As flu season swings into high gear, a new poll suggests that nursing homes and other long-term care facilities should be doing more to get their staff and patients vaccinated before sickness spreads or it's too late for the shot to be effective.

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Nearly three-quarters of people over age 50 say that all staff in such facilities should "definitely" be required to get the flu vaccine, the poll found. And more than 60 percent say all patients in nursing homes and assisted living facilities should definitely get vaccinated, too.

In fact, poll respondents felt so strongly about flu vaccination that 70 percent said that if they found out that one-third of a nursing home's staff wasn't vaccinated — roughly the amount that federal data show is the case — they would be less likely to choose the facility for themselves or loved ones.

The new results, from the National Poll on Healthy Aging, come at a time when nursing homes and assisted living facilities lag behind hospitals and other health care settings in the rate of flu vaccination among staff.

The poll was conducted in a nationally representative sample of 2,007 Americans ages 50 to 80 by the University of Michigan Institute for Healthcare Policy and Innovation. It was sponsored by AARP and Michigan Medicine, U-M's academic medical center.

A population at risk

Older people, and those of any age with chronic health conditions, are especially vulnerable to the influenza virus and are at an increased risk of developing flu-related complications such as pneumonia. Widespread vaccination helps create what is known as "herd immunity," making it harder for the virus to spread between people.

The Centers for Disease Control and Prevention recommends that everyone ages 6 months and older be vaccinated against the flu every year, with few exceptions.

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But the CDC has reported that only 68 percent of workers in long-term care settings such as nursing homes get vaccinated against the flu, compared with more than 92 percent of hospital workers.

"We've finally gotten to the point in the last few years where most inpatient hospitals require their staff to get vaccinated against the flu, or at least strongly promote it," says Preeti Malani, M.D., the poll's director and a professor of internal medicine at the U-M Medical School who specializes in infectious diseases and geriatrics.

"These results suggest that other types of care facilities should do the same to protect vulnerable patients — or potentially risk losing business," she says. "I encourage everyone to ask nursing homes and other long-term care facilities about their vaccination policies."

Getting the shot, experts note, does far more than help avert a seasonal nuisance.

"Flu and pneumonia are a critical health concern, and in recent years have resulted in over 50,000 deaths annually, making it the eighth-leading cause of death, just behind diabetes," says Alison Bryant, Ph.D., senior vice president of research for AARP. "Over 80 percent of these deaths were among older adults ages 65 and older.

"Increasing vaccination rates to increase herd immunity is imperative to the health and lives of our most vulnerable."

Influence on facility choice

It's up to nursing homes and other long-term care facilities to disclose their flu vaccination policies and practices to patients, visitors and prospective and current residents.

Still, the poll asked respondents to react to a hypothetical scenario in which a nursing home had a vaccination rate about the current national average.

Forty percent of respondents said if they found out 1 in 3 staff members at a nursing home weren't vaccinated against the flu, it would make them much less likely to choose that facility. An additional 30 percent said this statistic would make them slightly less likely to select it.

Data about staff vaccination are publicly available for some types of facilities, although many people may not know it.

In inpatient rehabilitation facilities, 91 percent of patients and 84 percent of staff have received flu shots, according to a searchable database managed by the Centers for Medicare & Medicaid Services. It also shows that 77 percent of staff at long-term care hospitals have been vaccinated.

However, the federal site that tracks nursing home data doesn't yet show nursing home staff flu vaccination rates — but it does show resident flu shot percentages for each facility.

The CDC makes a special recommendation that health care workers be vaccinated and offers a toolkit for long-term care facilities.

Impact on employment and visiting

In all, 73 percent of respondents said nursing home medical staff should definitely get vaccinated, and 71 percent said nonmedical staff should, too. An additional 20 percent of respondents thought staff should possibly be required to be vaccinated.

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The vast majority of respondents (93 percent) also thought that nursing homes should offer the vaccine to staff at work, at no charge, and should require unvaccinated staff to stay home if they get sick. But a lower percentage — 55 percent — thought that the flu vaccine should be mandatory for staff to keep their jobs.

In contrast, many hospitals require vaccination for staff members but allow some to opt out and instead wear masks around patients during flu season.

When it came to nursing home visitors, poll respondents were less strict: Only 25 percent said visitors should be required to be vaccinated before visiting their loved ones. An additional 45 percent said visitors possibly should be required to get the vaccine, and 30 percent thought visitors should not be required to get the vaccine.

Participants answered a wide range of questions online. The IHPI team wrote the questions and interpreted and compiled the data. Laptops and internet access were provided to those who did not already have it.

A full report of the findings and methodology is available at HealthyAgingPoll.org.