Transcripts For CSPAN Senate Hearing On Coronavirus Impact On Elderly 20240713

Covid19 crisis. It has brought tremendous hardship and tragedy, placing a heavy on frontline workers, straining our health care and Distribution System and imposing a deadly toll on seniors in particular. It has hit close to home for sure thatny and im all of our members want to join condolencessing our to senator elizabeth warren, who lost her 86yearold brother to the coronavirus. Elizabeth, we are very sorry for your loss. Visitor Nursing Homes has affected even those relatives who do not have virus. I know two brothers whose father is in a nursing home and has dementia. They have not able to see him for some time now and his health is failing. They are worried that he may not still be alive by the time that they are allowed to visit him, something that used to happen regularly. This virus has already claimed the lives of more than 90,000 american, the vast majority of whom were older adult. Adults 65 and older are more likely to suffer severe complications from covid19, and to have more difficult recoveries. They represent two out of every five lies nations and eight out of every 10 deaths from the virus. Those in Nursing Homes and other congregate care centers are especially at risk. Nationwide, and home resident represent one third of all coronavirus deaths. In maine, the toll on nursing home resident is even higher. Maine is the oldest state in the nation by median age. The centers for Disease Control 1890 team ineports our state and the virus has claimed 73 lives. More than half of those deaths have been residents of longterm care facilities. So you can see that maine has an even higher death in Nursing Homes and other longterm care facilities than the national average. , senator andmonth i wrote the administrators on medicare and medicaid outlining a series of recommendations to better protect older adults in Nursing Homes. Among the issues we urged be considered is how longterm care facilities and inhome care settings can access adequate testing as well as snow active meant as well as personal protective equipment and how adults in Nursing Homes can be taken into account in the distribution plans for any future covid19 treatments and vaccines. Tests,gnostic therapeutics, and vaccines are moving forward at remarkable speeds. I look forward to learning more about this Research Today as well as promising treatments and strategies that can speed recovery for the most vulnerable relation. Through this and subsequent hearings, i hope that we can gain insight into additional actions that may be needed to better protect our seniors. Takenss has already action in response to the epidemic we have passed for legislative packages totaling nearly 3000 to Public Health support for states and Economic Relief to Small Businesses and families. Phase one provided appropriations to supplement the Strategic National stockpile to develop and purchase diagnostics, therapeutics, and to Health Centers and to help hospitals and Health Systems respond. Phase two provided free coronavirus testing complaints for medicaid and critical safety net programs. Phase three was the cares at protectiveed equipment and testing for the stock pile, new resources for medical affectional on the front lines, to whom we owe a great debt of gratitude, direct aid to states and economic support for Small Businesses and employees through the paycheck traction program. Included the also Home Health Care planning improvement act. This is a bill that i have championed for 13 years to allow Nurse Practitioners and physician assistants to certify home Health Services, cutting down on timeconsuming, unnecessary paperwork requirements that not only failed to improve patient care, but also delays access to that care could not have because act makes improvement in the delivery of telehealth urine more prior art delivery of telehealth. Finally, phase four provided additional funding for the Paycheck Protection Program, 75 billion for our hospitals and 25 billion for additional testing. Much of the funding provided through these bills has yet to be released by the department of health and human services, therefore, i urge the department to act with urgency so that this funding can flow to areas where it is desperately needed. Today, we will hear from a panel seniorsts in supporting across a variety of settings of care, including in hospitals, Nursing Homes, and the community. We will be joined by dr. Mark mulligan, a physician who serves as the director of the vaccine university,w york dr. Temer can sgot, a professor of Health Services, research at the university of chicago Whose Research focuses on quality of settings,ngterm care and dr. Steven landers, a geriatrician who serves as the president and chief executive nursesof the Nonprofit Health crew. Im grateful to each of them for the work they are doing and for their taking the time to join us today. Their expertise will help us advance Public Policies to slow the spread of this devastating pandemic and to lessen its nations our vulnerable seniors. Senator casey, i know you are joining us remotely and i would now call on you for your opening statement. Acknowledge that senator braun has joined us in person at the hearing this morning and there are many joining us on bind and we expect others to be here physically as well. Senator casey. Sen. Casey can you hear me . Will assume you are hearing me. Thank you for convening this hearing. Our nation at this point in our history is facing the greatest Public Health crisis in a century. This terrible virus is causing death and destruction at lightning speed. For seniors, the only thing moving faster than the virus itself is fear, the fear of being alone, the fear of contracting the virus, and the fear that comes from isolation. That has every member of the family worried for our seniors. Thousands of seniors in icus and Nursing Homes are dying scared and alone with no family and no them in theirfort final moments. Are at home,eniors isolated from their loved ones and scared to death to leave the house even to get a bag of groceries. This unprecedented challenge calls for equally unprecedented action. The administration has to do more. Congress has to do more. To help our seniors and our families at every turn. It is now may 21. We still have no strategy from the administration. The lack of personal protective equipment continues to put our Health Care Providers and other frontline workers at risk. This puts every Single Person and alsos into contact a risk to the entire community. Nursing home resident makeup ,. 