Assisted living and skilled nursing facilities across the U.S. already contending with acute shortages in personal protective equipment amidst the evolving Covid-19 pandemic will soon run out of supplies unless drastic and creative actions are taken.
Without such action, 20% of assisted living and skilled nursing facilities will run out of PPE inventory within the next week, and another 20% will exhaust their inventory the following week, the American Health Care Association (AHCA) announced Wednesday morning. The trade association represents over 14,000 senior housing communities and nursing homes.
The acute care segment of the health care industry is already taking drastic measures to protect workers caring for people stricken by Covid-19. In Washington state, hospital workers are making protective gear out of office supplies and materials purchased from Home Depot. Memorial Sloan Kettering Cancer Center in New York — one of the country’s top cancer hospitals — has a shortage of N-95 respirator masks; five Sloan Kettering staff and three patients have tested positive for Covid-19, according to Buzzfeed News.
Most of the world’s PPE supply is manufactured in China, which shut down production in the early days of the coronavirus outbreak, resulting in severely limited new supply entering the U.S. The pandemic also dovetailed with traditional flu season and, as a result, nearly two-thirds of senior housing communities cannot access PPE for Covid-19, according to a survey conducted by health care supply company Premier, Inc.
This created a perfect storm for operators as the numbers of people in the U.S. testing positive continues to expand. Most officials assume it is a matter of when, not if, Covid-19 will enter a community, AHCA Chief Medical Officer David Gifford said during a Wednesday morning call with reporters.
“We have done some of our own surveys that suggest really over the next week to two weeks, we’re going to see that curve go up dramatically … assume it’s in your community and take action now,” he said.
AHCA’s tracking of Covid-19 cases indicates that between 20 and 30 communities have tested positive for the virus. This tracking, however, is mostly anecdotal and the number may be higher.
What is certain is that there will be more communities testing positive. When that happens, PPE inventories already in short supply will be wiped out in short order.
Federal and state authorities are working to release more PPE for health care use. Defense Secretary Mark Esper announced on Tuesday that he would release 5 million respirator masks, along with 2,000 ventilators, from the military’s strategic reserve to the Department of Health and Human Services to support the pandemic response.
But it will not be enough to address the supply shortages, and this has larger providers counting inventory, and smaller communities calling for stronger action from state and local governments.
Providers assess options, urge action
Asbury Communities has not had a staff member or resident test positive for Covid-19 so far, but the Frederick, Maryland-based nonprofit provider is monitoring the crisis and counting its PPE inventory, Senior Vice President of Health Care Services Henry Moehring told Senior Housing News.
Currently, Asbury has enough PPE inventory to last the next three to four weeks, depending on the community, and identified N-95 masks as a significant need moving forward. The operator is in constant talks with its supply partners to identify where it can fill the need.
One option involves obtaining masks from partners that have accounts with schools and businesses that are shuttered as the nation goes into self-quarantine in order to “flatten the curve” of the pandemic’s spread.
“Those accounts are not in service and [our partners] will look at ways for us to get our hands on [supplies],” Moehring said.
While that is ongoing, Asbury is looking at ways to extend PPE usage among staff, such as not changing masks and gloves while caring for multiple residents, Vice President of Clinical Excellence Skip Margot told SHN.
“We’re looking at conserving resources by using good science,” he said.
The Kendal Corporation has a limited supply of masks, gowns and eye protection on hand. But the Kennett Square, Pennsylvania-based company is concerned about wiping that inventory out if the self-isolation strategy continues beyond several weeks, Vice President of Culinary Services Ben Butler told SHN.
Kendal has a portfolio of 13 affiliated CCRCs in seven states. Butler is responsible for procuring protective equipment, in addition to culinary supplies. As the pandemic spreads, he and his team are scouring stores and reaching out to partners to build up inventory.
There have been some signs of hope. Construction companies that Kendal works with have been donating masks and other equipment. But the dynamic nature of the pandemic can blow up even the best plans, if providers are not careful.
“We have enough for right now, but as this expands and changes, we just don’t know what the need will be. If I could shout this from the rooftops right now, I would. We are at a critical moment in history, and decisions we make in the next 60 days will mean life and death for some folks,” Butler said.
Suppliers, like everyone else, are scrambling to respond to the pandemic, as well. In many cases, suppliers are unable to assist providers in procuring more PPE, and the U.S. end of the supply chain will be disrupted as China’s returns to stability.
“What companies like McKesson and Medline [Industries] have done is they’ve gone to the posture of, ‘We’ll ship to you based on what you ordered the previous 90 days.’ Well, nobody 90 days prior to this was ordering PPE because you had your inventory. it was not something you could order all the time,” Butler said.
Smaller communities are banding together to call for local officials to be more proactive in obtaining PPE supplies. Four suburban senior living and skilled nursing facilities in Chicago’s western suburbs called on Illinois Governor J.B. Pritzker to intervene to obtain, with extreme urgency, Covid-19 testing kits and for their staff.
The communities — Caledonia Senior Living in Riverside, Cantata Adult Life in Brookfield, Plymouth Place in La Grange Park and King Bruweart House in Burr Ridge — are adhering to Illinois Department of Health guidelines to cease visits from incoming visitors and residents have not been allowed to leave.
But staff at the communities are entering and leaving each daily, increasing the chances of one, if not all, of the communities testing positive for the virus as the pandemic progresses, Caledonia Senior Living CEO Gus Noble told SHN.
Caledonia has a limited supply of PPE. Since the response to the pandemic is a fluid situation, however, how long that stock lasts is difficult to determine.
Pritzker has emerged as a leader in response to the pandemic, ordering bar and restaurant shutdowns and activating the National Guard, among other actions. The suburban Chicago communities are calling on him to be more aggressive in securing what is vital equipment for preventing and containing the spread of the virus.
Long-term care, as a segment of the health care continuum, is on the front lines of the response, Noble told SHN.
“We literally don’t have the equipment we need. I don’t care who has it: local authorities, people hoarding inventory, state or [federal authorities]. Whoever can deliver this vital equipment, I don’t care as long as it happens,” he said.
Tim Regan contributed to this article.
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