Michael Snisky has been trying to catch his breath since July.
"It's almost like you're under water, and you want to take a breath, but you can't," he said. "It feels like you're drowning."
Snisky is a 57-year-old Army veteran who lives in Prattville and works at Maxwell Air Force Base's Gunter Annex in Montgomery. When he and his family caught COVID-19 during the summer surge of cases, he expected his flu-like symptoms to dissipate over the standard course of 10 days.
They didn't.
Four months later, Snisky still struggles to take a deep breath — though he has worked his way back to about 80% lung capacity.
After a weeklong stay at Prattville Baptist Hospital in August, doctors deemed him well enough to transition to home care. He would sleep using an oxygen concentrator, and when he was awake, Snisky would tote portable oxygen tanks all the time.
Though the supplemental oxygen was a necessity, he said it hurt his pride. As a veteran who spent 24 years in the service, had been shot during his 2006 Iraq tour and had undergone several related surgeries, Snisky never imagined feeling so defenseless.
"I didn't want to go out there and be seen lugging around an oxygen tank, but I had no choice. So I go to Lowe's and Home Depot, and we go out to eat, and I would just have that thing with me," he said. "As soon as you walk in the door, everybody stares at you, but it's a lifesaver."
Amid oxygen shortages and supply chain problems impacting equipment delivery, Snisky counts himself lucky that he was able to receive the equipment and oxygen he needed.
The homecare struggle
Snisky is one of thousands who have been hospitalized for COVID and discharged to homecare needing supplementary oxygen.
Since the start of the pandemic, homecare medical equipment companies have seen an increased need for their services, but many of them struggle to meet the demand.
Rick Lingo, president of Montgomery-based At Home Medical, said his company completes three to four times the number of oxygen deliveries now than it did in 2019.
Because of shipment delays, device shortages and rising costs, though, he isn't getting all of the equipment he needs.
"Some of the national suppliers of (oxygen) tanks can't get enough tanks, can't fill them fast enough and don't have drivers, so a lot of times, we don't get the tanks we're supposed to get," Lingo said.
Orders of oxygen tanks, portable concentrators and CPAP machines that would be delivered within days pre-COVID now take months to reach suppliers like At Home Medical. Lingo's company has not received a shipment of new oxygen tanks since September.
"You go to a car dealership, and they've got five new cars on the lot instead of 50 or 100, whatever they normally have. It's the same across the board, but the difference is we're supplying patients with ventilators and oxygen, which is critical," Lingo said.
While the shortages continue to impact At Home Medical, the demand has become more manageable than it was during the delta variant surge earlier this fall.
During that time, Lingo said his company's location in Columbus, Georgia, experienced such an extreme shortage of oxygen that the local hospitals had to delay releasing COVID patients to homecare for three to four days.
"Things are more relaxed now that case numbers aren't as high as they were a few months ago. We just don't want it to go back there," Lingo said.
Currently, the daily numbers of new COVID cases and hospitalizations are much lower than they were in August and September. On Sept. 2, Alabama was reporting a daily average of 4,719 cases, and on Dec. 21, the state average is 774 cases.
Over the last two weeks, though, Alabama has seen a 49% increase in COVID cases and a 9% increase in COVID-related hospitalizations.
Problems predate COVID
While the supply chain issues and increased demand are new challenges for the homecare medical equipment industry, companies have been buckling under the weight of increasing costs for years.
Some 22% of Alabama's homecare medical equipment suppliers have closed since 2013, with the total number dropping from 329 to 256, according to the American Association of Homecare.
Insurance companies dictate what homecare equipment companies are paid for their services, and while operating costs for homecare have been on the rise, the reimbursements that homecare companies receive have not increased in the last six years.
Industry experts such as Lingo and American Association of Homecare president Tom Ryan blame current Medicare policies for the problems.
"(Homecare medical equipment) suppliers can't incrementally pass along rising costs to patients under a mostly fixed reimbursement fee schedule, so a substantial adjustment is needed to bring Medicare rates back into line with the market reality our industry faces," Ryan said in a press release earlier this year.
Medicare introduced a competitive bidding process in 2013, which resulted in a dramatic drop in reimbursement that continued through the following years.
Today's rates are based on the most recent bids from 2015.
"That ran the prices down to a point that they were not sustainable for some companies to stay in business," Lingo said
His company was one of many that almost closed that year.
How to fix the industry
When it comes to solving industry-wide issues such as reimbursement, shipment delays and shortages, there is no clear answer.
Advocacy groups like the American Association of Homecare are pushing for policy changes, and equipment companies like At Home Medical are searching for ways around supply chain disruptions.
Meanwhile, those who have survived COVID hospitalization and know what it's like to not be able to breathe are just hoping they don't have to experience it a second time.
"I'm hoping now that I won't catch it again," Snisky said. "Knock on wood."
Hadley Hitson covers the rural South for the Montgomery Advertiser and Report for America. She can be reached at hhitson@gannett.com.
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