N95 medical mask

In the battle against coronavirus disease 2019 (COVID-19), caregivers at assisted living communities and skilled nursing facilities are among those on the front lines, and a key part of their defense is personal protective equipment such as gowns and face masks. But providers are facing equipment shortages.

That’s why groups such as the American Health Care Association / National Center for Assisted Living were eagerly awaiting guidance that ultimately came from the Centers for Disease Control and Prevention on Wednesday to help maximize resources for those who need them the most. The Centers for Medicare & Medicaid Services also issued advice.

To optimize the PPE supply, the CDC advised that providers implement extended use of face masks, restrict face mask use to healthcare workers and implement limited re-use of face masks and prioritize face masks for selected activities. For gowns, the federal agency encouraged operators to extend the use of disposable or cloth of isolation gowns under certain conditions, begin using cloth isolation gowns, consider using coveralls, implement extended use or re-use procedures and / or prioritize the use of gowns for certain activities. The federal agency also offered advice for eye protection.

President Donald Trump on Wednesday also announced plans to invoke the Defense Production Act, which would enable the federal government to compel certain businesses to manufacture medical supplies that are in short supply, to combat the pandemic.

The moves are the types of action called for by AHCA / NCAL earlier Wednesday on a call with members of the media, where they said the industry needed government leaders “to do everything they can to get us the equipment.”

“We need people to responsibly conserve the equipment that they have, but we also need people that don’t need the equipment to give it up,” AHCA / NCAL President and CEO Mark Parkinson said. He and AHCA / NCAL Chief Medical Officer Daivd Gifford, M.D., MPH, compared the sacrifices needed now to those made by people during World War II, with today’s “troops” being healthcare workers.

The two said they were encouraged by the example set in Ohio, where Gov. Mike DeWine (R) worked with the state dental association and dental board to request that dentists identify surplus supplies in their inventories and work with local emergency management agencies to share them with those who urgently need them.

Other states should follow suit, Parkinson and Griffin said.

“We really encourage all the governors to think creatively about where there might be equipment in their state [and] who can they work with to make sure they get this equipment to the right place,” Parkinson said.

Recommendations issued Wednesday by the CMS also should help. The federal agency advised that all elective surgeries and nonessential medical, surgical and dental procedures be delayed during the outbreak. “The reality is clear and the stakes are high: We need to preserve personal protective equipment for those on the front lines of this fight,” CMS Administrator Seema Verma said.

A supply shortage, Gifford said, has meant that one long-term care provider has had to use garbage bags instead of gowns, and others have been forced to make their own masks, but Parkinson said that an “overwhelming majority” of facilities have the supplies they need for now. Both he and Gifford, however, cited a survey that found that 20% of providers expected to run out of supplies next week, with an additional 20% expected to run out of supplies the following week, if providers continue to use supplies as they have in the past.

A survey by Premier Inc. found that more than two-thirds of the country’s assisted living and skilled nursing facilities were low on such equipment, with 87% of respondents reporting that they were not receiving all the PPE items they ordered. Inventories of N95 masks have been particularly difficult to source, according to the survey, with 30% of respondents reporting none on hand.

The American Seniors Housing Association and Argentum also previously have called for the federal government to make seniors housing residents and operators a priority for programs, supplies and PPE to fight the virus.

In other COVID-19-related news on Wednesday:

  • In the U.S., deaths from the virus have been highest among those aged 85 or more years, followed by those aged 65 to 84 years, the CDC said in an analysis.
  • The Senate passed the Families First Coronavirus Response Act, sending it to Trump, who signed it. The legislation will cost $104 billion, according to a Joint Committee on Taxation estimate. It is designed to ensure free coronavirus testing for everyone who needs a test, including the uninsured; increase Medicaid funding to support local, state tribal and territorial health systems in fighting the disease; provide two weeks of paid sick leave and up to three months of family and medical leave for eligible workers; enhance unemployment insurance; reimburse small businesses for providing leave; and strengthen nutrition initiatives for seniors, students and food banks.
  • Senate and House leaders now say they will turn their attention to legislation to provide relief to workers and families. “This bill will be crafted in consultation with the public health, labor, non-profit and business communities, so that we can deliver the most effective, evidence-based response,” House Speaker Nancy Pelosi (D-CA) said. Senate Majority Leader said the action will be “bigger and bolder.” “And we are not going to leave until we pass it,” he said.
  • CMS also released information explaining how state Medicaid agencies can use Section 1915(c) home and community-based services waivers in response to the pandemic. Among the moves states can make through Appendix K, the agency said, are increasing the number of people served under a waiver and increasing the pool of providers that can render services. States also can modify service, scope or coverage requirements; exceed service limitations and add services to the waiver, among other moves. States cannot, however, include changes not permitted by statute, such as room and board costs in noninstitutional settings.
  • The Equal Employment Opportunity Commission released information for employers about the Americans with Disabilities Act, the Rehabilitation Act and COVID-19. “The ADA and Rehabilitation Act rules continue to apply, but they do not interfere with or prevent employers from following the guidelines and suggestions made by the CDC or state / local public health authorities about steps employers should take regarding COVID-19,” the federal agency said. “Employers should remember that guidance from public health authorities is likely to change as the COVID-19 pandemic evolves. Therefore, employers should continue to follow the most current information on maintaining workplace safety.”