At Masonic Villages at Elizabethtown, it's flu shot or face mask.
And it will be flu shot or fired next year, when all employees will be required to get a flu shot. Exceptions will be made for people with a history of allergic reaction to flu vaccine, or who can't receive it for religious reasons.
For now, the face mask requirement applies to everyone -- employee or visitor -- who wants to go near the approximately 560 residents of the facility's skilled nursing or personal care areas, and who hasn't had a flu shot.
The Pennsylvania Department of Health last week reported 3,193 confirmed flu cases for the week ending Dec. 29, nearly 1,000 more than the previous week. That figures represents only a fraction of the actual cases, because many flu cases go untested.
In the 2012-2013 flu season, cases started picking up in early December -- far earlier than normal. Because the flu season normally peaks in late January (and continues through March), it remains to be seen if the early start will add up to an early peak or an especially bad flu season.
There were three flu-related deaths in Pennsylvania during the week ending Dec. 29.
The state heath department noted the strain that's responsible for most of the cases, H3N2, is associated with severe flu seasons and also tends to cause severe illness in older people. The good news is that H3N2 is one of the strains covered in this year's flu vaccine.
Meanwhile, nursing home administrators are employing flu-protection tactics from disinfecting handrails, which can give the flu bug a bridge from one person to another, to posting signs telling sick people to stay away.