Capitol Correspondence - 08.18.20

Big Picture: Sharp Disparities Continue with PPE Access, Health Labor Shortages

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As reported by Politico Pro:

“Doctors, nurses and caregivers at smaller and poorer hospitals and medical facilities across the country are still struggling to obtain the protective gear, personnel and resources they need to fight the coronavirus despite President Donald Trump’s repeated assertions that the problems are solved.

Health care workers at all types of facilities scrambled for scarce masks, gloves and other life-protecting gear at the beginning of the pandemic. The White House was letting states wage bidding wars against one another, rather than establish a central national manufacturing, supply and distribution chain.

But now, health care workers say a clear disparity has emerged and persisted. Larger and richer hospitals and practices outbid their smaller peers, sometimes for protective gear, sometimes to fill in staffing gaps. And some of those having the hardest time are precisely where the virus is spreading.

A POLITICO survey of health care workers elicited dozens of stories from the front lines across the country. Reporters did follow up interviews with about a dozen survey respondents, and also interviewed other health care practitioners and policy experts. Some spoke on the condition of anonymity because they feared retribution from employers, as some medical facilities have threatened to fire workers for airing complaints publicly.

Health care administrators say the smaller and poorer facilities are also being outbid in the labor market, as providers compete for a limited pool of trained nurses and specialists who can care for Covid-19 patients amid chronic staff shortages and pandemic-induced industry upheaval. Their descriptions illustrate the shortcomings of a federal response that was initially focused on major hospitals while scores of smaller providers fell through the cracks.

The resulting disparities, especially among long-term care providers who often continue to care for patients after they leave the hospital or whose patients don’t require hospitalization but are still infectious, puts an asterisk on Trump’s claim that ‘they’re very much stocked up, they’re in great shape,’ as he put it at one of his recent briefings.

[…]

The shortages of personal protective gear, or PPE, has taken a toll. Without adequate protection against a contagious pathogen, thousands of health workers have fallen ill, and at least 922 have died, according to a 50-state tracking project by Kaiser Health News and the Guardian.

[..]

GetUsPPE, the largest national organization distributing donated equipment, said it’s received a massive increase in requests for PPE over the past two months, as the virus walloped the Sun Belt states and spread throughout the country. But the group said there’s been a noticeable shift in who’s pleading for help. It’s no longer primarily hospitals, but smaller providers who can’t muster the same negotiating leverage.

[…]

Health care leaders said these shortages stem from a mismatch of resources, as well as the pandemic’s shifting nature. While Congress made available $175 billion in coronavirus relief payments to help hospitals, doctors, nursing homes and other care providers, much of the initial funding went to well-resourced hospital systems regardless of need, with more targeted funding rounds coming later.

[…]

The Trump administration has pushed back, arguing it has mustered a massive supply of resources in response to an unprecedented pandemic. […] According to the latest White House estimates, FEMA and HHS have distributed 203 million N95 masks, 855 million surgical masks, 36 million goggles and face shields, 364 million gowns, and 21 billion gloves. [ANCOR note: read a separate story on challenges with one Administration-led distribution program.]

[…]

Even for unskilled positions like home health aides — who are paid low wages for grueling jobs — labor shortages remain problematic. A home health worker in Ohio said her short-staffed employer saw a dramatic decline in job applications because ‘there’s fear attached to working in a health care environment.’

While hospitals have generally fared better, doctors and nurses say efforts were hampered by the massive staff furloughs that occurred during lockdown in the spring. With elective procedures paused, hospitals grappled with large revenue shortfalls and cut payrolls to cope.

In April and May, the health care industry reported more than 1.4 million job losses, including 161,600 hospital and 83,800 nursing home jobs, according to the Bureau of Labor Statistics. While hospitals rebounded in June with a gain of 6,000 jobs, nursing homes continued to suffer with an additional 18,300 job losses.”