Vulnerable groups are particularly affected by climate change. The healthcare sector is responsible for approximately 6% of the greenhouse gas emissions in Germany. It remains unclear to what extent hospitals and nursing homes in Germany have already implemented climate mitigation and adaptation measures.

The study was conducted in the predominantly rural Marburg-Fulda region of Hesse, Germany, which has a population of 2,028,359. A total of 91 of the 300 nursing homes (30%) and seven of the 32 hospitals (22%) from this region participated in a semi-standardized telephone survey. Data were collected between January 28, 2025, and July 31, 2025. Data were first analyzed descriptively. In the next step, the Fisher‒Freeman‒Halton test was used to identify correlations between institutional characteristics and various climate mitigation and adaptation measures.

Nursing home size was positively correlated with the presence of climate mitigation guidelines ( p = 0.012). Simple climate mitigation measures for everyday use (e.g., switching off lights or lowering heating) are generally implemented in nursing homes and hospitals, whereas larger, cost-intensive climate protection measures are less frequently implemented. Except for heat protection, climate adaptation measures are not very widespread. Barriers to the implementation of measures include financial constraints, staffing shortages, and structural limitations.

Hospitals and nursing homes in the Marburg–Fulda region are not yet climate-resilient. Implementing such measures often fails because of a lack of resources. To create a climate-resilient healthcare system, targeted financial and structural support is needed from policymakers.