This morning, the Milwaukee Journal Sentinel published a blistering story about shortages of personal protective equipment (PPE) at senior care facilities across Wisconsin. The article details how the Trump Administration sent “unusable” supplies to nursing home facilities around the state such as expired gloves and masks not formally approved by the FDA, forcing some staff members to “wear cloth gowns made out of bedsheets and other linens in order to conserve their limited supplies.”
In response to the new reporting, Biden for President Wisconsin State Director Danielle Melfi released the following statement:
“The Trump Administration has fumbled their response to the coronavirus at every turn, and Wisconsinites continue to pay the price. Months into this crisis, workers at nursing homes across Wisconsin are still struggling to get access to effective personal protective equipment despite the state’s best efforts to procure supplies under the leadership of Governor Evers. As cases continue to surge and the state hit record infection numbers last week, these front line workers are forced to scramble for their own equipment, with some Wisconsin providers reportedly even using bedsheets to protect themselves in order to conserve their limited supply of isolation gowns. As Trump’s failed leadership left states to fend for themselves to get the supplies needed to keep folks safe, Joe Biden has laid out a clear plan to implement a coordinated national effort to acquire, produce, and distribute PPE, including fully utilizing the authorities under the Defense Production Act.”
Read more about Joe Biden’s plan to establish a sustainable supply chain for PPE and supplies for health care workers HERE.
Milwaukee Journal Sentinel: Wisconsin nursing homes worried about PPE shortages as coronavirus cases climb
Expired gloves, masks not formally approved by the federal Food and Drug Administration, giant blue “garbage bags” unusable as gowns.
That is a sampling of the personal protective equipment sent last month to nursing homes in Wisconsin — not by a sketchy supplier, but by the Federal Emergency Management Agency.
Much of the equipment has gone unused, according to nursing home administrators, including the blue, garbage-bag-like gowns, which arrived without arm openings. Even if nursing homes fashioned them to be worn as gowns, administrators said they would be inappropriate and unsafe.
“We are grateful that they sent us what they could, but … when you can’t use what they send, it’s challenging,” said Emily Karls, administrator of Shorehaven Health and Rehabilitation Center in Oconomowoc.
The defective equipment is one more frustration for nursing homes struggling to outfit their staffs with the masks, gowns and other equipment needed to protect workers and patients.
Officials say protective equipment remains scarce, difficult to find from trustworthy suppliers and often priced at many times its pre-pandemic cost.
“As a leader, it’s terrifying that we can’t get what we need to keep our staff safe,” Karls said. “It is my job to make sure everyone has what they need to stay protected, and I haven’t been able to do that.”
The problems come at a time when COVID-19 cases are on the rise across the state and the nation.
“We’re a long way from solving these basic issues,” said Tamara Konetzka, a professor of health services research at the University of Chicago. “There are still many facilities that are struggling to have enough PPE and testing.”
Long-term care facilities have become deadly hot spots for the coronavirus. At least 40% of the nearly 900 coronavirus-related deaths in Wisconsin have been linked to nursing homes or assisted living facilities, according to the state Department of Health Services.
In a recent letter to governors, the American Health Care Association warned that a spike in COVID-19 cases in the broader community poses a great threat to long-term care facilities.
John Sauer, president and CEO of LeadingAge Wisconsin, noted the more cases that are in the community, the more likely they will find their way into nursing homes.
“We’re certainly not immune from what’s going on in the greater community,” he said.
New daily cases in Wisconsin began climbing around mid-June and have been on an upward trend since. In mid-June, new daily cases averaged in the high 200s. In mid-July, the number of new cases hit or topped 900 on four days.
On Tuesday, Wisconsin reported a record 1,117 new COVID-19 cases, in part driven by a spike of cases in Waukesha County, where Shorehaven is located.
Waukesha County reported a record 228 new cases Tuesday, when it had been averaging about 70 new cases the week prior. In mid-June, the county was averaging 13 or 14 new cases per day.
While the number of tests is up, the percentage of them coming back positive is also climbing, indicating the virus is spreading.
A ‘crisis’ in the making
Nursing homes have been stockpiling protective equipment in preparation for a possible outbreak of the coronavirus in their facilities, but they still have trouble finding enough, sometimes running out of a type of equipment.
“I haven’t spoken to any of our members — and I’m on the phone with them every day — who feels like their supply now and their supply in the future will be sufficient,” Sauer said.
His organization, LeadingAge Wisconsin, has around 500 member facilities owned or operated by nearly 200 organizations.
David Mills, CEO of North Shore Healthcare, which operates more than 50 nursing homes in the state, called it a “crisis.”
