Federal Help Falters As Nursing Homes Run Short Of Protective Equipment
Around the country, nursing homes trying to protect their residents from the coronavirus eagerly await boxes of masks, eyewear and gowns promised by the federal government. But all too often the packages deliver disappointment 鈥 if they arrive at all.
Some contain flimsy surgical masks or cloth face coverings that are explicitly not intended for medical use. Others are missing items or have far less than the full week鈥檚 worth of protective equipment the government promised to send. Instead of proper medical gowns, many packages hold large blue plastic ponchos.
鈥淚t鈥檚 like putting a trash bag on,鈥 said Pamela Black, the administrator of Enterprise Estates Nursing Center in Enterprise, Kansas. 鈥淭here鈥檚 no real place for your hands to come out.鈥
As nursing homes remain the pandemic鈥檚 epicenter, the federal government is failing to ensure they have all the personal protective equipment, or PPE, needed to prevent the spread of the virus, according to interviews with administrators and federal data.
Despite President Donald Trump鈥檚 pledge April 30 to 鈥渄eploy every resource and power that we have鈥 to protect older Americans, a fifth of the nation鈥檚 nursing homes 鈥 3,213 out of more than 15,000 鈥 reported during the last two weeks of May that they had less than a week鈥檚 supply of masks, gowns, gloves, eye protectors or hand sanitizer, according to federal records. Of those, 946 reported they had at least one confirmed COVID infection since the pandemic began.
鈥淭he federal government鈥檚 failure to nationalize the supply chain and take control of it contributed to the deaths in nursing homes,鈥 said Scott LaRue, president and CEO of ArchCare, the health care system of the Roman Catholic Archdiocese of New York, which operates five nursing homes.
Widespread equipment shortages continue in some places as the virus rages lethally through nursing homes and other long-term care facilities. More than have contracted COVID-19, and 43,000 have died.
Some homes still have not received the Federal Emergency Management Agency said it would ship in May. Instead, some got only cloth masks that the Department of Health and Human Services commissioned through a contract with , the apparel company known for its underwear. An HHS says the masks are not intended for caring for contagious patients but can be given to workers for their commutes or to residents when they leave their rooms.
As homes keep scrounging for supplies in a chaotic market with jacked-up prices and continued scarcity, 653 skilled nursing facilities informed the government they had completely run out of one or more types of protective supplies at some point in the last two weeks of May, according to records released last week by the Centers for Medicare & Medicaid Services, or CMS.
鈥淭he federal government has got to step up,鈥 said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an advocacy group based in Washington, D.C. 鈥淲e鈥檙e now 鈥 what? 鈥 three months into this pandemic, and these facilities still don鈥檛 have enough PPE to protect themselves and their residents?鈥
A 鈥楻elentless Commitment鈥
In April, Trump his administration 鈥渨ill never waver in its relentless commitment to America鈥檚 seniors.鈥 But FEMA鈥檚 shipments of masks, gloves, gowns and eye protection have had a more : 鈥渢o serve as a bridge between other PPE shipments.鈥
In written comments, FEMA defended the quality of the poncho gowns but said that because of complaints, the contractor was creating a 鈥渟hort instructional video about proper use of the gowns鈥 to share with homes. FEMA officials said that, as of June 4, the agency had shipped packages to 11,287 nursing homes, starting at 鈥渢he soonest possible date in the COVID-19 global supply chain climate.鈥
Yet 67 of the Good Samaritan Society鈥檚 147 nursing homes have not received a FEMA shipment, including homes that are fighting the biggest outbreaks in Sioux Falls, South Dakota; Greeley, Colorado; and Omaha, Nebraska, according to Nate Schema, the Evangelical Lutheran society鈥檚 vice president of operations. 鈥淲e have not received a shipment in our six or seven hot spots,鈥 he said.
The supplies that did arrive tended to be in one size only, he said, and 鈥渢he quality wasn鈥檛 quite up to the same level we鈥檝e been receiving鈥 through the society鈥檚 affiliation with Sanford Health, a large hospital and physician system.
The society has enough equipment, but small nursing home groups and independent homes are still struggling, particularly with obtaining N95 masks, which filter out tiny particles of the virus and are considered the best way to protect both nursing home employees and residents from transmitting it.
The CMS records show 711 nursing homes reported having run out of N95 masks, and 1,963 said they had less than a week鈥檚 worth. But FEMA is not shipping any N95 masks, and nursing homes are having trouble obtaining them from other sources. Instead, it is sending surgical masks, but more than 1,000 homes have less than a week鈥檚 supply of those.
Messiah Lifeways at Messiah Village in Mechanicsburg, Pennsylvania, received a FEMA shipment this week that had face shields and gloves, but only three days鈥 worth of surgical masks and 鈥渧ery low low-grade quality鈥 gowns that lacked sleeves, said Katie Andreano, a Messiah communications specialist.
Only two of ArchCare鈥檚 five nursing homes have received any FEMA shipments even though it is based in New York City, the site of the nation鈥檚 biggest outbreak. The equipment for those two homes lasted less than a week. LaRue tried to procure equipment from abroad, but all of the potential suppliers turned out to be fraudulent. He said ArchCare has had to rely on sporadic supplies from the state and city emergency management offices.
鈥淎s we sit here today, I鈥檓 still not able to get more than a few days鈥 supply of N95 masks, and I still struggle to a certain extent with gowns,鈥 LaRue said. 鈥淭hat doesn鈥檛 make you sleep at night, because you鈥檙e not sure when the next delivery comes.鈥
鈥業t鈥檚 Not Going To Work鈥
In addition to the supplies, the administration has to nursing homes out of $175 billion in provider relief funds appropriated by Congress. Hospitals are getting much more. Administrators said money doesn鈥檛 solve the broken private supply chains, where the availability of PPE is spotty and the equipment is vastly overpriced.
鈥淭oo often, the only signs of FEMA鈥檚 much-hyped promise of PPE are scattershot delivery with varying amounts of ragtag supplies,鈥 said Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit nursing homes and other service agencies for older people.
The cloth masks from HHS have been particularly perplexing to nursing home administrators, given the caveats that accompanied them. The instructions for the masks said they could be washed up to 15 times, according to Sondra Norder, president and CEO of St. Paul Elder Services in Kaukauna, Wisconsin.
鈥淚 don鈥檛 know how we would possibly track how many times each mask has been washed,鈥 she said. The instructions also said the masks should not be washed with disinfectants, bleach or chemicals, which is how Norder said nursing homes clean their laundry.
Norder said she laundered about 100 masks and they shrank. 鈥淭he ones that have been washed are tiny, and I certainly wouldn鈥檛 want to put something on someone鈥檚 face that hasn鈥檛 been laundered,鈥 she said. 鈥淎ll my colleagues [at other nursing homes] received the same thing and were also baffled by it, wondering, 鈥楬ow are we going to use these?鈥欌
KHN senior correspondent Christina Jewett contributed to this report.