Documents posted yesterday lay out last-resort alternatives for nursing homes facing critical shortages of protective gear, which is in short supply all across the country.

They recommend that staff first reuse respirators or use masks that have expired, as long as they still fit and create a seal around the nose and mouth. If the facility cannot get N95 masks, which prevent staff from inhaling the coronavirus, then similar masks from other countries can be used. At nursing homes without any respirators, staff can use surgical masks on patients and staff, which offer far less protection.

As a last resort, the document recommends assigning staff who have recovered from COVID-19 to care for infected patients. Researchers have not determined whether people can get infected twice.

Other recommendations for nursing homes include using cloth masks if medical supplies run out and gloves and gowns from home that can be washed and reused.

Hospitals and nursing homes have both been hit hard by shortages of protective gear, which has been held up by increased inspections in China and diverted to New York by emergency management officials.

Nursing homes in particular have had a hard time obtaining necessary supplies, said John Matson, spokesman for the Alabama Nursing Home Association. According to the Alabama Department of Public Health, most nursing homes in the state do not have enough masks and protective gowns.

“Demand is far outstripping supply,” Matson said. “That is hard for everyone, but especially hard for nursing homes.”

Nursing homes have become hot spots for COVID-19 across the country. It spreads quickly in places where people live in close quarters and can come in on staff members who may not know they are infected. A facility in Hoover that tested all residents and staff found 13 who tested positive without any symptoms.

COVID-19 is especially deadly for older people. Outbreaks have killed hundreds of long-term care facility residents in New York City and dozens in Washington State. The Wall Street Journal reported at least 2,100 nursing homes across the country have reported at least one case of COVID-19.

In Alabama, at least 40 nursing homes have reported cases and 374 residents and staff members of nursing homes and assisted living facilities have tested positive, according to the Alabama Department of Public Health.

Despite the danger to residents and staff, nursing homes have struggled to get priority for testing and personal protective equipment.

“Nursing home need just as much [personal protective equipment] as anywhere, if not more,” Matson said.

The American Health Care Association and National Center for Assisted Living created the document based on recommendations by the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration.