The morning the team comes round
Some time in the autumn a vaccination team arrives at the home, works through the building, and by lunchtime most residents have had their flu jab and their COVID booster. It is efficient and it is the right model — nobody should be taking a frail ninety-year-old to a clinic in November.
Two things go wrong with it, reliably, every year. Some residents are missed, usually because they were in hospital or unwell that morning and nobody diarised a catch-up. And some are vaccinated on the basis of a consent process that would not stand up if anybody looked at it. Both are worth ten minutes of your attention now rather than a difficult conversation in January.
What she should be offered
Care home residents sit in the top priority group for the seasonal programme, which means the offer should come to her rather than the other way round.
- Flu — annually, every autumn, with an adjuvanted or high-dose vaccine for older adults.
- COVID-19 — the seasonal campaign, with the formulation for that season; older care home residents are consistently in the eligible cohort.
- Pneumococcal — a one-off for people aged 65 and over. Not annual, which is precisely why it gets forgotten.
- Shingles — an age-based programme that has been expanding, given as two doses. Worth asking about specifically.
- RSV — a newer routine offer for older adults from age 75, with a catch-up for those already older when it started. Many families have never heard of it.
The last three are the ones that get missed, because they are not part of the autumn round and nobody chases them. Ask about each by name.
Consent: the part that is done badly
This is the section worth reading twice.
If your mother has capacity to decide, she decides. Not you, not the home, not the visiting nurse. If she declines, that refusal has to be respected and recorded — and a refusal obtained by rolling up a sleeve and saying "just a scratch" is not consent either. Capacity is decision-specific: a woman with dementia may well be able to decide about a vaccination even if she cannot manage her finances.
If she lacks capacity for this decision, vaccination becomes a best-interests decision under the Mental Capacity Act. Three things follow, and all three are routinely got wrong:
- The care home cannot consent on her behalf. Neither can you, unless you hold a health and welfare lasting power of attorney that is registered and covers this.
- A proper best-interests process must take place and be recorded — considering her past wishes and beliefs, and consulting those close to her. If she always had her flu jab, that matters. If she spent thirty years refusing it, that matters too.
- Blanket consent for a whole home does not exist. A list of residents ticked off by a manager is not a lawful basis for treating any of them. If that is what happened, you are entitled to ask what was recorded for your mother specifically.
None of this is an argument against vaccinating. For a frail resident it is usually clearly in her best interests, and saying so is part of the process. The point is that the process has to happen and be written down, because the same process governs decisions that are far less clear-cut.
How to check she was not missed
Do not ask "has she had her jabs?" Ask for the dates. Immunisations are recorded in her GP record and in the home's care records, and you can ask the practice or the home for the dates of each vaccine given in the last two years.
The commonest reason a resident shows as unvaccinated is simple: she was in hospital, or had a temperature, on the day the team came. That is nobody's fault. Leaving it there for eleven months is. Ask specifically: if she is missed on the day, what is the catch-up arrangement, and who books it? A home with an answer has a system. A home without one will miss her again next year.
Staff, and what happens in an outbreak
Staff vaccination is offered, not compulsory — the requirement that briefly made COVID vaccination a condition of deployment in care homes was revoked. But uptake among staff is a real number that homes know and rarely volunteer, and it is a fair question when you are choosing: infection almost always walks in through the front door.
Ask too what happens in an outbreak. The home should be reporting to the local health protection team, following their advice on isolation and admissions, and telling families promptly. The part families care about most is visiting: blanket, indefinite visiting bans are not the expected response, and the home should be able to explain how it will keep contact going. If your mother has dementia, the difference between "no visitors" and "visits in her room with precautions" is the difference between a fortnight and a decline she does not recover from.
Six questions to ask
- Which vaccines has she had, and on what dates? Flu, COVID, pneumococcal, shingles, RSV — by name.
- If she lacks capacity, what best-interests record exists for the vaccination decision?
- Is there a registered health and welfare LPA on file, and is it the current version?
- What is the catch-up arrangement if she is in hospital or unwell on the day?
- What is staff vaccination uptake this season?
- What is the outbreak plan, and how are visits handled during one?
If you get nowhere
Put it in writing, one question and a date. If it concerns the clinical offer, start with the practice manager at the GP surgery that covers the home, then the NHS complaints route through the integrated care board, with PALS to help you navigate it. If it concerns the home — residents missed, no records, consent taken from the wrong person — the manager first, then the Care Quality Commission, which will not resolve your individual case but does act on patterns and does read what families send.
Where to start
If you are still choosing a home, "how do you run the autumn programme, what is your staff uptake, and what happens if someone is missed?" tells you more in two minutes than the tour does in an hour. If your mother is already there, a written request for her vaccination dates is the fastest way to find out whether something has been skipped — and autumn is the month to send it.
If you would rather not do it alone, we can. For £69 we take down your mother's situation, look for the homes in your area that answer these questions properly, and report back what they told us, with names and dates. Start here
This article is for information and does not replace medical or legal advice on your own situation. Eligible ages and vaccine offers change every season and differ across England, Scotland, Wales and Northern Ireland: check the current programme with the GP practice. Curalune does not allocate beds and does not guarantee availability.
