Your Complete Guide to Long-Term Care Oxygen: Simplifying Costs and Choices

Choosing the best oxygen strategy for your skilled nursing facility (SNF) doesn’t have to be overwhelming. While oxygen invoices and vendor proposals may seem complex, the key to making the right decision is staying focused on your facility’s specific use case and understanding what you truly need. Once you know what to look for, it becomes much easier to cut through the noise.

At its core, oxygen is a stable commodity. Its price should be generally consistent, with variations driven only by factors like labor, storage, and transportation. However, in healthcare, the premiums facilities pay often have little to do with increased reliability. Instead, they are more often a result of not exploring the best cost options available. That’s why it’s essential to seek guidance from a non-biased party when evaluating oxygen pricing to ensure you’re making informed decisions and getting both value and service that align with your needs.

For most of you, you can stop reading after the following paragraph, as it tells you all you need to know. For those of you who want to really learn about oxygen in SNFs—tanks, concentrators, piped-in systems, or liquid portable systems—reading on will give you a great understanding of the world of oxygen.

The overwhelming majority of SNFs should use a combination of 5- and 10-liter stationary concentrators for bedside oxygen and e-tanks with built-in regulators for mobile patients. Facilities should stock enough oxygen to require deliveries no more than once per week—every two weeks would be even better. If you have a long-term resident who spends most of the day out of their room while requiring oxygen, consider a portable oxygen concentrator. The upfront cost of purchase or rental will almost always save you money compared to going through more than three tanks per day.

Now, let’s dive into the details...

Bedside (Stationary Oxygen)

Bedside oxygen delivery is typically provided in one of two ways:

1. Stationary Oxygen Concentrators: These are the most cost-effective and efficient way to deliver oxygen. Available in 5- or 10-liter-per-minute (LPM) models, they are the most common solution in SNFs. Despite frequent questions, no concentrator can exceed 10 LPM.

2. Pipeline Oxygen Systems: These systems, fed by liquid or gaseous oxygen sources, allow oxygen to flow through wall outlets. Most pipelines are liquid-based, with the ability to deliver as much oxygen as the flow meter allows. Standard flow meters go up to 15 LPM, while hospital-grade flow meters can reach 25 LPM or more. Of course, the capacity of your supply system will also play a role.

Pipelines are required for certain settings, like ventilator units, where steady utilization ensures efficient operation. In other facilities, pipelines can reduce noise and improve aesthetics for residents requiring oxygen. If your facility has a consistently high oxygen demand, a liquid-fed pipeline system can be both practical and reliable. However, evaporation from liquid bulk tanks can drive up costs if utilization is inconsistent. While pipelines may increase the theoretical capacity to accept higher-acuity patients, residents requiring more than 10 LPM often have comorbidities that make them unsuitable for SNFs.

Mobile (Portable) Oxygen

Mobile oxygen delivery also comes in two main options:

1. E-Tanks: These gaseous oxygen tanks are straightforward and reliable. They can come with built-in regulators or require separate ones to adjust flow rates. They’re cost-effective, simple to use, and provide an efficient way to meet mobile oxygen needs.
2. Liquid Oxygen Strollers: These portable units are filled from a liquid reservoir. They’re quieter, lighter, last longer, and are more appealing for mobile residents. However, there’s a tradeoff—strollers put more work on your staff to fill them. Each fill takes time, and if not managed properly, significant amounts of oxygen can be wasted due to evaporation and improper filling.

If you’re using liquid strollers, ensure they’re only filled when needed. Filling all portables at the start of the day leads to waste because liquid oxygen vents faster in smaller containers. Unlike e-tanks, which can last days for intermittent use, liquid strollers will vent out (evaporate) by the time you need them again, increasing your consumption and cost.

Another inefficiency with liquid systems is when accounts default to using e-tanks instead of utilizing the existing liquid oxygen supply. Since liquid oxygen vents off over time, this inefficiency can result in effectively paying twice for oxygen. Unless the vendor is transparent about this, it’s easy to overlook the issue and assume high oxygen costs are unavoidable.

Liquid Oxygen vs. E-Tanks: Considerations and Challenges

Liquid oxygen can be a great feature in facilities and for their patients, so long as all facets are understood. However, I’ve found that most providers choose it because they believe it’s cheaper. The reality is that, once put into practice, it often isn’t.

Liquid oxygen can be particularly advantageous for facilities with:

• High, consistent oxygen utilization (e.g., ventilator units or large pulmonary programs).
• Residents who require lightweight, long-lasting portable systems where staff have the capacity to manage refilling efficiently.

That said, there are significant caveats to consider:

1. Evaporation: Liquid oxygen “vents” over time, even when not in use. For facilities without continuous, consistent oxygen demand, any cost savings from purchasing liquid oxygen can quickly disappear—and you may end up paying more.
2. Labor Shift: Unlike e-tanks, which arrive filled and ready to use, liquid oxygen requires your staff to fill portable units manually. This added labor can become costly.
3. Usage Management: Poor management of liquid oxygen increases waste. For example, filling all portable units at the start of the day causes evaporation and higher costs.
4. Tank Size Matters: Larger storage tanks tend to reduce evaporation waste and lower per-unit costs. I’ve seen facilities save upwards of 50% simply by switching to larger liquid containers.

The COVID-19 pandemic illustrated one of the primary risks of liquid oxygen systems. As residents were confined to their rooms, facilities relying on e-tanks saw costs drop significantly due to reduced portable usage. Meanwhile, facilities using liquid oxygen saw costs remain steady because the oxygen continued to vent off, regardless of need.

The Bottom Line: Simplifying Oxygen in Your SNF

For most SNFs, the right oxygen strategy is straightforward:

• Use 5- and 10-liter stationary concentrators for bedside oxygen.
• Stock e-tanks with built-in regulators for mobile patients.
• Consider a portable oxygen concentrator for residents who spend most of the day out of their rooms to avoid skyrocketing tank usage.

When to consider liquid oxygen: Facilities with high, consistent oxygen demand or programs that prioritize lightweight portability for residents can benefit from liquid systems when managed correctly. Pipelines fed by liquid systems can also enhance aesthetics and reduce noise, adding value to the patient experience.

Ultimately, simplifying your oxygen strategy comes down to understanding your needs, managing resources wisely, and ensuring cost alignment with utilization. By focusing on reliable, efficient solutions, you can ensure your residents receive the oxygen they need without overcomplicating your operations—or your budget.

Need help navigating your oxygen strategy? Let’s talk!