Strategies to Promote Staff and Resident Flu and COVID-19 Vaccination in Skilled Nursing Facilities

Abstract

Influenza (flu) and COVID-19 vaccination of both residents and staff are critical components of infection prevention in skilled nursing facilities (SNFs). Our study sought to identify and characterize strategies that SNF staff are using to promote vaccination. Twenty-six semi-structured, qualitative interviews were conducted with administrators, directors of nursing, infection preventionists, and Minimum Data Set (MDS) coordinators at 13 SNFs across the country. Interview transcripts were analyzed using a content analysis approach and a detailed audit trail was maintained. Skilled nursing facility staff described varying approaches to promote flu vaccination in their facilities. These ranged from small-scale efforts, such as displaying informational posters and providing candy at flu clinics, to more hands-on strategies including holding health fairs and educational question and answer sessions and having one-on-one discussions. A few facilities reported having a formal “vaccine champion,” usually the infection preventionist, who was responsible for influenza vaccine promotion and education efforts. Use of incentives to promote flu vaccination also varied across facilities prior to the COVID-19 pandemic. Some used no incentives, while others provided bonuses to staff who were vaccinated or allowed staff who had received the flu vaccine to avoid wearing a face mask for the duration of the flu season. While many strategies and incentives had been in place prior to COVID-19 and did not change as a result of the pandemic, participants described concerns about the continued effectiveness of the masking incentive strategy, given that masks are expected to be a requirement of SNF staff for the foreseeable future. Participants reported similar approaches to educate about and promote COVID-19 vaccination for residents and staff. With regard to education, staff discussed both widespread, general education strategies as well as targeted, individual approaches. Where COVID-19 vaccination was not mandatory, it was incentivized for staff by reduced testing requirements and for residents by reduced restrictions on activities and visitation. A wide range of strategies to promote flu and COVID-19 vaccination were reported. Future efforts to promote vaccination, informed in part by our findings here, will be critical to avoid the potential burden of influenza and COVID-19 co-circulation.