In the past week, dozens of Massachusetts nursing home residents have tested positive for COVID-19, and at least 20 have died from the disease. Now, an industry group that represents hundreds of senior care facilities around the state says their members are facing a major a shortage of staffing, funds, and personal protective equipment like masks and gowns.

"We have nursing facilities today that do not have adequate supplies of masks, gloves and gowns," said Tara Gregorio, president of the Massachusetts Senior Care Association. "And it is not because they haven't tried desperately to find those."

Nursing homes and other long-term senior care facilities have go-to suppliers that they normally rely on for medical equipment, Gregorio said. However, following the coronavirus outbreak's escalation in Massachusetts, many nursing homes were placed on "allocations" — essentially, a purchase limit based on what the nursing facility received during the prior month. The problem is that, until recently, most nursing homes in the state had few, if any, confirmed cases of COVID-19.

That has changed. In the past week, outbreaks at long-term care facilities in Worcester, Wilmington, and Holyoke have sent up alarms about the risk of the virus rapidly spreading at such facilities.

Then, on Friday, state Health and Human Services Secretary Marylou Sudders said there are clusters of infection located near 80 longterm care facilities around Massachusetts.

Gregorio said the association is working with the state to try to get more supplies to nursing homes, but in the meantime senior care providers are "burning through their monthly allocations in a week, or 10 days, depending on whether or not they have COVID cases in their buildings."

Adding to the strain is the fact that, prior to the onset of the outbreak, nursing homes in the state were already about 5,000 workers short of where they wanted to be, Gregorio said. But as nursing home staff inevitably become infected, they will need to be isolated. And some are already staying home, afraid of spreading the virus. Gregorio estimates that at least 20% of the workforce could be affected this way.

And yet, the need for senior care workers is greater than ever. Most nursing homes are isolating residents to reduce the risk of spreading infection, which requires staff to serve residents one-on-one. With current staffers working longer hours, and additional measures being taken to prevent the spread of COVID-19, the Mass. Senior Care Association estimates the additional cost to nursing homes will be around $287 million.

That's why the association is asking the state to put some of the estimated $1.08 billion in new Medicaid funding it received through the coronavirus stimulus package toward increasing pay for nursing home workers.

In a memo dated April 2, the state Department of Public Health issued guidance to health care workers, expanding the criteria under which residents of long-term care facilities would qualify for COVID-19 testing at the State Public Health Laboratory.

Whereas prior guidance required residents of longterm care facilities to exhibit a fever and respiratory symptoms such as a cough or shortness of breath, the new guidance recommends a "low threshold" for such residents, and an expanded range of qualifying symptoms such as a sore throat, malaise, body aches, low-grade fever, changes in mental status, diarrhea and changes in control of diabetes.

"This is important and, I think, a critical step," said Gregorio. She added that as the state rolls out a plan to convert some nursing homes to dedicated COVID-19 treatment sites, all residents should be tested for the coronavirus prior to being moved. Plans to convert one such nursing home were halted Friday after nearly half of its residents, slated to leave to make room for COVID-19 patients, tested positive for the virus.

"We do expect that more residents will test positive, which makes the PPE needs of our sector all the more critical," she said.