State Laws on Flu Vaccination in Nursing Homes and Other Long-Term Care Facilities

This summarizes a legal "menu" from CDC's Public Health Law Program, covering state laws collected from September 9 to November 8, 2016.

Flu can be serious — leading to hospitalization and sometimes death — even in otherwise healthy people. It spreads mainly in households and the community, and each year 5% to 20% of U.S. residents catch it. Deaths fall hardest on older adults: in the 1976–2007 flu seasons, an estimated 21,098 adults aged 65 or older died of flu-related causes each year on average, 90% of all such deaths.

In health care settings, workers can carry flu on their hands or clothes to colleagues and patients. The Advisory Committee on Immunization Practices recommends yearly flu vaccination for all health care personnel; vaccinating them has been linked to less absenteeism and fewer deaths among nursing home residents and elderly hospital patients. Yet coverage among workers in long-term care is often lower than in hospitals and outpatient care — though it matters most there, because residents are often 65 or older, and the vaccine can work less well in the elderly. CDC recommends a flu vaccine every year for all adults, including health care workers.

What the laws require

Laws may require a facility to:

• assess — check a worker's or resident's vaccination status;
• offer — offer the vaccine;
• ensure — require proof of vaccination;
• and, for workers who are exempt or decline, mask — wear a surgical mask during flu season.

Long-term care facilities provide medical and personal care to people who cannot live independently — nursing homes and skilled nursing facilities, among others.

Health care workers: twenty-four states

Examples:

• Kentucky requires every long-term care facility to have each employee immunized against flu; Missouri facilities must help staff and volunteers with resident contact get vaccinated. Georgia nursing homes must offer free on-site flu shots every year to staff who have contact with patients; New Hampshire residential care facilities must give yearly shots to employees who consent.
• Arkansas nursing homes must document and report staff immunizations each year; New York nursing homes record each worker's flu vaccination status for the season; Utah facilities report how many workers are documented as vaccinated.
• Oklahoma nursing facilities must document offering the vaccine to each employee; Maine nursing and assisted living facilities must recommend and offer it to all direct-care staff; Texas requires nursing homes to offer it to staff in contact with residents.
• South Carolina requires a yearly flu shot for nursing home direct-care staff unless it is medically contraindicated or offered and declined; the District of Columbia requires nursing facility employees to be immunized.
• Colorado requires workers without proof of vaccination to wear a surgical or procedure mask in direct contact with patients during flu season; Rhode Island requires unvaccinated health care workers to mask during declared periods of widespread flu, as a condition of their professional licence.
• Exemptions: Massachusetts exempts employees for whom the vaccine is medically contraindicated; Alabama and North Carolina exempt those for whom it is against their religious beliefs; Pennsylvania facilities must ask employees to be vaccinated but cannot require it of those who object; Oregon facilities report how many staff documented a refusal.

Residents: thirty-two states

Examples:

• Alabama and New Jersey facilities must document each resident's yearly flu vaccination; Arkansas nursing homes document and report it; Delaware nursing facilities keep evidence of it on file; Kentucky facilities assess residents' flu immunization on admission.
• Illinois requires facilities for residents under 22 to give or arrange a yearly flu shot for each resident; North Carolina requires nursing home residents and staff to be immunized against flu, and residents against pneumococcal disease too.
• Michigan nursing homes must offer every resident a yearly flu shot; Nebraska nursing facilities must offer on-site vaccination to all residents and to inpatients before discharge; California and Texas require it to be offered to residents 65 and older.
• South Carolina requires residents to have a yearly flu shot; the District of Columbia requires nursing facilities to ensure each resident has been vaccinated or has refused.
• Exemptions: Arizona and Texas facilities need not vaccinate where it is medically contraindicated; North Carolina and Pennsylvania exempt residents on religious grounds; Hawaii (unless the resident refuses) and South Dakota (recording vaccination or refusal) allow residents to decline.

Even where the law makes no medical exemption, someone for whom the vaccine is medically contraindicated is probably not required to receive it.

Sources

• Centers for Disease Control and Prevention, Public Health Law Program, "Influenza Vaccination Laws for State Long-Term Care Facilities," developed by Hillary Li, Aila Hoss, Alexandra Bhatti and colleagues. https://www.cdc.gov/phlp/php/publications/flu-vaccination-laws-state-ltc-facilities.html
• Words on this page from people and organisations outside the federal government — including state statutes — are paraphrased; rewritten in hubnx's own words.