05 percent of the population yet deaths associated with Nursing Homes at longterm care settings account for over one third of all deaths from covid19. 0. 05 of the population, yet one third of the deaths are at Nursing Homes and longterm care centers. To this day, we are trying to help those residents and workers at Nursing Homes with one hand tied behind our backs because the administration is not releasing data on outbreaks in these facilities. And theunconscionable Administration Needs to act. We have heard promises that by the end of may, they will. We need to see specific evidence that they are changing policy to give families, residents, and workers in Nursing Homes and other longterm care settings more information. Congress has taken a number of steps. Allocated unprecedented amount of funding to purchase personal protective equipment to keep workers from contracting and transmitting the virus, we have funded Health Care Worker funded effort to help Health Care Workers and help providers put patients in those settings. Seniors have access the proper nutrition at home, not nearly enough. The policies and funding in these four bills we passed into law only begin to scratch the surface. Congress has to do more. Last week, the house of representatives passed the heroes act, among many things it does is it calls for policies that i have been calling for since the beginning of this crisis, especially as it relates to seniors. Homes toequire nursing collect data on the impact of the virus on residents in Nursing Homes and other longterm care facilities so we know how to distribute resources. The bill would also provide those Nursing Homes the dollars they need to contain the spread of the virus. The bill would address communitybased services for seniors and people with disabilities, especially the 800,000 seniors and people with disabilities on waiting lists for care so they can receive the services and the supports that they need to keep them out of congregants settings. Pairbill would also frontline workers with the safety of the home to care for patients. For the generation that has fought our wars and worked in our factories and taught our children and built the middle class, built the nation that we life,and gave each of us we have to do more for our seniors. Working, heop cannot stop legislating, we cannot stop appropriating dollars to help our seniors. We await to them to do everything we can. There is no such thing as doing too much for our seniors in the grip of this pandemic. Chairman collins, i want to thank you for convening. Congress hearing and on the impact of covid19 on seniors, and i look forward to the testimony of our witnesses as well. Sen. Collins thank you very much, senator casey. For those of you watching us on cspan, i want to explain that this room is specially configured in line with the social distancing recommendations of the cdc, which is why you see so many blank spaces and we have several bybers who have joined us remotely i see senator josh hawley, senator rick scott, there are others as well and some more who will be coming physically as well. There are also many other members whose pictures i cant see, but you have joined us at the hearing. I wanted to explain that this is one of only three hearing rooms that is configured to allow us to hold hearings. I see senator blumenthal has also arrived and want to acknowledge him as well. We are now going to move to our witnesses. Our first witness, dr. Mark mulligan, is joining us from new york university. Dr. Milligan is the director of the division of Infectious Diseases at the nyu Grossman School of medicine and director, as i mentioned, of the University Vaccine centers. He is a professor of medicine and a professor of microbiology at nyu. As the chief Infectious Disease specialist for nyu, he oversees the treatment of covid19 patients at the universitys Health System hospitals in brooklyn, long island, manhattan, bellevue, and the v. A. Next, we will hear from dr. Konetzka, the professor of Health Services research at the department of Health Sciences at the university of chicago. Her research focuses on the relationship between economic incentives and the quality of care in longterm care facilities. Untangleading work to factors associated with the disproportionate impact of covid19 on nursing home residents and staff. Dr. Lly, we will hear from landers, the president and ceo of the visiting Nurse Association health group. It is the nations secondlargest notforprofit Health Care Association in the country. Dr. Landers is a Family Doctor and geriatrician with a special interest in home care, hospice care. Visits to lowhome mobility older adults and has played a Critical Role in caring for seniors during this pandemic. Dr. Milligan, we will begin with you. Thank you for being here. Dr. Mulligan good morning, chairman collins, Ranking Member casey, members of the special committee. I wanted to mention, i an nih funded investigator working with the vaccine and treatment evaluation unit, part of a new network focusing on infectious ,iseases, Critical Research including work on seniors. This is an important part of the work i do as a critical investigator. It led torus the coal pandemic we find ourselves combating. The human population is highly susceptible, we are not