Preparing for Fall Vaccinations in Long Term Care

Quality; Programs and Resources

As fall approaches, long-term care (LTC) providers should be preparing to vaccinate their residents and staff against common respiratory viruses. There are three vaccines that providers should be aware of and prepared to offer to their staff and residents:  

  • Influenza  
  • COVID-19  
  • Respiratory Syncytial Virus (RSV)  

Below is a summary of clinical considerations and administration of each vaccine, other regulatory considerations, and resources to help promote uptake. This reflects information available to date, but more information is expected to be released in the coming months from the Centers for Disease Prevention and Control (CDC), Health and Human Services (HHS), and other relevant agencies. This blog post will be continually updated as new recommendations and considerations are released. 

Why Prioritize Vaccination? 

Respiratory season can be dangerous for individuals 65 and up, and those with underlying health conditions. Elderly individuals residing in nursing homes and assisted living communities are at most risk of complications due to respiratory illnesses.  

  • Adults 65 and older and individuals with certain chronic health conditions benefit from both the influenza and COVID-19 vaccine. 
    • Preliminary estimates show that last season, people who were vaccinated against flu were about 40% to 70%​ less likely to be hospitalized because of flu illness or related complications.  
  • RSV infections can be dangerous for older adults. Each year, it is estimated that between 60,000-160,000 older adults in the United States are hospitalized and 6,000-10,000 of them die due to RSV infection. Adults at highest risk for severe RSV infection include older adults 65 years and older, and those with chronic heart or lung disease and weakened immune systems. 

Clinical Considerations and Administration 

Influenza Vaccine
On June 29, 2023, the Centers for Disease Prevention and Control (CDC) announced its 2023-2024 recommendations for the annual influenza (flu) vaccination.​   
The composition of the vaccine for the 2023-2024 flu season was updated to best match the influenza strains that research indicates will likely be the most common during the upcoming season.  
Consistent with previous years, the CDC recommends individuals receive their flu vaccine in September or October. Vaccination for seniors 65 and older should be avoided in July or August unless vaccination in September or October is not possible.  

In years past, the Advisory Committee on Immunization Practices (ACIP) has recommended that adults older than 65 years preferentially receive any one of the following higher dose or adjuvanted influenza vaccines:  
  • Quadrivalent high-dose inactivated influenza vaccine (HD-IIV4),  
  • Quadrivalent recombinant influenza vaccine (RIV4), or  
  • Quadrivalent adjuvanted inactivated influenza vaccine (aIIV4).  
If none of these three vaccines is available at an opportunity for vaccine administration, then any other age-appropriate influenza vaccine should be used. AHCA/NCAL anticipates this recommendation to remain the same for the 2023-2024 flu season and will update this blog post once those recommendations are released. 
COVID-19 Booster 
The CDC also recommends that people aged 65 years and older may get one additional dose of COVID-19 vaccine four or more months after the first updated COVID-19 vaccine. 

​​​AHCA/NCAL also expects that an updated COVID-19 booster targeting the most prevalent strains of COVID-19 will be distributed as early as September as part of a fall booster campaign and will confirm. 
RSV Vaccine 
The FDA recently authorized the first vaccination to protect against RSV. The vaccines, from manufacturers GSV and Pfizer, will be available this fall. The CDC recommends these vaccines for people aged 60 and older using shared clinical decision-making​. This means these individuals may receive a single dose of the vaccine based on discussions with their health care provider about whether RSV vaccination is right for them.  

Based on the risk posed by RSV to older people and those with underlying health conditions, AHCA/NCAL recommends providers discuss these vaccines with their residents.  

Other Regulatory Considerations
COVID-19 vaccination is no longer required for nursing home staff. However, CMS-certified nursing facilities are required to report both the Influenza Vaccination Coverage among Health Care Personnel and the COVID-19 Vaccine Coverage among Healthcare Personnel to the National Health and Safety Network (NHSN) to meet the requirements of the SNF Quality Reporting Program (QRP). 

Encouraging Vaccine Uptake 

Vaccine hesitancy continues to be a huge challenge for LTC providers. Several resources providers can use to encourage vaccine update are as follows: 

Note: this blog post will be updated as new information becomes available.