing home staff are the lagging sector when it comes to vaccinations, in particular flu vaccinations,” said Christopher Laxton, executive director of AMDA—the Society for Post-Acute and Long-Term Care Medicine.

Only 68% of health-care workers in nursing homes and other long-term care facilities received flu vaccinations during the 2018-2019 flu season, according to surveys by the Centers for Disease Control and Prevention.

That’s the lowest of all health-care settings, well behind hospitals, at 95.2%, and nearly 80% for outpatient care settings like clinics and doctors’ offices. Unlike nursing homes, those providers typically require vaccination as a condition of employment, Laxton said.

‘I Don’t Feel Like It’

Some nursing home operators, like Genesis HealthCare, Avalon Health Care, Signature HealthCARE, and the nonprofit Good Samaritan Society, already require flu shots for their health-care staff, said Laxton, whose group represents more than 50,000 medical directors, doctors, and assorted caregivers at nursing homes and other long-term care facilities.

But typically, nursing home personnel can refuse the vaccine, citing various religious, cultural, and anti-science reasons, Laxton said. When that happens, medical staff can require them to wear a mask. But because they’re already wearing masks due the pandemic, the medical team tries to counsel them about the benefits of vaccination.

“But sometimes it’s just ‘I don’t feel like it. I don’t feel like getting a shot so I won’t.’ And that’s unacceptable,” Laxton said. ”This is a health-care setting with a very frail population, and you have to protect the staff and you have to protect the residents.”

The American Health Care Association, the leading nursing home industry trade group, said in a statement that the “importance of vaccines has never been more prominent, and providers will continue to promote and offer influenza vaccine to residents and staff.”

“COVID and the seasonal flu mimic many of the same symptoms, which caused a lot of confusion and tragedy when this pandemic first began. It will be imperative that residents and staff get a flu vaccine this year,” the association said.

LeadingAge, the trade group representing nonprofit nursing homes, said it hasn’t taken a position on mandatory flu vaccinations.

Lobbying for Executive Orders

Because a federal vaccination mandate would require an act of Congress, AMDA is urging its state chapters to lobby their respective governors for an executive order mandating flu vaccinations for nursing home staff, Laxton said.

Nancy Istenes, president-elect of the Ohio Medical Directors Association, said her group hosts weekly roundtable calls about the proposal with state health associations, industry representatives, and state health officials.

“But I can’t say that it’s gotten much traction at this point,” with the stakeholder groups nor state lawmakers, said Istenes, a practicing geriatrician. ”There doesn’t seem to be a lot of interest in removing the barriers.

“And my point is, if there’s ever a year to remove the barriers, maybe this is that year.”

From Oct. 2019 through April 2020, there were between 24,000 and 62,000 flu deaths, the CDC estimates. And people age 65 years and older account for an estimated 71% to 85% of seasonal flu deaths, AMDA has estimated.

In light of the “myths, rumors and unfounded fears about vaccines,” mandatory flu shots for nursing home staffers would provide a welcome layer of protection, said Danny Williams, president and CEO of Eliza Bryant Village, a nursing home in Cleveland, Ohio.

“Those of us down here on the ground, we would love to have the cover of a mandatory order,” said Williams, whose majority-black, low-income residents with underlying health problems are more susceptible to both flu and Covid-19 infection.

Without the vaccination requirement, “I just don’t think that we can rely on hopes that this won’t converge with Covid-19 and create some real disasters,” Williams said in response to a question from Bloomberg Law during a recent telephone conference call by LeadingAge.

As of Aug. 20, there were 70,649 Covid-19 deaths at nursing homes and other long-term care facilities in 45 states, according to the Kaiser Family Foundation. That’s 43% of all Covid deaths in those states.

A spokesperson for the Centers for Medicare & Medicaid Services said the agency encourages—but doesn’t require—nursing homes to provide flu shots to their employees.

“Although vaccination for these workers is not required, immunizing nursing home workers has been shown to reduce mortality rates among residents of long-term care facilities,” the spokesperson said.

The agency does require nursing homes serving Medicare and Medicaid beneficiaries to provide immunizations against influenza and pneumococcal disease to all residents, the spokesperson said.

To contact the reporter on this story: Tony Pugh in Washington at

To contact the editors responsible for this story: Fawn Johnson at; Brent Bierman at