“It’s starting to get better, but in no way are we anywhere near where we need to be with PPE,” Mills said.
In its letter to governors, the American Health Care Association said nearly 20% of nursing homes recently reported to the federal Centers for Disease Control and Prevention that they either did not have, or had less than a one-week supply of, masks, gowns, gloves, eye protection or hand sanitizer.
In late April, President Donald Trump announced that FEMA would send a 14-day supply of supplemental protective equipment to the country’s more than 15,000 nursing homes by early July — shipments that included those blue, garbage-bag-like gowns.
In an email, FEMA spokesperson Alexandria Bruner said that in response to feedback on the first round of shipments, the agency replaced the “blue gowns” with “a more familiar disposable gown style.” The shipments also included surgical masks and eye protection that Wisconsin centers said were usable.
At a press briefing Wednesday, Trump announced an additional $5 billion in funding from the federal CARES Act for nursing homes, along with a new mandate that nursing homes in states with worsening outbreaks test all nursing home staff each week. The rule will apply to states where 5% or more of COVID-19 tests come back positive.
Earlier this month, the Trump administration announced it would send rapid point-of-care tests to nursing homes in COVID-19 hot spots.
The types of equipment in shortest supply are N95 masks and disposable gowns, the latter of which Sauer said have gone from about $1.25 per gown to as high as $9 each.
At St. Paul Elder Services, which has centers in Kaukauna and Green Bay, staff members wear cloth gowns made out of bedsheets and other linens in order to conserve their limited supply of isolation gowns, said President and CEO Sondra Norder.
“Costs have definitely skyrocketed,” Norder said. “On average, everything that we’re buying we’re paying about three times as much as we would under normal circumstances.”
Some products are priced at 10 times the cost they used to be, she said.
“We have a purchasing agent who’s become like a professional shopper,” she said. “She has scoured all corners of the internet trying to find things.”
Sometimes, Norder and her team aren’t sure whether to trust the suppliers they find. Once, they placed an order for what looked like quality isolation gowns.
“What came to us looked like it was designed for a two-headed elephant,” the arms as wide as elephant trunks, she said. “Those are the kinds of chances we had to take, and that one didn’t pan out for us very well.”
Facilities deal with shortages
In the past week, Shorehaven in Oconomowoc ran out of KN95 masks, Karls said. The masks are similar to N95 masks that, when worn properly, filter out at least 95% of very small particles in the air, including viruses.
Shorehaven ordered more masks in May but hasn’t received them.
“Nothing is guaranteed,” she said. “We can order a shipment but it might not come in.”
They’ve now put in a new order, but Karls said the cost was “obscene.”
Shorehaven started burning through its air-filtering masks and other equipment after a staff member tested positive this month for COVID-19, Karls said. The staff is taking extra precautions with residents in the units where that person worked, wearing full PPE around them and keeping them under observation for any symptoms for 14 days.
Like other facilities, Shorehaven, which has a nursing home, assisted living facility and memory care unit, is rationing and stretching the life of what equipment it does have.
At one point, staff members were limited to a single surgical mask for seven shifts. Now they may have two masks, Karls said.
“But that’s not how it had been done ever in the history of PPE,” she said. “It’s extended use of PPE, so it’s not how we would use PPE before the pandemic.”
Karls and Norder both said they have had staff members quit because they did not feel safe.
Supplies are stretched even thinner due to residents leaving the facility to visit family or to go shopping, Karls said.
The reason: When they return, they are quarantined for 14 days. And staff members wear full protective equipment, including an N95 or equivalent mask, when around the residents in case they were exposed to the virus while out of the facility.
“We have sometimes 14, 15 people in isolation that just chose to leave the campus, and as a result, we’re depleting our supply” of PPE, she said.
St. Paul Elder Services has about 500 N95 masks saved up, enough that Norder feels confident they could weather an outbreak for a few weeks.
Norder said she wished the Defense Production Act would have been used more to spur production of gowns, and she called on government leaders to prioritize long-term care facilities for protective equipment.
“Frankly, we’re competing on an open market right now with salons and tattoo parlors” and other non-health-care entities, she said.
Sauer, of LeadingAge Wisconsin, called on the federal government to take a more central role and said there must be a sustained focus on making and distributing protective equipment.
“This is a pandemic. I don’t think we can just say every organization for themselves,” he said.
The need is not going away, he added.
“In fact, as we enter the flu season, nursing facilities, assisted living facilities are going to have an ongoing need for PPE,” he said.
What providers like Karls would like is to step down from crisis mode, to at least give her staff one new mask per day.
“I’m happy to pay for them. We just want the ability to order them and for the assurance that we are actually going to get what we order,” she said.