KEYWORDS:
Assisted Living Facility
Immunization
Influenza
Long-term Care
Nursing Home
Pneumonia
Standing Orders
Vaccine

BACKGROUND:
Influenza and pneumonia are two of the leading causes of preventable morbidity and mortality among adults age 65 years and older. To increase vaccination rates for these diseases, the CDC has recommended that long-term care facilities implement standing orders programs that allow facilities to immunize residents based on a pre-approved protocol without a physician’s examination.

OBJECTIVE(S):
This report describes current state policies regulating influenza and pneumonia immunizations and the use of standing orders in long-term care facilities; and examines states’ definitions of “long-term care facilities” and the scope of these industries in each state.

METHOD(S):
Researchers surveyed each state’s health department and peer review organization to learn about state policies on influenza and pneumonia vaccinations and the use of standing orders in long-term care facilities; reviewed state laws and regulations to obtain states’ definitions of long-term care facilities and policies on prescriptive authority; and contacted the American Health Care Association and major corporations operating long-term care facilities to determine the market saturation of these corporations in each state.

RESULT(S):
Eighteen states have established immunization policies on influenza and pneumonia vaccinations in long-term care facilities. State policies differ in the vaccine regulated, mandate specified, and population targeted. Most states have no formal policy that specifically defines or regulates standing orders for immunization in long-term care facilities; however, states generally permit the use of standing orders in the absence of regulations prohibiting them.

CONCLUSIONS(S):
The absence of state policies regulating influenza and pneumonia vaccinations and the use of standing orders has left much of the responsibility for establishing policies to individual facilities.

LEARNING OBJECTIVES:
Learners will know how each state’s regulatory environment affects the implementation of vaccination programs in long-term care facilities, particularly standing orders programs.