Cap on COVID charges, pushes small Delhi nursing homes to brink

Pankaj Solanki, doctor who runs the 50-bed Dharamveer Solanki Hospital in Rohini, spent ₹5 lakh to create a separate entrance for the COVID patients, installed monitors, jumbo oxygen cylinders, air conditioners, and a host of other structural changes to comply with COVID treatment norms.

Another 100-bed nursing home on the Najafgarh road built an entirely separate structure for the COVID patients inside its premises, equipped with all medical facilities, including for testing. Its owner said the motive was to bar contact between COVID and non-COVID patients -- to check infection spread.

Solanki's and the Najafgarh facility are among many small scale nursing homes which modified their infrastructure and build capacity to treat COVID patients after the Aam Aadmi Party government came out with an order directing the private hospitals/nursing homes to reserve 20 per cent of their bed capacity for COVID-19 patients.

Weeks later, the government also capped charges for the treatment of COVID-19 patients.

The government fixed the charges for isolation beds at ₹ 8,000 to ₹10,000 per day; ₹13,000 to ₹15,000 for treatment in ICU and ₹15,000 to ₹18,000 per day if a patient is put on a ventilator.

While for the public, the orders of reservation of beds and capping treatment charges for COVID-19 patients came as a huge relief; for the small-scale nursing homes, it was a nightmare.

Threat of contraction and competition with big leagues making small hospitals bleed. The owners of small-scale nursing homes are facing extreme hardship in following government orders. The owners said that while they are already witnessing a steep fall in the admission of non-COVID patients, the cap on treatment charges for COVID patients has created a situation as most of them opt for big corporate hospitals instead of these nursing homes.

"After conversion, the non-COVID patients stopped coming to the hospitals. With the cap on treatment charges, the COVID patients are turning towards big and corporate hospitals. Why would patients choose a small nursing home if they can avail a 5-star treatment at the same price?" asked Dr Bhaskar, who runs Kapil Hospital, a 50-bed nursing home in Burari.

The small-scale nursing homes are now worried what lies ahead for them. The procurement of medical equipment, infrastructural changes and employing more staff for converting a non-COVID hospital into a COVID facility have put a dent in their pockets.

The owners said that if the situation remains the same, they would be left with the only option to shut down their facility.

Many nursing homes said that their occupancy has decreased to 10% after the government orders.

The owner of Najafgarh hospital told that the maximum number of occupancy his nursing home reached in June was barely ten beds out of 100 available. "The COVID patients occupied only two," he added. Similarly, Dr Solanki said that he received only seven patients in June. Of them, five were non-COVID. "The non-COVID stayed only for a day," he added.

Stall in surgeries, reduced footfall in OPDs pose further challange. The owners find it difficult in managing the daily expenses. The surgeries are the major source of income for private hospitals. "The OPD footfall has now reduced to 20%; the number of surgeries done is limited. The occupancy rate of COVID 19 patients is around 20-25 %. The patients with moderate to severe symptoms are going to corporate hospitals because they have better facilities, and the rates are capped," said Dr Solanki said.

Meanwhile, the owners said that the revenue generated from the treatment of the COVID patients is insufficient to run the operations of the COVID dedicated wards itself. "To treat COVID patients, we hired additional nursing staff, resident medical officers, and sanitation workers. We divided them into two groups. While one group provides service for two weeks and another remains on stand-by. Then the previous group goes into isolation, and the stand-by group fills its place," Dr Solanki said.

Losing staff to stigma and big hospitals.

The owners also said that they are also struggling to maintain the required number of staff since their facility converted to COVID care. Their staff is leaving jobs or showing reluctance to come on duty. Those who had agreed, are demanding high incentives, the owners said.

"Many among our staff are reluctant to come on duty because of the fear of contracting the infection. I have to persuade them with incentives despite a decrease in income," Dr Solanki said."I had to increase their salary by 25 to 30% only to make them (staff) stay. However, a few still left. I hired their replacement on 50 % extra of standard salary package we offer," Dr Solanki added.

Meanwhile, the owner of the Najafgarh-based hospital said that the staff is allured by the attractive pay big and corporate hospitals are offering. He informed that around 10 workers from his hospital resigned and joined big hospitals recently.

Apart from these expenditures, other costs have been added to run a medical facility now like PPE kits, consumables, and increased electricity bills. The owners of small nursing homes said that expenditure has increased, and they are not generating even 50% of the required amount of the expenditure.

"We are also human. There are bank loans, EMIs, and families to feed as well. We can't help others if we can't help ourselves, and in the current situation, we are feeling helpless. We are struggling to survive and need some help from the government," Dr Bhaskar said.

The small nursing homes are hoping to receive some aid from the government. Their demands include workforce availability, relief in charges of electricity bills, and capping in prices of PPEs and consumables.

"We should not be charged with commercial electricity charges in this crisis. We want the government to provide us electricity on domestic charges. The rate of PPEs and consumables like masks and gloves are increasing every month. We want them to be capped. Besides, we are operating with minimum staff in high-risk COVID dedicated area. If, at any point in time, 25 % of our staff gets infected, it will be tough for us to run the facility. The government should provide a pool of health care workers who could be deployed on duty if more than 25% of staff gets infected," Dr Solanki suggested.

Dr Ajay Bedi, vice-president of Delhi Medical Association, also suggested that the government should look into the challenges the small nursing homes are facing. "We are preparing a draft and would soon present it to the government, which will include our suggestions to solve the crisis faced by them (nursing homes)," he said.