To identify nursing home resident and facility characteristics associated with patients not receiving influenza immunization and having unknown immunization status.

Secondary data analysis using multinomial logistic regression of data from the National Nursing Home Survey, a nationally representative establishment-based survey.

A total of 1,423 nursing facilities of all ownerships and certifications systematically sampled with probability proportional to number of beds.

A total of 7,350 randomly sampled people aged 65 years or older residing in nursing homes between July and December 1999 (approximately 6 per facility).

Immunization status of residents.

Fifteen percent of residents were not immunized and 19% had unknown immunization status. In multivariate analysis, lack of immunization and unknown immunization status were each separately associated with being newly admitted, with no or unknown pneumococcal immunization, and with facility failures to screen for immunization and to record inoculation in the medical record. High-risk status and staff immunization requirements had no effect. Separate analyses showed that residents with unknown immunization status are statistically significantly different from both those vaccinated and those not vaccinated.

This study indicates that both resident and facility characteristics are associated with failure to be immunized for influenza. Facilities should consider targeting younger, newly admitted, and residential care residents for influenza immunization, since they are more likely to be missed. Further research into the barriers to immunization specific to nursing home resident choice or opportunity may be warranted.

Studies have found residency in long-term–care facilities (LTCFs) a risk factor for influenza and pneumonia and have demonstrated that vaccinations against these diseases reduce the risk of disease. However, rates are below Healthy People 2010 goals of 90% for LTCFs. During 1999–2002, a multi-state demonstration project was conducted in LTCFs to implement standing orders programs for immunizations.

Identify nursing home resident–specific characteristics associated with vaccination coverage at baseline.

Facility-level data were collected from self-reported surveys of selected nursing homes in 14 states and from the On-line Survey and Certification Reporting System. Resident-level data, including demographics and physical functioning, were obtained from the Centers for Medicare & Medicaid Services' Minimum Data Set; 2000–2001 vaccination status was obtained by chart review. Influenza vaccination status reflected a single season, whereas pneumococcal vaccination status reflected vaccination in the past. Multilevel analysis was used to control for facility-level variation.

Of 22,188 residents sampled in 249 LTCFs, complete data were obtained for 20,516 (92%). The average coverage for immunizations was 58.5% ± 0.7% for influenza and 34.6% ± 0.3% for pneumococcal. On bivariate analyses, residents with cognitive, psychiatric, or neurologic problems were more likely to be vaccinated; those with accidental injuries, unstable conditions, or cancer were less likely to receive either vaccine. On multilevel analysis, the strongest resident characteristics associated with receipt of immunizations, controlling facility variation, were cognitive deficits and psychiatric illness.

The variation in baseline vaccination coverage associated with LTCF resident characteristics supports the need for strategies to increase vaccination coverage in LTCFs.