The shortage of personal protective equipment (PPE) in the skilled nursing setting has led to donation drives, workers making their own equipment from fabric and trash bags, and increasingly desperate searches for supplies on the part of providers as they try to cope with the COVID-19 national emergency.
The search for supplies can get particularly costly, as the markup for some supplies has skyrocketed with demand; using the equipment as mandated by the government could end up costing providers $10,000 a day or more.
Though the shortages of PPE represent a major hurdle for operators trying to contain the spread of COVID-19 in their nursing homes, stop-gap solutions can still be useful.
Post-acute and long-term care operator PruittHealth — which is based in Norcross, Ga., and has more than 180 locations in Florida, Georgia, North Carolina, and South Carolina — got a recent boost in the form of donations of cloth masks from Aaron’s, Inc. (NYSE: AAN).
The retailer converted its Woodhaven Furniture manufacturing facility in Coolidge, Ga., to produce masks, sheets and gowns, according to an April 6 announcement.
Skilled Nursing News spoke with PruittHealth CEO Neil Pruitt Jr., about the donation from Aaron’s and how the company is using it to allocate PPE — and about how the COVID-19 emergency will change providers’ supply strategy in the months and years ahead.
After the interview was conducted, PruittHealth took another bold step in the fight against the coronavirus: posting a detailed, interactive breakdown of positive, negative, and pending COVID-19 tests at all of its facilities on its website.
The move came amid growing public calls for a federal database of COVID-19 cases at the nation’s more than 15,000 nursing facilities.
“We know how stressful this time is for our patients and their loved ones,” Pruitt Jr. said in a Tuesday statement. “That’s why we decided to publish location-specific COVID-19 data on our website to help families stay informed and connected.”
This interview was recorded on April 9 and reflects the COVID-19 situation of that time. It has been edited for length and clarity.
How many masks are being donated, and where are they being distributed?
Aaron’s is donating masks by the thousands, and will keep them coming as long as we need them; they have already started showing up at our corporate office, and are actually out in our facilities being used as we receive more and more PPE, and N95 masks.
We are incredibly thankful for them to step up and offer to help and be corporate citizens. It really is heartwarming to see that, out of the blue, an organization would retool one of their factories to go from making furniture to be able to make protective equipment for our caregivers. We have over 16,000 [workers], and they’re showing up to work every day fighting this terrible virus. So we can’t thank them enough.
How many of the masks from Aaron’s are in circulation right now, at the facilities?
There’s several thousands. I can’t give you an exact number, but they have opened their supply line to us about a week ago — and this is a important interim step. Just to give you an idea, we’ve ordered, and are in the process of receiving, 2.5 million surgical masks, and we have 750,000 kn95s. That mask was put on order weeks ago, but they come in slowly.
This interim step from Aaron’s — I can’t tell you how much we appreciate it. It can be used to extend some of the PPE that we have. Like the PPE, it can be used to protect our staff members and units that don’t have COVID-19 present.
It’s really helped us get through a tight time; we’re starting to see some of our other supplies start to release and come in, so this support has really been a crucial part of keeping our workers safe.
You mentioned it was a surprise, so how did this donation end up coming about?
This idea, as far as I know, came from John Robinson, who’s Aaron’s CEO. He gave me a call and said that they had retooled their factories in order to help support fighting COVID-19, and asked if we needed any support.
I told him our situation, and I believe next day, we had our first shipment should show up, of these masks. So he was kind enough to reach out to us and offer to help.
When did he make that call to you?
I do not know the exact date, but I believe it was a couple of weeks ago, about a week and a half ago. It’s been really helpful in this interim step, as we wait for more PPE to come in.
Can you go into that a bit — paint a picture of what your situation was at the time that call was made. Reports talk about supplies across the country being backed up, so I want to know where you were at the time, in terms of PPE and what was needed.
Well, at the time, we were had not started receiving our PPE in the additional [quantities] that we had ordered. Our public health authorities have been incredibly helpful, but the quantities aren’t large. We always had enough to take care of our buildings where patients were exhibiting symptoms. But we worried that if we had a mass outbreak, that we wouldn’t have enough PPE to take care of the whole organization.
So that help really came at a critical time for us, and has really made our partners feel safe.
Have you had any other partnerships or sources of donations?
