Trend In Influenza Immunization Coverage Among Residents of Long-Term Care Facilities Certified by CMS, 2005-2009

Background: In October, 2005 the Centers for Medicare and Medicaid Services (CMS) required that long-term care (LTC) facilities certified by CMS offer each resident annual influenza vaccination. Influenza vaccination coverage of 63% reported by the National Nursing Home Survey conducted in 2004, prior to CMS’ requirement, was well below the Healthy People 2010 goals for influenza vaccination coverage among nursing home residents.

Objectives: Examine changes in influenza immunization coverage among residents of LTC facilities certified by CMS since 2005.

Methods: We analyzed CMS’ Minimum Data Set consisting of all resident assessments based on documented immunization histories conducted October 1 through March 31 of each year from 2005 to 2009 to determine residents’ influenza vaccination status.  Influenza vaccination coverage for each year and coverage by race over time were examined.

Results: Approximately 2.5 million persons lived in CMS-certified nursing homes for some period of time each year from 2005 to 2009. Vaccination coverage increased from 66.4% during the 2005-2006 influenza season to 69.5% during the 2008-2009 season. Refusals of the vaccine increased from 10.9% in 2005-2006 to 12.8% in 2008-2009. The proportion of residents not offered the vaccine dropped from 13.8% to 10.1% by 2009. The proportions with missing vaccination status (3.7% to 4.7%), unable to obtain vaccine (3.2% to 1.4%), and contraindicated (2.1% to 1.5%) remained constant from 2005 to 2009. The White-Black difference in receiving the vaccine also remained constant (8.3 percentage points in 2005-2006 to 8.4 percentage points in 2008-2009).

Conclusions: Vaccination coverage was not substantially affected by the CMS mandate. Influenza vaccination coverage among residents of LTC facilities increased slightly but remains below the Healthy People 2010 goals of 90%. More residents are being offered the vaccine, but understanding the factors contributing to suboptimal coverage and continued disparities is important.