Assessment of Regional Nursing Home Preparedness for and Regulatory Responsiveness to Wildfire Risk in the Western US

Key Points

Question

Are nursing homes at elevated risk of wildfire exposure likelier to meet federal emergency preparedness standards or subject to greater regulatory oversight?

Findings

In this cross-sectional study of 2218 nursing homes in the western US, regional heterogeneity in nursing home emergency preparedness for wildfire episodes was observed, and facilities at elevated exposure risk in the Mountain West and Pacific Northwest had poorer compliance with emergency preparedness criteria than unexposed facilities. Of the noncompliant facilities, exposed nursing homes in the Mountain West incurred longer times to reinspection than their unexposed counterparts.

Meaning

These findings suggest that there are opportunities to improve the regional responsiveness of nursing homes and regulatory oversight to surrounding environmental hazards.

Abstract

This cross-sectional study assesses emergency preparedness for and regulatory responsiveness to wildfires among nursing homes at elevated wildfire risk in the western US.

Abstract

Importance

It is uncertain whether emergency preparedness and regulatory oversight for US nursing homes are aligned with local wildfire risk.

Objective

To evaluate the likelihood that nursing homes at elevated risk of wildfire exposure meet US Centers for Medicare & Medicaid Services (CMS) emergency preparedness standards and to compare the time to reinspection by exposure status.

Design, Setting, and Participants

This cross-sectional study of nursing homes in the continental western US from January 1, 2017, through December 31, 2019, was conducted using cross-sectional and survival analyses. The prevalence of high-risk facilities within 5 km of areas at or exceeding the 85th percentile of nationalized wildfire risk across areas overseen by 4 CMS regional offices (New Mexico, Mountain West, Pacific/Southwest, and Pacific Northwest) was determined. Critical emergency preparedness deficiencies cited during CMS Life Safety Code Inspections were identified. Data analysis was performed from October 10 to December 12, 2022.

Main Outcomes and Measures

The primary outcome classified whether facilities were cited for at least 1 critical emergency preparedness deficiency during the observation window. Regionally stratified generalized estimating equations were used to evaluate associations between risk status and the presence and number of deficiencies, adjusted for nursing home characteristics. For the subset of facilities with deficiencies, differences in restricted mean survival time to reinspection were evaluated.

Results

Of the 2218 nursing homes in this study, 1219 (55.0%) were exposed to elevated wildfire risk. The Pacific/Southwest had the highest percentage of both exposed (680 of 870 [78.2%]) and unexposed (359 of 486 [73.9%]) facilities with 1 or more deficiencies. The Mountain West had the largest difference in the percentage of exposed (87 of 215 [40.5%]) vs unexposed (47 of 193 [24.4%]) facilities with 1 or more deficiencies. Exposed facilities in the Pacific Northwest had the greatest mean (SD) number of deficiencies (4.3 [5.4]). Exposure was associated with the presence of deficiencies in the Mountain West (odds ratio [OR], 2.12 [95% CI, 1.50-3.01]) and the presence (OR, 1.84 [95% CI, 1.55-2.18]) and number (rate ratio, 1.39 [95% CI, 1.06-1.83]) of deficiencies in the Pacific Northwest. Exposed Mountain West facilities with deficiencies were reinspected later, on average, than unexposed facilities (adjusted restricted mean survival time difference, 91.2 days [95% CI, 30.6-151.8 days]).

Conclusions and Relevance

In this cross-sectional study, regional heterogeneity in nursing home emergency preparedness for and regulatory responsiveness to local wildfire risk was observed. These findings suggest that there may be opportunities to improve the responsiveness of nursing homes to and regulatory oversight of surrounding wildfire risk.