immune to this virus. Seasonal cold viruses are also coronavirus is, unfortunately, they do not provide cross protective immunity to the current virus. Physicians, scientists, and leaders, the virus has continued to follow us. There is so much we dont know yet about diagnosis prevention and treatment, about medical countermeasures. But that is an important part of what i will be discussing today. Riskrs are at an increased system, it isune not only their age that renders seniors less able to mount the treatment and immunity against microbial threats including this coronavirus. Conditions that are present more frequently in seniors such as cancer, immuno depression, heart and lung and kidney diseases, and diabetes. The highest risk for critical disease due to this coronavirus is seen in the trail the frail out really, those in Nursing Homes and longterm care facilities. The nurses, doctors i have worked with in the hospital since late february, taking care of patients, are incredibly dedicated and caring. It is moving to see how much they put into their jobs to help their patients. Yet, it has been a struggle. They have not had the medical countermeasures they have needed, particularly to help seniors fight this virus. Settings with effective social distancing in longterm care facilities we have talked about had the worst outbreaks of covid19 and we have heard that while 11 of covid19 infections in the u. S. ,ave been in Nursing Homes deaths have occurred more in Nursing Homes. Be main weapons continue to nonpharmaceutical intervention, the social distancing. We know these work and are effective and they have provided a strong benefit in society and individuals by reducing spread of the virus. However, they come with a cost to the economy, society, and to human existence. An important category are the medical countermeasures, which i will now talk about. Vaccine holds the promise of immune protection that is producing an entity within our body that will protect us against the virus upon some future exposure with the virus. Vaccines have always been our most important weapon to battle Infectious Diseases with Public Health importance. Two days ago, the first early report of a covid19 vaccine appeared and it was promising. There is a long road ahead for the development of a covid19 vaccine, but it was great to have a positive early signal. Included by the efficacy trials that are planned to be supported by the u. S. Government. However, the outlook did not respond as well to vaccines and younger adults. The approach of providing an drugody with a preformed in seniors is one that is attractive. One u. S. Government and industry partner is moving as quickly as possible with a randomized controlled trial of an antibody that would be delivered conversing home residents in nursing home workers to try to get control of outbreaks. Quality research comes from randomized controlled trials. They provide the answer. Remdesivir,l drug, with limited information from a randomized controlled trial of remdesivir versus placebo in hospitalized covid19 patients, including seniors, yielded a modest benefit of 31 reduction in time to recovery. This is modest but significant and a first signal we have an effective approach to start to battle this virus. Testing must be continued and increased. It allows us to identify those with infection until they recover and can be isolated and produce further spread of the virus. The more we test, the more we can fight the virus. I will close by saying that the nonpharmaceutical interventions we have deployed against the virus have been highly beneficial. This remains important for protecting our vulnerable seniors as we await further development of medical countermeasures, including vaccines and treatments and testing. Medical countermeasures may need to be tailored specifically for seniors given the differences in their biology. I think the committee for the excellent work they are doing. Sen. Collins thank you very much, dr. R. Konetzka chairman collins, Ranking Member casey, and numbers of the committee, thank you for the opportunity to testify today. Im a professor of Health Services and research at the university of chicago and ive been researching longterm care for 25 years, focusing on nursing home quality. The role of Nursing Homes in the covid19 pandemic has become increasingly clear. A month ago, a nursing home staff and residents were estimated to account for 1 5 of all deaths. The estimate is now at least one third nationally and more than half in many states. In some ways, these numbers are not surprising. She homes provide handson care daily to large numbers of people with Underlying Health conditions living in close quarters. Facilities are often understaffed and the situation has been exacerbated by the pandemic. They compete with hospitals for testing and ppe, which is still in short supply. Of is the spread of covid19 inevitable . Or have some Nursing Homes managed better deco we set out to answer that question using data on Nursing Homes from 12 geographically diverse states. States reported covid19 cases and deaths with data on nursing home characteristics including we counted Nursing Homes with at least one case or death. For analysis, we had three key results. First, we found a strong and consistent relationship between race and the pub ability of covid19 cases and deaths. Nursing homes with the lowest percent white residents were more than twice as likely to have cases or debts as those with the highest percent white residents. Second, we found no relationship between the fivestar rating and a probability of at least one case or death. The direction of the relationship was inconsistent from state to state. We found a difference between forprofit and nonprofit facilities and a weak relationship with residents on medicaid. We conclude from this analysis that while some Nursing Homes undoubtedly have better control practices than others, the enormity of the