Date of Award

Spring 5-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)


School of Public Service


Public Administration and Policy

Committee Director

John R. Lombard

Committee Member

J. Gail Nicula

Committee Member

Tancy Vandecar-Burdin


The effects of Hurricane Katrina and other natural disasters have increased the focus on nursing homes, particularly nursing home emergency preparedness. Nursing home administrators and direct care employees have described the challenges faced when responding to an emergency event. Due to numerous emergency preparedness insufficiencies, requirements were implemented to protect the vulnerable population of older adults who reside in nursing homes. In 2016, the Centers for Medicare & Medicaid (CMS) added specific emergency preparedness requirements to the existing fire safety requirements for regulated nursing homes. These deficiency evaluations are the only routinely collected source of information detailing compliance with the Emergency Preparedness Rule for regulated facilities. The purpose of this study is to provide a baseline assessment of nursing home facility characteristics associated with having an Emergency Preparedness Rule deficiency citation. This study tested the Organization- Based Conceptual Framework that relates internal and organizational factors to Emergency Preparedness Rule deficiencies for CMS regulated nursing homes. This research is significant in several ways. First, examining CMS Emergency Preparedness Rule deficiencies as one measure of quality of care may provide further understanding about how complex quality issues are in nursing homes. Second, no research to date has presented a nationally representative picture of CMS Emergency Preparedness Rule deficiency citations in nursing homes. The study found that there was support for four of the five variables of interest identified in the study. The resulting data can be used to evaluate facility compliance with the new federal guidelines and consider the overall effectiveness of the CMS Emergency Preparedness Rule on the emergency preparedness process in U.S. nursing homes.


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