Post-acute care providers and senior living facilities are a key aspect of the COVID-19 response, so paying attention to their capacity and supply issues is critical. More than two-thirds of senior living facilities in the United States cannot obtain the necessary N95 masks, face shields and other personal protective equipment (PPE) that may be needed to care for current or suspected cases of COVID-19, according to a survey from Premier Inc. Primary care practices also are struggling with access to PPE.
Charlotte, N.C.-based Premier’s survey was conducted from March 6-15, 2020, and sent to a representative portion of non-acute care providers in its membership. Approximately 179 skilled nursing facilities and assisted living facilities with more than 267,000 beds (approximately 10 percent of the total senior living beds in the United States) provided responses.
Premier explained that healthcare distributors have placed more than 700 unique PPE stock-keeping units (SKUs) on allocation due to COVID-19. Allocation is a process that restricts ordering when demand for a particular product spikes. Allocations are typically set to match the customer’s historic purchase volume in order to protect the supply chain and prevent unnecessary hoarding. A downside of allocation is that, while well intentioned, it may limit healthcare providers in the amounts they can buy, even if they have legitimate reasons for larger orders.
In most hospitals’ and health systems’ facilities, PPE orders are common, as these goods are required to perform a range of activities, including surgeries, ICU care and infection prevention. However, most senior living facilities don’t perform critical care functions, and thus purchase almost no PPE at all. According to Premier data, about 43 percent of the senior living facilities responding to the survey do not have a consistent ordering history for PPE, effectively leaving them without a legitimate channel for purchasing supplies that may be necessary to protect workers and elderly residents in senior living facilities. Of respondents that have a consistent purchasing history of PPE products, 87 percent are not receiving the full quantity of products ordered.
“We’ve already seen a COVID-19 outbreak in a senior living facility in the United States, and now we know this setting is at the greatest risk for shortages,” said John P. Sganga, Senior Vice President of Alternate Site Programs at Premier, in a statement. “This problem grows more severe by the day, as states such as New York implement requirements for all nursing home employees to wear masks. We urgently need immediate action from the government to prioritize the creation of a controlled and secure distribution channel to get products to these non-acute healthcare providers.”
According to the survey, about one-third (30 percent) of senior living respondents reported no inventory of N95 masks, and 68 percent said they had limited to no ability to access additional masks. Nearly 60 percent of respondents also indicated limited to no ability to access gowns. Approximately 65 percent have limited to no ability to obtain disinfecting products such as wipes, spray and hand sanitizer. Nearly 70 percent reported limited to no ability to acquire face shields and other facial protective equipment.
Among its recommendations, Premier urges the government to immediately act upon the President’s Executive Order and begin to exercise its authority to expand the domestic production of PPE using any manufacturing line possible – healthcare and industrial. It also recommends that senior living facilities implement the CDC’s guidance for infection protection, including monitoring residents for symptoms and triaging and isolating potential COVID-19 cases. In addition, facilities should also follow guidance from the Centers for Medicare & Medicaid Services (CMS), which recommends cancelling visitation and limiting all communal/group activities.
Primary care providers also are worried about access to PPE. Aledade, a company that works with independent primary care practices on accountable care organization efforts, surveyed doctors in 100 practices about what worries them most about COVID-19 today. Aledade CEO Farzad Mostashari, M.D., tweeted about some of the results. “Their number one concern right now is that they can’t get masks, gowns, eye shields to protect themselves, their staff, their patients. The supply chain has completely broken down for them. I've reached out to health plan CEOs, innumerable GPOs [group purchasing organizations], state health officials, to no avail.”
He quoted one doctor as saying, “I am most worried that I will be infected and therefore be unable to care for my patients appropriately. I have a large number of patients over 65. I do not have appropriate PPE to protect myself or my staff.”