pandemic coupled with the inherited vulnerability of a nursing home setting left even the highest quality Nursing Homes largely unprepared. It is not random. Homes are often a reflection of the neighborhood in which they are located. Nursing homes with traditionally underserved, nonwhite populations are bearing the worst outcomes. Turning to solutions, it is increasingly clear that longterm care facilities must be a top priority in fighting the pandemic as that is where the deaths are. Homes need ag direct influx of funding and Technical Assistance to achieve adequate numbers of staff, availability, and appropriate use of ppe and Rapid Testing of all nursing home residents and staff to enable separation. Second, we need to enhance the ability of medicaid beneficiaries to receive Homebased Services instead of institutional services. The decision between care at home or at a nursing home is difficult for families in the best of times. Now, the risks and benefits have shifted. To help families in this situation, resources need to be directed to enabling them to avoid institutionalization during this time. Third, transparency about cases and deaths is essential. Reporting allows resources to be directed where they are needed most in older adults and their families need this information to make their own decisions that may be about life or death. They do nothing to change the underlying systemic challenges to improving the quality of nursing home care and the lives of older adults who live in them. Areing home residents illequipped to monitor their own care, to advocate for themselves, or exert political influence. This means regulation and oversight is necessary. Some regulations have been relaxed during this pandemic, but it will be important to reinstate them was the crisis has passed with increased attention to Infection Control practices. When these structure of Nursing Homes is fragmented and leads to underfunding of essential services, those of us who study welcome care are accustomed to hoping for fundamental change and not seeing it. When positive outcomes of a severe financial fallout of a pandemic may be that it forces every evaluation of how we pay for longterm care in the u. S. Thank you for the opportunity to provide insight on this issue. Sen. Collins thank you for your excellent testimony. Dr. Landers. Dr. Landers good morning, chairman collins, making never casey, numbers of the Senate Committee on aging. Geriatricly doctor in medicine. My clinical work focuses on house calls to homebound seniors and i serve as the president and chief executive officer for visiting Nurse Association health group, a large nonprofit home health and Hospice Agency , anduartered in new jersey in ohio and florida. Our team of 3000 dedicated caregivers have stepped up during this crisis to help medically fragile, older adults home from hospitals and nursing facilities and in some cases never have to go to the hospital in the first place. We serve 9000 people in our programs and services and we have taken care of 650 older adults in the home care setting with known covid19 infections. I have never seen the system so stressed and at the same time, never felt more proud of the incredible people i work with every day. One of the reasons we have been able to keep serving has been because of chairman collins, her leadership and the cares act, the relief fund, some of the measures have been important because our revenues have gone down because of the cancellation of elective medical procedures it at the same time, expenses related to personal protective equipment, ppe, testing, those expenses have gone up. Financial support has been critical and i want to thank you, chairman collins and her colleagues for your leadership, advancing the ball of Nurse Practitioners and physicians in homebased eldercare. Have had older adults limited access to medical care, covid19 has made it harder and that extension of the team with the Nurse Practitioners and physician assistants is important in preserving access and the other measures related to geriatric workforce that were the cares act, very important. Ive been reminded again of the incredible difference that hospice can make on quality, compassion, patient safety. Instressed that hospitals, terms of that capacity, emergency rooms, nursing facilities, the challenges they highlighted the need for a strong homecare option, an option home care does its best when working in concert with hospitals, physicians, and nursing facilities to deliver a coordinated care. In order for us to provide that option, job number one is protecting our treasured frontline caregivers. We have been able to maintain care because we have been able to maintain a supply of ppe. That has been difficult to do. We are using 17,000 surgical 95 a week, 3500 and n95s a week. We have had to pay seven times the normal price and use vendors from all over the world that we cannot always verify, hoping shipment would arrive. Going forward, i urge us to look at policies that could make sure Home Health Agencies have the needed ppe at a reasonable price. Also, important to our ability to serve has been our spirit of innovation. We embraced the use of telehealth and virtual visits in order to help people stay safely at home during this crisis, with a covid19 patient, they need monitoring of vital signs, oxygen, respiratory assessment. Even though Home Health Agencies are not reimbursed for telehealth, we felt that was important. We had seen even before this crisis that telehealth could play an Important Role in home health and we have been trying to advance that. Going forward, to make sure we have a Strong Home Health option for Older Americans, finding a way to reimburse teleHealth Services within agencies is important. Preservingting the ability for physicians to do facetoface encounters and certifies people for home health yet telehealth is important. Via telehealth is important. Thank you for including me in the