Sens. Wyden, Casey Sound Alarm on Growing PPE Shortages in Nursing Homes

WASHINGTON, Aug. 27 -- Sen. Ron Wyden, D-Oregon, ranking Democratic member of the Senate Finance Committee, issued the following news on Aug. 26:

Senate Finance Committee Ranking Member Ron Wyden, D-Ore., and Senate Aging Committee Ranking Member Bob Casey, D-Pa., today highlighted worsening shortages of personal protective equipment (PPE) reported by nursing homes across the country in recent weeks.

A new analysis of Centers for Medicare & Medicaid Services (CMS) data by the minority staffs of the U.S Senate committees Finance and Aging found that roughly one out of every 12 nursing homes in the United States reported having no current supply of one or more type of PPE as of August 9--a nearly three-fold increase since July 5.

"The Trump Administration's continued failure to provide nursing homes with adequate supplies of PPE is one in a long line of decisions that has put residents and workers in unnecessary danger," the senators wrote. "Nursing homes and other congregate settings have been at the epicenter of the COVID-19 pandemic since the beginning. With CDC warning that the United States may be headed for the 'worst Fall from a public health perspective, we've ever had,' it is far past time for the Trump Administration to robustly respond to the supply shortages facing nursing homes."

In the letter, sent to Vice President Mike Pence in his capacity as the head of the White House Coronavirus Task Force, the minority staff's analysis furthermore found that all 50 states and the District of Columbia had at least one nursing home report being out of stock of one or more type of PPE as of August 9. In more than 40 states, the number of facilities that reported being out of supplies has increased since the beginning of July.

As the U.S. battles the COVID-19 pandemic, nursing homes have been among the hardest hit. Recent reports indicate more than 70,000 residents and workers in long term care facilities, including nursing homes, have lost their lives to COVID-19, and more than 420,000 have been infected. The minority staff analysis of CMS data shows significant increases in shortages among all types of PPE, including N95 respirators, eye protection, masks, gowns, gloves and hand sanitizer.

The analysis also includes PPE shortage trends for all 50 states, the District of Columbia, Puerto Rico and Guam.

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Read the letter below:

August 26, 2020

The Honorable Michael R. Pence

Vice President of the United States

The White House Office of the Vice President 1600 Pennsylvania Avenue, NW Washington, DC 20500

Dear Vice President Pence:

We write to reiterate our deep concern that the Trump Administration's continued failure to secure and distribute personal protective equipment (PPE) leaves nursing homes without the resources necessary to protect residents and workers from the novel coronavirus (COVID-19). Masks, gloves, gowns, and other PPE are the armor that nursing home workers wear into battle against COVID-19, and their continued scarcity in nursing homes around the country puts residents and the workers who care for them at unneeded risk.

Nursing homes and other congregate settings have been at the epicenter of the COVID-19 pandemic since the beginning. According to media reports, more than 70,000 nursing home residents and workers have lost their lives to COVID-19, and more than 420,000 have been infected./1 Moreover, Federal data show that there are now more nursing home residents currently infected with COVID-19 than there were at the end May, making the persistent and increasing prevalence of PPE shortages in nursing homes all the more alarming./2 Researchers have found that PPE shortages have resulted in health care workers unnecessarily contracting COVID-19./3 PPE shortages also contribute to reductions in available health care services, as providers strive to preserve limited PPE supplies, putting additional strain on an already overloaded system./4 With supply shortages worsening, nursing home residents and workers are under growing threat from COVID-19.

During recent trips to Indiana, North Carolina, and Florida, you said that PPE supplies "remain very strong,"/5 assured local leaders that the Trump Administration is quickly responding to shortages,/6 and asserted that frontline medical workers will "have all the PPE that's needed."/7 Your rosy assessments fly in the face of Centers for Medicare & Medicaid Services (CMS) data collected weekly from over 15,000 nursing homes. An analysis of CMS data by the Minority staffs of the Senate Finance and Aging Committees clearly shows that PPE shortages are worsening at nursing homes across the United States. These shortages have occurred despite the Trump Administration's announcement on April 30, 2020 that it planned to send two-week's worth of PPE supplies to every nursing home in the United States--an initiative that ultimately sent faulty supplies and, in fact, failed to reach all nursing homes./8

CMS, in conjunction with the Centers for Disease Control and Prevention (CDC), collects weekly COVID-19 data from nursing homes in all 50 states, the District of Columbia, Puerto Rico, and Guam./9 In addition to case and death count information, nursing homes are required to report the adequacy of PPE supplies across six different supply types--N95 respirators, surgical masks, eye protection, gowns, gloves, and hand sanitizer. For each supply type, they are asked to state whether they have sufficient supply to last one week, and whether they "currently have any supply." According to CDC guidance, when nursing homes state that they have no current supply of a given type of PPE, they are indicating that there is none available for their workers to use./10 Contrary to your assertions, all 50 states and the District of Columbia had at least one nursing home report being out of stock of one or more type of PPE as of August 9. In more than 40 states, the number of facilities that report being out of supplies has increased since the beginning of July. Over a one-month period, the number of nursing homes that reported having no current supply of one or more type of PPE nearly tripled, increasing from 486 nursing homes on July 5 to 1,335 on August 9. Of these, 842 nursing homes reported not having current supplies of two or more types of PPE. Many more facilities are operating with dangerously low inventories of PPE supplies. CMS data show that 3,216 nursing homes did not have a one-week supply of one or more type of PPE as of August 9--an increase from 2,698 homes since July 5. Of these homes, 1,979 reported having less than a one week's supply of two or more types of PPE.

