Nursing homes are used to cutting corners and doing the bare minimum to increase profits. With COVID-19, the facilities are having a hard time exploiting the situation. Updated guidelines on the use of personal protective equipment (PPE) are causing associated financial pressures, even though the facilities are always supposed to be prepared to prevent and contain infections and viruses. In mid-March, the American Health Care Association (AHCA) predicted that 20% of nursing homes in the U.S. would run out of masks and gowns in a week’s time. Now, at the beginning of April, providers across the country are struggling to keep enough PPE In stock for their staff.
The federal government expanded use of PPE, with the Centers for Medicare & Medicaid Services (CMS) calling for the blanket use of face masks as long as an emergency declaration was in effect — as well as full PPE in all buildings with evidence of COVID-19 transmission.
For the average 100-bed SNF, following these new guidelines in the long-term care setting would lead to increased costs of $10,000 per day as staff follow the directive to “wear full PPE for the care of all residents irrespective of COVID-19 diagnosis or symptoms,” according to an analysis announced by the Society for Healthcare Organization Procurement Professionals (SHOPP) by Michael Greenfield, the CEO of Prime Source Healthcare Solutions and one of the cofounders of SHOPP, and Faygee Morgenshtern of People Powered Nursing. Greenfield broke it down in terms of the equipment an average facility with a census of 100 would need, should it have “one active COVID patient.” According to Greenfield, the minimum amount of PPE items per day would be:
- 100 N95 facemasks (reusable)
- 100 gowns x 100
- 200 gloves x 100
- 100 face shields (reusable)
- 100 8-ounce hand sanitizers x 3
The biggest challenge now is the same challenge for the caregivers before the pandemic: they don’t have funds, they don’t have the support, they don’t have the training, and they don’t have the supplies. Of course, the challenge is that product arriving in two weeks’ time does not help a facility that has an outbreak in that interval — and outbreaks in nursing homes in the U.S. have been growing by the day. In the meantime, providers are still paying significantly more for PPE than they ever have in the past. Though the number fluctuates from day to day depending on market demand, some operators told SHOPP that they used to only spend between $20,000 to $25,000 per year on PPE items.
In addition to the PPE expenses, staffing poses a significant concern, particularly amid new CMS guidance requiring operators to assign specific staff members to groups of residents. If a facility has a 1:10 staffing ratio of nurse to patients, and four patients arrive with a diagnosis of COVID-19, then one nurse cannot take care of four COVID-19 patients and six patients without the virus. That means staffing ratios have to change, which in turn means having to creatively use the layout of a given building.