Lessons Learned From an Immunization Quality Improvement Project Focused on Residents Living in Long-Term Care Settings, United States, 2022 to 2024.

Publication date: Jul 06, 2026

Older adults living in post-acute and long-term care (PALTC) settings are especially vulnerable to vaccine-preventable illnesses, yet national data show that many are not up to date on recommended immunizations. This quality improvement (QI) project aimed to increase immunization coverage among PALTC residents while exploring improvement strategies tailored to this setting. QI project conducted in 2, 12-month cohorts between 2022 and 2024. QI teams from 15 skilled nursing facilities and 6 assisted living facilities across 9 states participated in the QI project. QI teams included staff and administrators working at the facility and corporate levels in roles such as medical directors, directors/assistant directors of nursing, and infection preventionists. QI teams implemented immunization strategies, reported monthly resident immunization coverage for 5 vaccines (COVID-19, influenza, pneumococcal, Tdap, and shingles), received monthly technical assistance, and met quarterly with other facilities to share lessons learned. We report resident immunization coverage at baseline and end point by facility and vaccine. To provide context, we share lessons learned and examples across facilities, including common improvement strategies. Seventeen facilities improved resident immunization coverage for at least 1 vaccine; 5 improved coverage for 4 or more. Common challenges included difficulty gathering and aggregating immunization data, limited staff bandwidth and high turnover, and vaccine resistance. Improvement efforts focused on monitoring immunization coverage, making immunization routine, and building organizational support for immunization. Learning from this large QI project shows that while there are many barriers to immunizing PALTC residents, both skilled nursing facilities and assisted living facilities can make meaningful improvements in resident immunization within a year with focused QI efforts and practical support. Investments in technology to automate immunization monitoring, strengthening pharmacy partnerships, and demonstrating leadership commitment to immunization are promising strategies for improving resident immunization in PALTC settings.

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