The number of nursing homes reporting supply shortages increased across every type of PPE from early July to early August. Shortages of N95 respirators and eye protection appear to be the most severe and are worsening most quickly. By August 9, roughly 8 percent of nursing homes reported having no supply of N95 respirators; 17 percent reported lacking a one-week supply of N95s. More than 10 percent of nursing homes lacked a one-week supply of disposable gowns, while another 9 percent did not have a one week supply of surgical masks or eye protection such as goggles or face shields. Nearly 5 percent had no supply of gowns or surgical masks, and 4 percent had no supply of eye protection.

Table 1 shows the number of nursing homes nationwide that reported experiencing PPE supply problems as of the July 5 and August 9 reporting periods. As noted above, some facilities reported shortages of multiple types of PPE. Additional state-level data collected and analyzed by the committees' Minority staff are attached to this letter.

Table 1: Nursing Homes PPE Shortages by Type and Shortage Severity

as of July 5, 2020 and August 9, 2020

[Table omitted]

View table at https://www.finance.senate.gov/imo/media/doc/082620%20Wyden-Casey%20to%20Vice%20President%20Pence%20re%20Nursing%20Home%20PPE%20Shortages%20Final.pdf

The shortages reflected in these data are consistent with testimony that the Senate Finance Committee received from supply chain experts across the health care sector during a hearing on July 30, 2020,/11 as well as recent press reports,/12 and a survey of 21,000 nurses from across the nation conducted in July. The survey found "87 percent of nurses who work in hospitals report reusing at least one piece of PPE," including N95 respirators, single-use face shields, and single-use surgical masks./13 Similarly, the CEO of Premier Inc., which operates a group purchasing organization representing more than 4,100 health systems, 200,000 providers, and senior living facilities,/14 said in an interview last week that 50 percent of its members "still have back orders for products, so they don't think that they're out of the woods completely."/15 And a recent Health Affairs article examining nursing home industry shortages soberly concluded that unless supplies and staffing shortages "are prioritized by policymakers, long-term care residents will continue to be at a great disadvantage in the pandemic."/16

The Trump Administration's continued failure to provide nursing homes with adequate supplies of PPE is one in a long line of decisions that has put residents and workers in unnecessary danger./17 The Trump Administration has yet to even fully capture the disease's impact on seniors, people with disabilities and nursing home workers. This failure is due to long delays standing up data collection,/18 which still does not require nursing homes to report vital demographic information, or COVID-19 cases and deaths that occurred prior to May 1./19 Additionally, several hundred facilities each week are failing to either report required information at all, or are reporting incomplete data to CMS. As a result, CMS data has likely undercounted by tens of thousands the number of nursing home residents and workers who have been infected by and died from COVID-19. It also is likely undercounting PPE shortages. With CDC warning that the United States may be headed for the "worst Fall from a public health perspective, we've ever had," it is far past time for the Trump Administration to robustly respond to the supply shortages facing nursing homes.

In light of the data provided to CMS by nursing homes showing that PPE supply is a persistent and growing problem, please answer the following questions no later than September 9, 2020:

1. A recent Health Affairs article that analyzed CMS's PPE supply data found that "for-profit nursing homes reported substantially higher rates of PPE shortages than other facilities."/20 What is CMS doing to ensure that for-profit homes are maintaining adequate PPE supplies at their facilities?

2. Given CDC's expectation that COVID-19 transmission will worsen in the Fall, what steps does the Trump Administration plan to take to bridge supply shortages at nursing homes and in other congregate settings? Does the Trump Administration plan to distribute supplies in the coming weeks to help facilities build stockpiles? In particular, please provide information regarding how the Trump Administration determined which nursing homes will receive the announced delivery of N95 masks./21

3. The Finance Committee recently received testimony from Rob Wiehe, the Chief Supply Chain and Logistics Officer at UC Health in Cincinnati, who recommended that health systems and hospitals should be required to carry at least 30 days of critical PPE./22 Does the Administration plan to issue any guidance for nursing homes regarding the amount of PPE they should have on hand during the COVID-19 pandemic or other public health emergencies?

4. Since the beginning of the COVID-19 pandemic, "burn rates" of PPE, i.e., the amount a facility uses, have dramatically increased, in some cases by a factor of 10 or more./23 As such, what once may have been an adequate one-week supply of PPE may not be enough even for one day for a facility battling the virus. CMS and CDC do not appear to have defined how much a "one-week supply" of PPE is in its nursing home data collection requirements. Will the Administration issue guidance to nursing homes to somehow quantify, or otherwise make clearer, what a "one-week supply" of PPE actually means?

5. Long-term care facilities that house Black and Latino residents are more likely to have been hit by COVID-19 than ones that house White residents.24 Has the Administration used demographic data to determine if PPE shortages are disproportionately impacting nursing homes serving these or other minority communities?

Thank you for your attention to this matter. If you or your staff have questions concerning this request and analysis of CMS nursing home data, please contact Sen. Wyden's staff at (202) 224-4515 and Sen. Casey's staff at (202) 224-0185.

View the signatories of the letter at https://www.finance.senate.gov/imo/media/doc/082620%20Wyden-Casey%20to%20Vice%20President%20Pence%20re%20Nursing%20Home%20PPE%20Shortages%20Final.pdf