Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Social Work

Degree Program

Social Work, PhD

Committee Chair

Sar, Bibhuti

Committee Co-Chair (if applicable)

Barber, Gerard "Rod"

Committee Member

Barber, Gerard "Rod"

Committee Member

Golder, Seana

Committee Member

Stone, E. Ramona

Committee Member

Johnson, H. Arleen

Author's Keywords

emergency preparedness; long term care; nursing homes; diffusion of innovation; no-notice emergencies


Kentucky is one of the top ten states in the U.S. in the number of Presidential Declarations of Disaster (PDD) over the past ten years. This is due to its geology and weather patterns. The far western portion of Kentucky lies on the New Madrid Seismic Zone, one of the most dangerous fault lines in the United States; and natural hazards such as tornadoes, earthquakes, flash floods, severe storms offer only minutes or even seconds of advance notice. These “no-notice” emergencies with no timely warnings are the most common hazards experienced in Kentucky. In these events, individual long term care facilities and local/state responders rely even more so on good planning (Bolton & Zimmerman, 2007; Waxman et al., 2017). Emergency responses need to be based on sound plans that are pre-tested using exercises organized and facilitated by community partners that include first responders. The lessons learned by the research about solid decision-making for shelter-in-place or evacuation decisions are just as important in no-notice events as hurricane emergencies. In 2016, CMS announced a Final Rule for Emergency Preparedness for seventeen categories of health care providers, including long term care facilities, with a required vii implementation date of November 2017. The components of the CMS Final Rule are comprehensive, wide-reaching and very new to many LTC facilities creating apprehension, confusion and a strain on management resources. The conceptual foundation/theory chosen to assess the process of diffusion, adoption and implementation of emergency preparedness of KY LTC is Everett Rogers’ Diffusion of Innovation Theory (Rogers,1995). A survey based on best practices for long term care preparedness was sent to ninety-one KY LTC that had attended training in emergency preparedness to identify the adoption and implementation levels of their preparedness and their readiness to reach compliance with the CMS Final Rule. Fifty completed responses were received and analyzed. Results found that 70% of LTC had adopted comprehensive best practices and over 74% and 72% had participated in training and emergency exercises, respectively. A further 90% had established partnerships with their first responders and/or participated in their regional health care coalitions. Evacuation preparedness presents a gap in planning and requires ongoing support and emphasis. Diffusion of Innovation theory proved valuable in measuring the impact of relationships, communication and overall preparedness. The theory also identified the significance of change agents as key players in diffusion and adoption resulting in implementation. The most utilized change agents were the KY Emergency Preparedness for Aging & LTC Program, the two state long term care associations and the KY Office of Inspector General. Regional health care coalitions were found to be the major source of preparedness networking