hearing this morning and im very sad about all the death and suffering, but also optimistic that we can strengthen homecare and eldercare for Older Americans, so thank you. Sen. Collins thank you very much, doctor. I want to note that senator tim mcsallyd senator martha have joined us in person physically today. What we are going to do, because there were many people who log we arehe very beginning, going to go in order of seniority. I cant figure out any other way people who given the have showed up physically, but also the people who have been online at the beginning of the hearing. Usually, i like to reward those who show up first, but i think since there were people online, i cant figure out any other way to do this fairly. So let me begin with my own questions and then senator casey will question that remotely. , when we hear the statistics, which are so devastating with half the deaths in maine being in longterm care facilities, a third nationally, my heart goes out not only to these patients, but to their families and to the staff of Nursing Homes and other assistedliving facilities, congregate care settings. They were all praying that covid19 does not find its way into their facility. Yesterday, the Government Accountability Office Released a report that found that nearly half of the more than 13,000 nursing facilities surveyed had Infection Control deficiency citations in consecutive years, which the report called an indicator of persistent problems said in dr. Konetzka her testimony, even the highest quality Nursing Homes have been largely unprepared. What we have usually looked at, the ratings by cms, the number of stars, has not proven to be a who ofndicator of which Nursing Homes are safest in this environment. And indeed, one of the worst outbreaks in maine was at a nursing home that had five stars. I think what we are learning is that Health Care Providers are rethinking some of their initial assumptions in that we need to think more about hospital discharge planning, but dr. Konetzka, i want to have you expand a little bit more on what we can do. I believe that you recommended universal testing for every nursing home resident and staff, which i think is a good idea and have been recommending. How often, however, would you have to do that and would that allow Family Members who have been tested to finally be able to visit their loved one . And i hope we can unmute dr. Konetzka because i can see that she is responding but we cant hear her. Go ahead. Dr. Konetzka can you hear me . Yes, thank you for that question. I think we are learning a lot as we go about how best to fight this virus in Nursing Homes. Yete dont have great data on what testing strategies have been used and how successful they have been. A lot of what we are going on is anecdotal evidence. What i can see is that there have been a few key Lessons Learned and one is that it is important to test all residents and not wait until residents are asymptomatic until residents are symptomatically, because then it is too late. There is a symptomatic spread and given the close proximity and that staff go from resident untilnt, the virus people get symptomatically spread throughout the facility we have learned that lesson, all residents should be tested and not only tested, but tested regularly. From what i heard from geriatricians is weekly would be good, at least biweekly, so residents can be separated in the transmission can be stopped. It might be very hard, especially as we relax some of the restrictions on visitors, which is essential to prevent a wese of social isolation, as lessen those restrictions, it will be hard to prevent all cases in a nursing home. The key is a Rapid Response to prevent transmission to the rest of residents and staff. Sen. Collins thank you. Appreciate your talking to us about the about the importance of home care and that can help people be safer. I have always been a strong supporter of home care. Is thate that we have people who are older are being increasingly isolated and that can have a detrimental impact on their Underlying Health and make them more vulnerable to the coronavirus. Could you comment on how Home Health Visits can help keep a senior more connected and less isolated . Chairman collins, waylutely, home health is a to show people that they are known and worth something, they are valued. It is an act of humility and in this crisis, it has been more important. Sometimes our nurses are the only people that are even checking in on a frail elder. I tell stories of having to go out and make sure that the person had a food supply or undergarments or other things that are essential. So the isolation is critical. Telehealthr focus on also adds although it is not perfect making sure those people that are homebound, need help, also have access in between the visits to some interaction via telehealth could also improve the amount of it the amount of attention that our older patients are getting. Inis a real crisis loneliness and isolation. We are trying to do all we can. Sen. Collins thank you. Sata casey. Sen. Casey thanks very much. I wanted to start my questions with dr. Konetzka. I have a particular question regarding Nursing Homes. We know that Nursing Homes have become, unfortunately, ground theren this pandemic, yet is still no National Strategy and i believe i think the testimony today indicated in part that there still is an inefficient inefficient supply of personal protective equipment for nursing home staff. These are among the heroes in our society, literally soldiers on a battlefield in a war against the virus. They are putting themselves at risk for the disease, contracting the virus, also putting themselves at risk for death itself. That includes their family. Applies hero definitely to these healthcare workers. Believe, more leadership out of the administration and congress, or help. They dont need pats on the back only and expressions of gratitude and acclamation, thats