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Nursing Homes Reported Wide-Ranging Challenges Preparing for Public Health Emergencies and Natural Disasters


Although most nursing homes met Federal emergency preparedness requirements, an estimated 77 percent reported challenges with preparedness activities intended to ensure that resident care needs are met during an emergency. The most frequently cited concerns among nursing homes were ensuring proper staffing during emergencies and transporting residents during evacuations.


OIG has identified emergency preparedness and nursing home safety as priorities. Nursing home failures to adequately plan for and respond to public health emergencies and natural disasters have led to tragic results. Although such outcomes were not typical, they point to the need to identify the source of breakdowns and to strengthen nursing home preparedness efforts.


We surveyed a random sample of 199 nursing homes located in geographic areas rated by the Federal Emergency Management Agency (FEMA) as having a very high or relatively high risk for natural hazards. We received responses from 168 nursing homes and projected the results to all nursing homes in the FEMA risk areas. Respondents rated how challenging each of

49 preparedness activities were for their facility. The activities covered seven topic areas related to emergency preparedness capabilities that are important for ensuring safety of residents during emergency events.


In June 2022, an estimated 77 percent of nursing homes located in areas at greater risk for natural disasters reported experiencing challenges with emergency preparedness activities. Administrators reported concerns across seven topic areas, with activities related to ensuring proper staffing during emergencies and transporting residents during evacuations being the most problematic. An estimated 62 percent of nursing homes reported at least one challenge regarding staffing and an estimated 50 percent noted at least one challenge regarding transportation. Other challenges reported by some nursing homes related to securing beds for evacuated residents and planning for infection control and quarantine during emergencies.

We found that even those nursing homes that meet the Federal requirements for emergency preparedness face challenges with critical aspects of emergency preparedness. Specifically, we found that only 24 percent of nursing homes in areas at high risk for disasters received a deficiency for not meeting emergency preparedness requirements established by the Centers for Medicare & Medicaid Services (CMS) during their most recent compliance survey—but an estimated 77 percent of nursing homes reported at least one challenge with preparedness activities.

We found that nursing homes reporting challenges had lower community resilience compared to other nursing homes, indicating that availability of community resources may be a factor in nursing homes' experience with preparedness activities. Further, an estimated one in five nursing homes reported difficulties coordinating preparedness activities with multiple community partners.