BACKGROUND: This study aimed to analyze the coronavirus disease-19 (COVID-19) response in long-term care hospitals (LTCHs) and establish a preparedness and management framework for addressing novel infectious diseases. METHODS: A national survey was conducted in Korea between June 19 and June 30, 2023. Using an anonymous online questionnaire, the survey gathered information on the general characteristics of participating hospitals, preparedness for infectious diseases in LTCHs prior to the COVID-19 pandemic, preparedness for in-house outbreaks during the COVID-19 pandemic, experiences of in-house COVID-19 outbreaks, and a section related to vaccines and treatments. RESULTS: Of the 1,425 domestic LTCHs, 201 (14.1%) completed the survey. Of the 201, before the COVID-19 pandemic, 24.9% of LTCHs had a disaster preparedness team and 27.9% had conducted training for infectious disease disaster preparedness. During the COVID-19 pandemic, 99.0% of the institutions established response teams for preparedness against COVID-19, and 89.1% of the 201 institutions experienced in-house outbreaks. Most institutions had experienced shortages of materials (78.8%), staff (96.1%), and caregivers (88.3%). The COVID-19 treatments prescribed at the LTCFs were: nirmatrelvir/ritonavir (86.6%), molnupiravir (36.8%), and remdesivir (22.4%). Independent vaccination was administered in 99% of the institutions. CONCLUSIONS: Despite the establishment of response systems, most LTCHs experienced in-house outbreaks during the COVID-19 pandemic. These institutions commonly faced challenges such as staffing shortages and supply constraints. To ensure better preparedness for future outbreaks, infection control systems should be regularly evaluated and maintained through ongoing training, even during non-outbreak periods.