nice, but what they need is direct support and more than that. I will start with the support for what they do on the job. The most important thing, one of the both important things we can do is to help them implementing what the Public Health experts. Ell us our proven practices ive been asking the administration for data, the centers on medicare and medicaid services, and the cdc, are the ones that would have to transmit this data to the american people. We are talking about basic information on case counts, on deaths, so we can direct and target the resources to the Nursing Homes that need it the most. That it is coming by the end of may, but we have been hearing that for a long time. I have introduced legislation ont would focus specifically Nursing Homes and other longterm care settings. This particular bill, a nursing home covid19 prevention act that i introduced to senator whitehouse and a number of our focus on 20as its billion on emergency funding to invest in what works. Homes, younursing separate the residence with covid19 from those who dont have the virus, that is a good practice, but that costs money. We have to help them with that. Other uses for the dollars could be surging of medical expertise into a nursing home. You two basic questions, why is it important that we have basic data on covid19 and Nursing Homes, that is question number one, and question number two, what are some of the policies that we can use to help Nursing Homes put in and amplermation resources . Thank you for that question. As i touched on in my testimony, i think data and transparency are critically important in this crisis. There was a downplay in need of collected data and prioritize other actions, but it is essential in this case for three reasons. One, we need to know where resources need to be directed. We can direct resources to them, but we can also identify the communities in which the virus is probably spreading. Second, as we look back on this crisis, we need data to do the Hard Research to figure out what works and what did not work so we can make better policies in the future. Third, consumers and their families need to have this information. Anybody looking for a nursing home placement right now or worried about their loved one in a nursing home right now really needs to be able to know what is going on in a way to make the best decisions. In terms of the exact resources, i think a lot of it is about staffing. We have had a problem with chronic understaffing and Nursing Homes and the kinds of resources that could help most on an emergency basis for a facility that has an outbreak is to strategize to ensure enough staff. This means providing paid sick ppe, providing adequate basically putting nursing home staff on par with what we want to provide for hospital staff, it is the same situation. Sen. Casey thanks very much. Time, im almost out of chairman collins has been generous with our time. I would just ask dr. Landers a quick question about our frontline heroes. A number of us in the senate, i know this is true in the house towell, have made it a focus create a heroes fund. Some manifestation of our gratitude for those who have put themselves at risk on the front lines and i know that, in the case of dr. Landers, im told fact, taken a in lead on this. 50 othere employees have volunteered to care for patients who tested positive for covid19 and i understand that in recognition of their work, you are providing these individuals with additional compensation. We commend you for that. I think the basic question is simple, a yes or no question, but if the federal government provided you with the option to receive funding to provide what we call pandemic premium pay for essential workers and the work they have done in this pandemic, would you apply for the funding . You,anders senator, thank yeah, we were trying to do all we can to support our frontline heroes. If there is something we were eligible for in the criteria where appropriate, we would certainly do so. Sen. Casey thank you. Sen. Collins thank you. Senator tim scott. Sen. Scott thank you. , will say this, nor leadership chairwoman, has been spectacular. From the aging community to the Paycheck Protection Program and to this hearing, you consistently show up for the seniors in maine, seniors in america, for the Small Businesses, how you accomplish all that you do, im not sure, but you are one of the hardest working, most dedicated Public Servants i have met, thank you for this hearing and the opportunity to discuss this incredibly vital issue of our aging communities, which im closer and closer being part of. Sen. Collins thank you so much for your kind words. Sen. Scott to the panel, without any question, if you are in South Carolina or most of our state, what you will realize quickly is that those diagnosed with covid19, on average, is just over 50 years old who are hospitalized, and those who die from the disease in South Carolina is just over 75 years old. Nearly 90 of fatalities in my carolina, have been from those over the age of 60. It is one of the reasons why i highlighted senator collins dedication to this issue, because one third of all covid19 deaths in South Carolina happen in a nursing home or another senior care facility. So this is an incredibly important issue and an incredibly timely hearing. In other states, the numbers are even worse than in South Carolina. There have been some encouraging numbers recently, and our governor of South Carolina and governors around the nation, i would like to highlight the governor in florida as well, who decided to focus the attention on the Nursing Homes, it is exactly where we should start this challenge, how we should face this challenge is by focusing on the most vulnerable populations. I have often thought about how important it is to recognize that Nursing Homes are the epicenter of activity, also, the folk to take care of the patients are disproportionately minorities, africanamericans, who