Opinion — Having my say: Lisa Shugarman, Ph.D.

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While more than 3,200 Americans have died in Iraq since the United States invaded that nation in March 2003, about 120,000 Americans have died in their own country during the same period after losing battles to a microscopic enemy – the influenza virus.

More than 90% of Americans who die from the flu are 65 or older, and many of them live in nursing homes, where flu outbreaks are common. In fact, one study found that nursing home residents 65 and older are three times more likely to be hospitalized for influenza than people of similar ages who do not live in nursing homes.
Many of these nursing home victims could be saved from illness and death – not as a result of some expensive, high-tech medical procedure, but by a campaign that would focus on persuading more nursing home employees to get flu shots.
It is time to begin that campaign.
But wouldn't shots for the estimated 1.7 million people who work in nursing homes in the United States cost a lot of money? And don't many of the roughly 1.4 million residents of America's 16,000 nursing homes already get flu shots, protecting them from catching the flu from the people who care for them? The answer to both questions is no.
No one can put a price on a human life or human suffering. But in strictly dollars-and-cents terms, the price of a flu shot is about $10. The cost of stopping a flu outbreak can be $200 to $250 per resident in a nursing home. The bill can run up to several thousand dollars for an elderly person hospitalized with the flu. Funeral bills cost thousands of additional dollars.
Because many elderly nursing home residents are in poor health and have weakened immune systems, they are vulnerable to getting the flu when exposed to the influenza virus, even if they have already been immunized. While the flu vaccine can be 86% effective for healthy adults when the vaccine matches the prevailing influenza strain, in nursing homes it is estimated that the vaccine is only 23% effective for residents.
A study I led for the RAND Corporation, a nonprofit research organization, looked at influenza immunization rates at 301 nursing homes around the United States.
My research team found that nursing homes were 60% less likely to have a cluster of influenza-like illness cases if more than 55% of the employees and more than 89% of the residents were vaccinated for influenza. We defined clusters of influenza-like illness as more than three cases with influenza-like symptoms reported within 72 hours in close proximity within the nursing home.
While it is true that more than 75% of nursing home residents get flu shots each year, only about 40% of nursing home employees get the shots.
Nursing home residents spend most of their time in the homes. But nursing home employees go to their own individual homes each day, exposing themselves to the flu virus that may be carried by their children, spouses and other people they encounter. That makes it easy for these employees to bring the virus into nursing homes as an unwelcome guest.
Currently, flu shots can't be mandated for nursing home employees, but they can be strongly encouraged. The following actions would be both cost-effective and relatively easy to implement.
• Free flu shots for nursing home employees. Insurance companies and nursing homes would spend a lot less paying the $10 cost of a flu shot for each employee than they would pay to stop the resulting outbreak and treat nursing home patients who contract the flu.
• Payments to nursing home employees who get flu shots. One nursing home recently offered $150 to each employee who received a flu shot and achieved very high rates of immunization very quickly. This is a lot cheaper than treating residents who contract the flu.
• Vaccinating employees first, before nursing home residents get the flu shot. Employees are harder to get to when it comes to arranging the flu shot, so the effort to immunize always takes longer for them than for residents. They also keep flu immunity longer than residents.
• Employee education. Many nursing home employees are afraid that the immunization will give them the flu or cause other health problems. A well-directed education campaign can alleviate these fears and help employees understand the benefits of immunization.
• Requiring that the level of employee immunization for each nursing home be publicly reported, so that prospective nursing home residents and their families could use this knowledge in selecting a safe nursing home.
For many young and middle-aged Americans, the flu is an unpleasant inconvenience. A stuffy nose, fever, headache, stiffness, perhaps a few days missed from work or school. But for many vulnerable older Americans in nursing homes, the flu is a killer. Too many are dying needlessly. n

Lisa Shugarman: Lisa Shugarman, Ph.D., is a health policy researcher at the RAND Corp., a nonprofit research organization, and is an assistant professor at the USC Leonard Davis School of Gerontology.

(This first appeared as a special report on washingtonpost.com's Think Tank Town.)
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