What is really heartwarming is we’ve had people throughout the community making handmade masks, and sending them to our corporate headquarters. Really, it’s heartwarming to see everyone coming together and fighting this pandemic. Aaron’s is the largest, obviously, of such — but some of our residents, we’ve had people in the communities, we’ve had family members that are making these masks for our caregivers, and we’re immensely grateful for them.
We’ve had a Waffle House that showed up with food trucks that help feed our partners. We’ve had many companies out there that really have stepped up, and it shows really the best of humanity when you see so many people trying to fight this terrible virus.
As good as that is, obviously it comes from a less-than-ideal situation, given the shortage of PPE. So what have the donations done in terms of allowing for the conservation and allocation of supplies that are in stock?
As soon as COVID-19 is detected in one of our buildings, it goes to what we call a “Code Red” status, and we publish that on our website within five minutes. What that does is that triggers allocation of PPE, that’s the N95 masks that you hear so much about, the gowns, the gloves, etc. All of our facilities has some, but when they go Code Red, we have an extra allocation that goes to them.
What these cloth masks have allowed us to do, while we wait for more surgical masks, is: all the patients that our staff members that are serving, healthy patients, we’re able to put them in masks that they normally wouldn’t have available to them. Eventually, we have to have surgical masks available, but the supply chains just aren’t there yet. Aaron’s donations really allowed us to fill that that critical gap.
Also, when there are shortages of PPE, there are protocols that have been given by CDC and the public health authority that would allow us to extend the PPE. So this generous donation has given us a lot more flexibility in our supply chains, and how we’re able to protect our workers and ultimately, our patients.
Given how helpful it’s been, how could other facilities facing the same supply challenges try to draw lessons from your experience?
I would encourage them to use social media to put out their needs. On our website, pruitthealth.com, we have a real time update on COVID-19. And in addition, we have a section on there that says how you can help and we even give instructions on how you can help make these masks.
So Aaron’s has been incredibly helpful, but so have our average citizens —stepped up and helped us out. A lot of civic organizations are doing that. So I would encourage them to reach out to their local communities. Although this virus is terrible and scary, the one thing that I think is true is it’s bringing us all together to fight it. There’s a large network that we have out there; they’re incredibly supportive of the people we serve. So I’d encourage them to tap into it.
And in terms of making the best use of the donated supplies, what advice would you give?
I would advise they look at the CDC guidance, [which] talks about critical shortage of PPEs and ways to extend them.
I think it’s time — this isn’t necessarily always popular — I think it’s time that all caregivers wear masks, even if they’re asymptomatic and there’s no signs for the patients. We’ve got to do everything we can to fight back this disease, and so that’s a very appropriate time to use masks. Not all providers are treating it the way that we do. But I think it’s time to use every single precaution.
As I talked to some of the medical authorities, the more cloth masks you have that you can change within a shift is also helpful. Obviously, these are not surgical masks, and they aren’t KN95s. But they’re incredibly helpful to extend the life of PPE, and to provide some protection while we wait for our supply chains to catch up to give us the resources we need.
How long do you think it’s going to take the supply chains to catch up?
We’re starting to see some of our equipment start to come in. And we’ve seen allocations from our public health authorities. So I’m more and more hopeful that within the next couple of weeks, we will start to see return to normal levels.
The problem is our population and long-term care providers don’t typically use this type of PPE, so our allocations from manufacturers are based on historical percentages. We’ve had to go outside those normal supply chains directly to the manufacturers, in some cases.
I see hope. I think within the next couple of weeks, we hopefully will be catching up to where we need to be.
You’ve mentioned the historical use determining allocation — would that change going forward, in terms of how the need for PPE is assessed?
I can tell you that PruittHealth is going to have a emergency store allocation of PPE. We haven’t seen anything like this before. So I think most providers will make sure they have adequate PPE in an emergency stockpile of their own, instead of relying on the [Strategic] National Stockpile.
Unfortunately, it wasn’t as adequate as we would hope that it would have been, and we understand the challenges behind that. But I think you’ll see, after this passes, more and more providers have their own stockpile.
How many weeks’ worth of supplies would you want to have in that stockpile — can you estimate?
You know, I would even hesitate to guess at this point. We’re spending every waking hour fighting COVID-19. There’ll be time to look back at historical usage patterns and then determine the appropriate amount, but right now, we’re doing everything we can to get supplies, and to make sure that we have adequate supplies.