Effectively Managing Immunizations in the Long-Term Care Setting

With immunization season fast approaching, pharmacies across the nation are preparing to administer millions of vaccinations for infectious diseases such as influenza, COVID-19, respiratory syncytial virus (RSV), and pneumococcal pneumonia. The long-term care sector is an important priority group for these vaccines, but pharmacists face unique challenges when immunizing this group.

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Long-term care facilities—such as assisted living facilities, nursing homes, group homes, and senior daycare centers—serve vulnerable populations who are disproportionately impacted by infectious respiratory diseases. Compared with the general population, residents of long-term care facilities are older and frailer and have more comorbidities that put them at an increased risk for severe outcomes from respiratory infections.¹ Further, the collective environment of long-term care facilities makes containing the spread of infection more difficult, further underscoring the need for effective vaccination programs in these settings.

Long-term care facilities often contract with a long-term care pharmacy to fulfill residents’ pharmacy needs, such as vaccinations. Key challenges that long-term care pharmacies face when administering vaccinations in these settings include the need to coordinate across multiple departments, managing documentation, and ensuring vaccine supply and storage compliance. Additionally, residents of long-term care facilities often have complex physical and/or mental health needs, which can impact vaccine eligibility and consent processes. Vaccine hesitancy, fatigue, and misinformation are often barriers among residents and their families, as well as long-term care staff.

The long-term care pharmacy should assign a dedicated account manager for each facility. Immunization programs are most effective when the clinical pharmacy team works hand-in-hand with providers to create proactive, personalized programs. Coordination between pharmacists, nursing teams, directors of nursing, and medical directors is paramount to ensure every resident is evaluated for vaccine eligibility. The pharmacy team’s role should include assisting with consent management, documentation, and scheduling to ensure vaccinations are delivered safely and efficiently. Clinical pharmacists should also collaborate with facility teams to periodically review resident records and identify any immunization gaps. This allows for missed and upcoming vaccinations to be flagged and for administration to be coordinated during scheduled clinics or medication passes.

Ideally, the pharmacy’s system should be integrated with the facility’s electronic medication administration records (EMAR) system, thus allowing the pharmacy team to track vaccine records, generate real-time reports, and flag upcoming vaccine needs. By leveraging EMAR integration, the pharmacy team can align all stakeholders throughout the vaccination process and ensure that no resident falls through the cracks. With the pharmacy team handling vaccination logistics, the facility staff can remain focused on resident care.

An efficient way for pharmacists to administer vaccinations is to host regular on-site clinics for common vaccines such as influenza, COVID-19, pneumococcal, RSV, and shingles. Immunization-certified pharmacists and trained pharmacy staff should manage all aspects of the clinic, from setup and administration to documentation and postvaccination monitoring. Clinics should be scheduled to minimize disruption to the facility’s schedule, such as avoiding mealtimes or other activities. Following the clinic, the pharmacy should provide detailed reports to facility leadership, including which patients received which vaccines and any adverse reactions.

As with the general population, vaccine hesitancy and misinformation are barriers to vaccine uptake among long-term care residents and their family members, as well as long-term care staff members. According to a 2024 CDC report based on data from nursing home facilities that elected to report vaccinations, as of November 10, 2024, only 30% of nursing home residents had received a COVID-19 vaccine for 2024 to 2025, 58% had received an influenza vaccination, and 18% had received an RSV vaccination.

“Mistrust in institutions and concerns about safety, efficacy, the rapid development and approval of the vaccines, and the type of vaccine (ie, mRNA) are the most commonly reported factors contributing to COVID-19 vaccine hesitancy. Misinformation and doubts regarding efficacy also might contribute to hesitancy about other vaccines,” the report read.²

A study published in 2025 in The Gerontologist showed that vaccine hesitancy among health care workers in long-term care facilities is a complex issue influenced by lack of knowledge, misinformation, and doubts about vaccine safety, efficacy, risks, and benefits. The survey and focus groups identified effective interventions to reduce health care worker vaccine hesitancy, including educational campaigns, on-site vaccination, and vaccine recommendations from trusted nursing staff.³

Long-term care pharmacists are significant in lessening the vaccine hesitancy hurdle by providing staff with ongoing education through in-services, printed materials, and virtual sessions on topics ranging from the benefits of vaccinations to safe vaccine administration and potential side effects to how to approach vaccine hesitancy with residents and families. Pharmacies can also provide staff with talking points and frequently asked questions to help them feel confident when answering residents’ and family members’ common concerns.

REFERENCES

1. Frangos E, Barratt J, Michel JP, Ecarnot F. Vaccines in long-term care settings: a narrative review. Gerontology. 2024;70(3):241-247. doi:10.1159/000534435

2. National Healthcare Safety Network. Coverage with influenza, respiratory syncytial virus, and COVID-19 vaccines among nursing home residents—United States, November 2024. MMWR Morb Mortal Wkly Rep. 2024;73(46):1052-1057. doi:10.15585/mmwr.mm7346a2

3. Brumbaugh KQ, Kaplan L, Ma KPK, et al. Identifying emerging drivers and interventions to reduce vaccine hesitancy among long-term care facility nursing staff. Gerontologist. Published online January 29, 2025. doi:10.1093/geront/gnaf012