Emergency Preparedness and Risk Management in Nursing Homes: Managers' Assessment of Internal and External Threats

This study assessed nursing home managers' perceptions of internal and external threats and examined descriptive threat patterns across facility-capacity groups. The aim was to provide evidence relevant to emergency preparedness and risk management in nursing homes.

A questionnaire-based survey was conducted among nursing home management in the Czech Republic. Responses were obtained from 368 of 524 eligible facilities. The questionnaire comprised 47 predefined internal and external threats. Each threat was rated separately for perceived probability of occurrence and severity of negative impact. The analyses reported in this manuscript were based on the negative-impact ratings. Facilities were grouped by maximum accommodation capacity. Data were analyzed using descriptive statistics, Cronbach's alpha, Kaiser-Meyer-Olkin and Bartlett tests, and an exploratory factor-analytic procedure using principal component extraction with Varimax rotation and Kaiser normalization, conducted separately for external and internal threats.

Managers reported a broad range of internal and external threats, with descriptive patterns varying across facility-capacity groups. Cronbach's alpha ranged from 0.940 to 0.947 for external threats and from 0.946 to 0.955 for internal threats. KMO values ranged from 0.910 to 0.937 for external threats and from 0.890 to 0.920 for internal threats. Primary threats within extracted components were identified using factor loadings of at least 0.70. External patterns included supply, infrastructure, natural and societal threats, while internal patterns included anthropogenic and technical threats.

The findings identify descriptive differences in managers' perceived threat patterns across nursing homes of different capacities. They support the use of structured threat assessment as one input to preparedness and continuity planning, while further work is needed to test whether the observed group patterns are reproduced in other samples and care systems.