Strengthening resilience in nursing homes The role of emergency preparedness in mitigating COVID-19 outcomes

Abstract

This study investigates the relationship between compliance with Centers for Medicare and Medicaid Services (CMS) emergency preparedness standards and COVID-19 morbidity and mortality rates in U.S. nursing homes. Given the severe impact of COVID-19 on nursing home residents, this research addresses how preparedness influences pandemic outcomes. Using publicly available datasets from CMS and FEMA covering the period 2017 to 2021, a retrospective and longitudinal analysis was conducted. Multiple linear regression analyses were employed to evaluate the association between emergency preparedness deficiencies (E-Tag citations) and COVID-19 morbidity and mortality rates, controlling for facility size, regional location, and ownership type. Statistical significance was set at α = 0.05. The results demonstrated a statistically significant association between emergency preparedness deficiencies and increased COVID-19 morbidity (P < .001, 0.06% increase per deficiency) and mortality (P = .035, 0.01% increase per deficiency), though the effect sizes were modest. Significant regional differences (P < .001) and impacts related to ownership type (P < .05) were also observed. There was no statistically significant relationship identified between a state’s history of federally declared disasters and compliance with emergency preparedness standards. Findings highlight the critical role of adherence to emergency preparedness standards in mitigating COVID-19 impacts in nursing homes. Despite modest effect sizes, even minor improvements in compliance could lead to substantial public health benefits. The study underscores the necessity for targeted training programs, robust emergency planning, and clear policy interventions to strengthen nursing home resilience for future public health crises. The study’s reliance on secondary data and potential reporting inconsistencies represent limitations that should be considered when interpreting the findings.