Nursing homes, where COVID-19 cases abound, struggle to find protective equipment
Boxes of surgical gowns, which nursing homes in Oklahoma find hard to procure, are among the personal protection equipment delivered to an Oklahoma City warehouse where the state is building a stockpile for its COVID-19 response. CHRIS LANDSBERGER/THE OKLAHOMAN VIA OKLAHOMA WATCH
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Nearly a month after the state’s first nursing home residents died of COVID-19, many of Oklahoma’s long-term care facilities are struggling to find enough gowns and other protective equipment needed to prevent infections.
The Oklahoma State Department of Health announced April 14 that it had created a task force to work with long-term care centers and distribute personal protective equipment to them. But some nursing home officials and employees say deliveries have been slow and inconsistent and they are scrambling to buy PPE on the open market.
By April 24, at least 654 residents or staff members at 44 long-term care facilities in Oklahoma have been infected by the novel coronavirus. Seventy-three residents or staff have died, representing 39% of all COVID-19 deaths in the state.
Steven Buck, president of Care Providers Oklahoma, which represents for-profit nursing homes, said most facilities with positive cases have enough masks, gloves and other equipment to last a few days or a week at most. The hardest item to procure is disposable gowns, which are worn to prevent droplets from falling on staff members’ clothes. Buck wasn’t sure why they’re hard to obtain.
The state’s website said it had more than 840,000 gowns on hand as of April 24.
Shipments from the state’s stockpile had increased during the past two weeks, but more is needed, Buck said. Uncertainty about when the next shipment will arrive and what it contains is draining for staff members already stretched thin. He called it the health-care equivalent of living paycheck to paycheck.
“It’s like, rent’s due on the first and you don’t know if the paycheck’s going to arrive or not,” Buck said. “There’s a toll in that and we should acknowledge it.”
Roger Stack, a registered nurse at Coweta Manor Nursing Home, which had 51 cases and 7 deaths by April 24, was out of breath when he answered the phone.
“We have sufficient PPE as of today, but that’s only because we just got a shipment in (from the state),” Stack said. “Up until the shipment, we were sanitizing equipment that should be disposable so we could reuse it.”
Stack said the shipments have made it easier for staff members to focus on resident care instead of worrying about their own safety and searching the building for masks and gowns.
State health department spokeswoman Shelley Zumwalt said facilities should be receiving shipments from the state within two days of their first reported case. Facilities with one case are receiving five days’ worth of equipment and facilities with multiple cases get a 10-day supply, she said.
Zumwalt said in a statement that distributing equipment to long-term care facilities “is our highest priority” and no facility has reported running out of supplies during the pandemic. However, she said the state faces the same challenges nursing homes do in acquiring equipment.
“Ideally, we would like to proactively prepare every nursing home with PPE to handle any issue they may be facing,” she said. “But that is not the reality we are living in right now with supply-chain issues that restricts our ability to purchase PPE in unlimited quantities.”
Kimberly Green, chief operating officer for Diakonos Group, which owns 20 long-term care facilities in Oklahoma, said the company had not received any help from the state until the weekend of April 24-26, including at its Broken Arrow center, which was among the first to report a positive coronavirus case.
Zumwalt said the department is unaware of any shipments being delayed beyond 48 hours after a request was received.
Green said Diakonos facilities have not run out of equipment, but the cost of equipment is high and could financially cripple the company.
“We’re wondering if we’re going to be in financial ruin when this is over,” she said.
The cost of PPE is being driven up by high demand and tight supplies. Six weeks of equipment used to cost less than $100,000 but now runs $500,000, partly because the facility needs greater quantities and higher quality to deal with the pandemic.
“The state has the supplies and it should have been provided to us,” Green said. “Hospitals are being praised, and everyone is a hero and they get the first of all the PPE and we got a sliver of what we requested, even though we’re taking care of the most vulnerable.”
In late March, the state ramped up purchases of equipment for hospitals in preparation for a surge of COVID-19 cases. On April 2, Care Providers Oklahoma released a statement in which Buck called nursing home supplies “dangerously low” and urged the state to distribute more of its surplus to long-term care facilities. By April 5 hospitals had 14.2 days of supplies on average.
Since then, the number of hospital patients testing positive or under investigation for COVID-19 has begun to decline, from 495 on April 2 to 306 on April 24. This was one of the main reasons cited by Gov. Kevin Stitt on April 22 for deciding to start reopening Oklahoma’s economy. The average days of PPE at hospitals statewide has held steady, at 14.5 days, according to the state’s April 24 report.
Meanwhile, new cases and deaths continue to be reported in nursing homes across the state.
Rachel Shearer, executive director at Adams Parc Post Acute Recovery in Bartlesville, said it doesn’t make sense why hospitals would continue to have a surplus of protective gear when hospitalizations are falling and nursing homes struggle every day to maintain their supply.
“The supplies have been going to hospitals because they’re considered the front line, but now my team is the front line, so where’s our support?” Shearer said.
Shearer said a shipment was scheduled to be delivered on April 27 to her facility, which has 42 positive cases, of which half are staff members. But the facility will have to scrape by until then. She said gowns, surgical masks and shoe covers are in short supply.
Premium N95 masks and disposable gowns are running low at Skiatook Nursing Home, which has reported 37 cases and six deaths.
Administrator Melissa Johnson said the state has delivered two shipments to the facility since its first COVID-19 case was confirmed March 28. The supply was expected to last through April 24, when the last group of residents who tested positive were to be released from isolation.
“I don’t know what we’ll do after that,” Johnson said. “If we have any new cases, I think we’ll be back at square one.”
An administrator at Grove Nursing Center, which has the state’s largest outbreak of cases, 78, with nine deaths, said allocations from the state and the center’s corporate office have provided enough protection for remaining staff.
Grace Skilled Nursing and Therapy in Norman and Mangum Skilled Nursing and Therapy did not directly answer questions about protective equipment. The Norman nursing home has the state’s highest reported death toll, with 10 deaths and 77 cases. The Mangum home, which is partly owned by the same family, has 5 deaths and 52 cases.
The state has more than 650 long-term care facilities, and most haven’t reported any COVID-19 cases. Facility representatives say equipment is harder to come by for those without infections, but the need may expand as the state moves to reopen businesses. That could mean more staff members become infected outside the facility they work in.
Mary Brinkley, executive director of Leading Age Oklahoma, which represents nonprofit nursing homes, is urging the state to be proactive with supplies. None of the centers Brinkley represents have positive cases, but many won’t be prepared if that changes, she said. The facilities can’t get N95 masks for staff members now, she said.
“Every facility should have PPE in stock in case they do have a suspected case because you have to take those precautions immediately,” Brinkley said.
The state’s website said it had a supply of more than 496,000 N95 masks as of April 24.
Buck, of Oklahoma Care Providers, said Stitt’s plan to reopen the state will put facilities at a higher risk and many infection-free sites do not have the equipment on hand to handle an outbreak. In the meantime, facilities will remain closed to visitors for the foreseeable future, he said.
Zumwalt, of the health department, said prioritizing distribution of PPE among long-term care centers is challenging.
“Every day, the state’s warehouse employees are facing a difficult puzzle of priorities to navigate when to distribute PPE, but getting PPE to LTCFs (long-term care facilities) with positive cases has always been, and remains, a priority.”
“LTCFs without an outbreak are supplied with PPE for their needs today,” she said, “and if a resident or staff member becomes symptomatic or through contact tracing, we identify possible exposure, members of that district’s LTCF Task Force immediately respond with PPE and testing supplies to address the needs that arise with the change in circumstance.”