Date of Award

Summer 2021

Degree Type


Degree Name

Doctor of Public Health (DrPH)


Public Health

First Advisor

Harry J. Heiman, MD, MPH

Second Advisor

Tara Ramanathan Holiday, JD, MPH

Third Advisor

David L. Ashley, PhD


Leveraging Federal Policies to Prevent and Respond to Communicable Disease Outbreaks in Skilled Nursing Facilities

Objective: The coronavirus (COVID-19) pandemic significantly impacted the health, safety and well-being of patients and healthcare workers in skilled nursing facilities (SNFs) across the United States (US), resulting in approximately 1.2 million confirmed cases, and 134,000 deaths as of May 30, 2021. The purpose of this study was to apply principles of legal research to identify federal policies aimed at preventing and responding to communicable disease outbreaks in SNFs, to assess these policies based on current evidence and expert opinions, and to provide policy proposals to address identified gaps.

Methods: An environmental scan of the Library of Congress, Google Scholar, the Federal Register, Centers for Medicare and Medicaid Services (CMS), and Westlaw Edge databases was conducted to identify federal policies relevant to the prevention and response to communicable disease outbreaks in SNFs. Results were reviewed against study inclusion and exclusion criteria to identify policies to be included in the final analysis. The CDC’s Policy Analysis Framework was then used to assess current policies relative to current evidence as well as their overall public health impact, feasibility of implementation, and the economic impact. Gaps in existing policies were identified and policy proposals were made based on the analysis.

Results: The environmental scan identified 571 policies across the five databases. Application of inclusion and exclusion criteria resulted in the elimination of 563, leaving a total of eight policies for review and analysis. Policies were categorized as preventative, responsive, or both. Nursing services (preventative) and Infection Prevention and Control/Training Requirements (responsive and preventative) were identified as policies needing modification to better improve patient care and safety.

Conclusion: While there are many federal policies to prevent and respond to communicable disease outbreaks in SNFs, some of those policies do not reflect the best available scientific evidence. To improve the quality of care and safety for patients in these facilities, changes are needed to existing policies to ensure the appropriate prevention and response to communicable disease outbreaks such as COVID-19, among this vulnerable population.


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