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The worst of COVID-19 seems to be over for Colorado nursing homes, but they continue to face challenges trying to cover higher costs with decreased revenue.

Nursing homes were hit hard in the first months of the pandemic, both in Colorado and around the country, with residents accounting for a disproportionate number of deaths. Since mid-May, outbreaks in Colorado have shifted away from health care facilities to places where the general community gathers, like stores and restaurants. Nursing homes have to continue taking extra precautions, however, because an asymptomatic employee or visitor could easily ignite another outbreak.

The American Health Care Association, a nursing home trade group, said a survey of 463 facilities around the country found 55% were operating at a loss, and most others had thin profit margins. About 72% thought they couldn’t sustain their current pace of spending on protective equipment and extra staff time for a year, unless they receive additional funding.

Colorado nursing homes are dealing with higher costs for protective equipment and staff time, and they report anywhere from 10% to 40% fewer residents than they had before the pandemic, said Doug Farmer, president and CEO of the Colorado Health Care Association. That’s due to a combination of families putting off the decision to find long-term care for parents and grandparents due to the virus, and fewer people getting surgeries that require a short stay for physical therapy, he said.

If the number of residents stays below normal, that creates concerns about nursing homes’ financial viability, Farmer said. Most have slim profit margins, and their overhead costs don’t fall proportionately when they have fewer residents, he said.

“There definitely have been increased costs, and with decreased residents, that puts a squeeze on,” he said.

Jay Moskowitz, CEO of Vivage Senior Living, said costs for protective equipment are still high, though not as bad as they were in the spring. Vivage has 29 facilities in Colorado, and 21 had outbreaks, though all but three are over.

A few months ago, disposable gowns that normally cost 40 cents were selling for $5, Moskowitz said. The price has improved somewhat, but homes still have to pay about $2 for each gown, which staff need to wear over their scrubs when providing care to potentially infectious residents, he said.

“We’re seeing supplies get a little better, but it’s still way above what we were paying” before COVID-19, he said.

Nursing homes’ supply chains improved over the summer, but the progress could reverse as health care facilities have to compete with reopening schools and businesses for gloves and other supplies, Farmer said. The state has set up an online tool where nursing homes and assisted living facilities can report how much protective equipment they have and how much they need, to learn the scope of the issue, he said.

Three companies supply most of the nursing home market for protective equipment, and under normal circumstances homes will have about three days’ worth of supplies on hand, Farmer said. When the pandemic hit, all homes needed substantially more supplies, and the major manufacturers couldn’t scale up fast enough, he said.

“The expansion in what was needed was so great, they didn’t have the capacity,” he said. “Everybody was trying anything they could to get their hands on masks.”

The association tried to help, but ran into frustrations along the way, Farmer said. Federal officials stepped in and bought out the first shipment they’d secured, the second couldn’t make it through customs at the Los Angeles port, and only the third reached Denver and their member homes, he said.

Julian Hazlett, executive director of The Peaks Care Center in Longmont, said the protective equipment situation has improved since this spring, though gloves can still be hard to find. The Peaks had 51 coronavirus cases among residents and 36 among staff before the state health department determined its outbreak was over on July 9.

“We have had to use different channels and vendors to obtain them, but thankfully we currently have what we need,” he said.

Ryan Mertz, administrator of the Good Samaritan Society’s Bonell community in Greeley, said they still have some challenges getting enough protective equipment, but their parent company has helped with supply chains. Weld County also has offered some for free, which is a significant help, he said. Bonell had 33 resident cases and 27 staff cases in an outbreak that ended in June.

The Bonell home has seen fewer people moving in for long-term care or rehabilitation, Mertz said, but they’ve used that as an opportunity to move all residents to single rooms, to reduce the odds of spreading the virus.

All three administrators and executives said they had difficulty covering shifts at the most severe point, when many employees had to isolate themselves after testing positive. The Bonell community had to rely on staffing agencies to fill in gaps during the spring wave, but that hasn’t been an issue in more recent weeks, Mertz said.

“It’s our people now,” he said.

In March and April, it was difficult to cover all shifts at some homes because so many employees needed to go home and quarantine, Moskowitz said. It’s eased up somewhat since then, but people still are reluctant to take jobs in a setting where they perceive their risk of getting the virus is high. A few hundred staff members across the company chose not to return to work because of their own health concerns, he said.

Low funding has long been a concern for nursing homes, but they haven’t experienced anything where patient revenue is decreasing at the same time costs are going up in decades, if ever, Moskowitz said. Staff have done great work, but homes need more people and the money to pay them, he said.

“This is different. Every one of our employees who come to work every day put their life on the line,” he said. “We’re still a hands-on profession. We need people who are willing to be caregivers.”

This content was originally published here.