PPE Shortages Remain a Top Concern for Hospice Providers

Health care organizations of all stripes have been struggling to obtain the necessary personal protective equipment (PPE) to maintain continuity of care safely during the pandemic, and hospices have been no exception. Hospice providers of all walks have had varied experiences in PPE supply lines, with some having deeper pockets and greater access than others.

“The provider relief fund was helpful with the costs of dealing with COVID, including PPE funds” said Terri Walter, chief administrative officer and senior vice president of hospice provider HopeWest in Grand Junction, Colo. “Luckily, the government recognized that we’re all going to need some help or there weren’t going to be health care organizations in operation. But we did have to explain that our reach goes beyond our 13-bed inpatient facility and into the community at-large that we serve with home hospice patients and families. I don’t think they saw how widespread we are.”

When the Federal Emergency Management Agency (FEMA) distributed PPE such as surgical and N95 face masks in March of this year, much of the supplies went primarily to hospitals, leaving hospices struggling to protect staff and vulnerable patient populations. As the cost of PPE products went up exponentially during the first quarter of 2020, supply disparities spread as quickly as the disease itself, with PPE sustainability largely dependent on a hospice organization’s ability to both source and afford it.

“We had approximately $1 million in increased costs related to COVID-19, and approximately $200,000 increased costs related to PPE,” said Paul Kusserow, president, and CEO of Amedisys (NASDAQ: AMED) in a Q1 2020 Earnings Call. “We are paying nearly five times more for PPE than pre COVID-19 prices. We have spent significant effort in dollars to ensure that we will have necessary PPE to protect our patients and clinicians.”

Many larger hospice providers have reported stockpiling an estimated six-month or greater supply to plan ahead, expecting a surge of COVID-19 cases with loosened restrictions and states reopening.

“As certain markets across the country prepare to reopen in a phased approach, we are similarly working with our partners to remind them we will adjust in lockstep to help support them to receive care for eligible patients as we plan for this new normal,” said Nick Westfall, CEO of VITAS Healthcare, a subsidiary of Chemed Corp (NYSE:CHE), in a Q1 2020 Earnings Call. “We’ve been successful in our tireless efforts to source appropriate PPE by any means possible, allowing us to not negatively impact our ability to admit new patients, as well as service our existing patients since the start of the pandemic.”

Smaller organizations are pursuing creative strategies to maintain longer-term supplies. As some areas have been harder hit than others by the COVID-19 pandemic, an industry-wide look at PPE allocation has revealed disparities among hospice’s experiences with emergency preparedness, with larger companies facing less intense headwinds than their counterparts.

“Not every county in our service area had as big of focus on emergency planning as of one our biggest counties did, and so we did not get as many supplies from that source as we thought we might,” Walter told Hospice News. “We still keep connected with them through regular calls because it helps hospices to be connected to their county plans, but we sourced a lot of supplies ourselves. We reached out to vendors not typically used like a nursing school, veterinary offices, dental offices and vendors. We asked around on our staff. We did lots of Amazon shopping. PPE management has been hard. We’ve been on the conservative side of things, and we’ll probably continue to be on the conservative side.”

Organizations such as Project N95 and Get Us PPE have developed during the pandemic to donate supplies to institutions struggling to acquire and afford PPE. Many hospices have received supply donations or formed community collaborations amid strains in supply lines, finding non-traditional ways of obtaining protective equipment and supplies. The National Hospice Foundation recently established a PPE grant program.

Sourcing supplies in the COVID-19 era has taken increased time, research and staff resources to track current inventory and anticipate long-term needs without an end to the pandemic on the horizon.

Despite increased cost-saving efforts and federal assistance, access to PPE remains difficult as the spread of COVID-19 continues across the country. The U.S. Centers for Disease Prevention and Control (CDC) reported that the number of new COVID-19 cases each day throughout the nation since the beginning of the outbreak totaled near 15,000 at the beginning of the month. With many states beginning to relax social distancing restrictions, that number has more than doubled hitting over 37,000 as of June 24, leading many hospices to anticipate that PPE will remain a top concern as the pandemic continues.

“Access to PPE changed from being readily available to a limited amount being available for purchase from our main supplier. Our routine supplier allowed us a limited, or allotted, amount based on historic use, which was low,” said Mary Pat Stickler, vice president of quality and clinical excellence at Hosparus Health. “Through a lot of grassroot efforts and work by many people, we were able to obtain PPE from non-traditional sources. We quickly moved to a stage where we asked our marketing and development teams to put out requests for donations of PPE, and many of our local distilleries donated hand sanitizer. We looked at non-traditional companies who were importing goods and used them to help secure suppliers in China. This took a good deal of education and ongoing back and forth with the supplier to get medical-grade PPE. We also leveraged connections at our professional organizations, collaborating with hospices around the country in order to purchase bulk items.”