We are seeking to gauge the additional costs nursing homes are facing due to the COVID-19 emergency and to collect current indicators of the severity of the existing financial stress member organizations are enduring.  This information will allow us to educate policymakers and more effectively advocate for needed financial relief.   The information you provide will be kept strictly confidential and will be used only in the aggregate.

IF YOUR ORGANIZATION OPERATES MULTIPLE NURSING HOMES PLEASE COMPLETE A SEPARATE SURVEY FOR EACH. 

Please complete and submit the survey at your earliest convenience, but no later than Friday, April 10th.  If you have questions on the survey please contact Carl Pucci at cpucci@nyshfa.org.

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* 1. Respondent Contact Information

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* 2. Please enter the approximate proportion of your total resident care days that were paid by Medicaid and Medicaid managed care payers in 2019 (as a percent):

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* 3. Days Cash on Hand (COH)

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* 4. Days in Accounts Receivable (AR)

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* 5. Please enter your facility's 2019 operating margin as a percentage (operating income divided by operating revenue).  Hospital-based homes should enter their sponsoring hospital's operating margin if nursing-home specific margin is unavailable.

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* 6. Please enter the estimated ADDITIONAL staffing costs related to COVID-19 that your facility has endured between Jan. 1 and March 31, 2020.

Please include costs related to:
- maintaining current or higher staffing levels (including overtime)
- staffing pattern disruptions/new staffing patterns due to any COVID-19 unit re-configurations
- back-filling for unavailable staff
- paid leave for quarantined staff
- increased housekeeping/cleaning staff
- replacements for staff in training
- consultants and trainers
- increased contract staff
- staff hours for pandemic planning
- child care and other staff benefit cost increases

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* 7. Please enter the estimated ADDITIONAL equipment and material costs related to COVID-19 that your facility has endured between Jan. 1 and March 31, 2020.

Please include purchase costs of additional materials including PPE, cleaning and disinfecting supplies.

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* 8. If your facility encountered revenue loss/cost increases from the items below, please indicate the estimated impact between Jan 1 and March 31, 2020:

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* 9. If your facility is encountering additional costs related to the emergency that are not captured above, please enter a description of the cost, the amount and the time-frame (ex. monthly starting March 1, weekly starting March 15) on the lines below:

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* 10. If your facility is encountering new costs or decreased revenue in addition to those identified above (whether COVID-related or not), please specify the cause and provide an estimated impact for the period Jan 1 through Mar 31. Please indicate the time-frame during which the situation was impacting, or is expected to be impacting, your facility.

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