have perhaps the second was vulnerable population in our nation. States like louisiana, 70 of the deaths are africanamericans , only 33 of the population. In my home state, 53 of the deaths are africanamericans, only 27 of the population. Vulnerablee community being served by another Vulnerable Community and that only highlights the importance of testing, testing, testing in our nursing home facilities. Im thankful that in South Carolina, the 40,000 nursing home residents will be tested june. N now and the end of im thankful that in South Carolina, people have over 220,000 tests completed in may and june of residents in South Carolina, 60,000 already tested so far this month. These are encouraging numbers and it is one of the reasons why i have introduced legislation to make this the model for the nation, that our nation should take serious testing first in our Nursing Homes and providing more resources for the vulnerable populations in this country. Along those lines, i have encouraged hhs to set aside a robust share of the Provider Relief Fund that we appropriated through the cares act along with 25 Million Dollars 25 billion that we dedicated to testing, specifically for Nursing Homes and Community Residential care facilities, they need the resources, the supplies, and tests as soon as possible. My question to the full panel, beyond funding, what steps should we be taking at every level of government to help these providers and communities develop the tools and strategies isolate, to detect, and address cases where they occur without straining existing resources by increasing administrative burdens . Dr. Konetzka if i may answer, one part of that, in addition to funding, Technical Assistance to Nursing Homes is essential. Just providinges the funding for it does not mean that Nursing Homes will necessarily know what we are learning about the best practices in terms of actually stemming an outbreak. I think the extent that local lth departments, states state organizations can supply Technical Assistance as well as the funding and resources, that would be helpful. Sen. Scott thank you. Add, thed like to importance of Clinical Research in seniors in Nursing Homes, educating families, because they are often legally authorized represent us about Clinical Research, everything in our medicine cabinet is there because we adopted Clinical Research and we absolutely need to include seniors in our vaccine trials, which we will be launching in march, numbers in july, as well as in special seniorfocused studies to go into Nursing Homes and provide this option to participating research. Sen. Scott thank you very much. Sen. Collins thank you, senator. Senator gillibrand is joining us remotely and she is next. Sen. Gillibrand can you skip me . Im having a technical problem. I just need five more minutes. Sen. Collins absolutely. On your sideheck of the aisle. It is senator blumenthal. Who is right here. Sen. Blumenthal thank you, madam chair. Thank you, senator collins and togetherasey, four us on this supremely important topic. As i was listening to my colleagues, i could not help but remember last monday, when i pastornied senior Patrick Collins in a ritual he has done every morning. On thees white flags lawn in front of the First Congressional Church in greenwich, connecticut, and i accompanied him last monday as we, together, placed 69 flags for each covid19 death in the state of connecticut. Afterwards,the day pastor collins placed 41 more right now,erday 23, as we hold this hearing, exactly to the moment, pastor collins is almost certainly placing another 57 new white flags, adding to markers of the First Congregational Church in greenwich. Every one of those flags represent a life in the thousands of lives lost around the country, 70 of them are seniors. Seven in 10. Many are in Nursing Homes. Havee obligation that we two these vulnerable individuals , pronto very dramatically and graphically by that picture worth 1000 words come literally. That is why i have supported the hazardous duty pay, the heroes fund for our nursing home workers, who too often are risking their lives and making financial sacrifices, and it is more than just aborting or recognizing, it is also to justn them more than rewarding or recognizing, it is also to retain them. Let me ask dr. Konetzka a question, isnt it a fact that too often, the employees of these Nursing Homes are risky andfor the backbreaking work that they do . Dr. Konetzka that is exactly right. Nursing home workers, especially are generally paid minimum wage, often have no paid sick leave, often have no health insurance. It is natural that in normal circumstances, Nursing Homes have a hard time stepping adequately, but under these circumstances, where staff are afraidraid to get sick, to bring the virus home to their other hand, all the may show up to work because they dont have paid sick leave, even though they are feeling ill, i think that all contributes to the issues we are seeing in Nursing Homes and the understaffing problem in particular. Sen. Blumenthal thank you. One of our Nursing Homes run by provides living facilities for the nursing home employees on the premises, so they are protected, they have to live away from their families, but they are sealed away from possible infection. The result has been greatly reduced the incidence of infection. Is that kind of innovation a possible promising about that others should follow . Yes, certainly. I think nursing home workers should have the option of having a different place to stay, whether that is provided by the nursing home or, like many cities have done for hospital workers, perhaps providing them with hotel rooms so they have the choice of not risking infecting their families. A veterannthal having served multiple toys and the afghanistan and iraq multiple tour of the afghanistan and iraq wars. I have introduced legislation called the quality care for nursing home residents and workers during