Home health care agencies provide services to some of the most vulnerable patients and must encourage influenza vaccinations of their employees. The current study assessed the impact of increasing employee compliance with vaccinations and aimed to determine why certain employees refuse vaccinations. This was an observational study that looked at employee vaccination rates, employee sick days, and responses to an employee survey of those who refused vaccinations. Data were collected at a large not-for-profit home health care agency in the northeast that provides services primarily to Medicare patients. Vaccination compliance and sick days information were collected on all employees of the home care agency over three flu seasons (2012-2015). Survey data were collected on employees ( n = 240) who refused the influenza vaccination during the 2014-2015 flu season. The agency more than doubled vaccination rates from 38% to 88% and found a corresponding reduction in staff sick time. By surveying the “refusers,” it was found that the common reasons for avoiding vaccinations were beliefs of not being in a high-risk group, not needing vaccine, being healthy and never getting the flu, and not liking injections. It is clear that a concerted effort to increase employee influenza vaccination rates can be successful and possibly decrease staff sick days. However, there seems to be a small group of employees who refuse vaccination. Better education of these employees should help eliminate the common reasons people decline vaccination.