Key PointsQuestionAre nursing homes at elevated risk of wildfire exposure likelier to meet federal emergency preparedness standards or subject to greater regulatory oversight?FindingsIn 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.MeaningThese findings suggest that there are opportunities to improve the regional responsiveness of nursing homes and regulatory oversight to surrounding environmental hazards.