We are seeking to update key data regarding the financial impact of COVID-19 on nursing homes.    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.

Note that some questions request data for a two month time period (May 1 through June 30), while others ask for a six month figure (Jan. 1 through June 30). 
Please complete and submit the survey at your earliest convenience, but no later than Friday, August 21st.  If you have questions on the survey please contact Ken Allison at kallison@leadingageny.org

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* 1. Respondent Contact Information

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* 2. Staffing Costs.  Please enter the estimated ADDITIONAL TOTAL staffing costs  related to COVID-19 that your facility incurred during the period May 1 through June 30, 2020 (i.e., costs that you would not have incurred had it not been for COVID-19).

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
-hazard pay or wage enhancements
** please DO NOT include staff COVID testing costs- enter them in Q3 below**

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* 3. Staff Testing Costs.  Please enter the estimated costs your nursing home incurred during the period May 1 through June 30, 2020 related to mandatory testing of staff for COVID-19.

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* 4. Supplies and Materials.  Please enter the estimated ADDITIONAL equipment and material costs related to COVID-19 that your facility incurred during the period May 1 through June 30, 2020 (i.e., costs that you would not have incurred had it not been for COVID-19).

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* 5. Lost Revenue:  ADHC & Outpatient Therapies. If your organization was impacted by the ordered closure of your Adult Day Health Care program and/or the discontinuation or reduced volume of outpatient therapies, please enter the estimated lost revenue for the period May 1 through June 30, 2020.

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* 6. Lost Revenue:  May & June. If your nursing home patient revenue in May and June was lower than budgeted or projected, please enter the estimated lost revenue for the period May 1 through June 30, 2020.

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* 7. Lost Revenue:  6 Months. If your nursing home patient revenue in 2020 has been lower than budgeted or projected, please enter the estimated shortfall for the period Jan. 1 through June 30, 2020.

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* 8. Revenue:  6 Months.  Please enter the budgeted nursing home patient revenue for the period Jan. 1 through June 30, 2020.

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* 9. Increased Expenses:  6 Months. If actual expenses for the first half of the year (Jan. 1 - June 30, 2020) exceed budgeted or projected expenses, please enter the overage amount.

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* 10. Expenses:  6 Months.  Please enter the budgeted or projected nursing home expenses for the period Jan. 1 through June 30, 2020.

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* 11. Financial Relief.  Approximately what percentage of COVID-related expenses and revenue losses do you anticipate to be covered by the total COVID relief funding you have received and expect to receive? (CARES Act Provider Relief funding, forgivable portion of PPP loans, FEMA Public Assistance)  Please provide your best estimate.

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* 12. Additional Information/Comments.  Please provide any additional information or clarifying comments.

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