covid19 act, it would immediately address some of these same problems, not just more testing, in fact it would require weekly testing of every resident, and testing before every shift for healthcare workers, it would mandate that all healthcare care workers have sufficient ppe and comprehensive Safety Training for dealing with covid19 in each facility have a fulltime Infection Control prevention on staff to keep residents and workers safe, it would guarantee a sufficient staff is available to facilitate weekly virtual visits between residents and their families. Those are just examples of the kinds of measures that i hope that may reduce the number of flags, those white markers, that pastor collins places every morning in front of the First Congregational Church of greenwich, we outweigh to our seniors, to all of our families and their loved ones that we do better in our Nursing Homes. Thank you. Sen. Collins thank you, senator. Senator mcsally. Sen. Mcsally thank you, chairman collins. Scottso echo senator comments about your leadership and your passion for seniors, for Small Businesses, and your leadership in this unprecedented challenge and thank you for this hearing. And to our witnesses for their testimony. In arizona, as of last night, there have been 747 deaths related to the coronavirus, and 593 are over the age of 65. That is about 79 . , this is aabout this cruel virus, and it is the cruelest to our most vulnerable. This is the greatest generation we are talking about. This is our opportunity as we learned more about the virus, we did not know a lot about it, but as we are learning about it, to do everything we can to protect the greatest generation. This is our generations opportunity to give back. There has been an important focus on Nursing Homes for the vulnerable who are in these settings. We also need to think about those in memory care, those in assisted living, those who are older but in independent living. My mom is 85, she is in good health, she is in independent living, but also has been isolated for two months because she is just as vulnerable as others from this disease. I have neighbors and constituents who are sharing their stories of loved ones who are in these settings and we need to make sure that we protect them. As i think about Going Forward it is not a choice of rb going to continue to protect lives or allow people to safely return to work as we move forward, we can do both, but for seniors encumbered settings, we need to put a boat around them, to ensure we have high situational awareness, anybody who goes to work there or visits there, we know they are not inadvertently bringing the virus with them. We now know, unlike several months ago, that people can asymptomatic be carrying the virus. Checking temperatures is not enough. Thank you for the testimony, but i want to look more broadly, are all connor betts settings, one of the challenges we have, where there is oversight of our Nursing Homes in arizona, oversight from hhs, at the state and county level, the living, assisted living, they are usually private entities. They are trying to get ppe, trying to get testing, it is not an easy thing to do with the supply chains. We have had innovations in arizona, one company i visited used to make seatbelts and airbags, they just started making masks and downs to support our Nursing Homes. There is an incredible story, more of that is to happen. , cant to ask dr. Konetzka you share broadly if we are looking at all seniors and hundred settings, what does it look like to keep that moat around them . For visitors and staff to go in there, highlevel situational awareness, plus the controls, what does it look like not just for Nursing Homes but for everyone in this vulnerable category . Thank you very much for that question because i think theres a tendency to focus only on Nursing Homes and in many states assisted living facilities look very much like Nursing Homes in terms of the level of care needed and provided, and the vulnerability of the resident. And yet because assisted living facilities are licensed by state and dont receive medicaid or t of medicare funding we tend to ignore them in these situations and yet theyre completely just as vulnerable. So i think your question about the social isolation in these settings, not just assisted living but also independent living is a huge challenge. So i think in the riskiest time where we have to prohibit visitors, something can be done in the meantime like making sure that the facilities have appropriate technology so that residents can at least communicate through facetime or other video chats with their families on a regular basis. In the longer run its essential for all the reasons you and others have mentioned that we do worry about the social isolation and start allowing visitors. Thats one of the things i think well learn as we go in terms of how much is too much. Set. At balance has to be i know im over my time. Isolation, ive heard cruel story after cruel story. The virus is cruel. Of people fighting for their lives alone and the amazing nurses who are with them, but not with their loved ones and Family Member. People taking their last breath alone without loved ones and Family Members, not able to be there for their funeral. Weve got to focus on allowing people when they can as quickly as possible to be with their loved ones safely during these times so it can be im. Its impactful not just for the senior but for other Family Members who feel hopeless. We have to allow people to be safely to visit at the right time. Thank you. Thank you, senator. Senator jill brand has fixed her technical problem and she is next. Thank you, mammed chairwoman. I appreciate this hearing very much. My state of new york, the most horrible stories are coming out of our Nursing Homes. A lot of the people who lost their lives have lost them from Nursing Homes. One of the concerns i have is for workers who work there. If we had National Paid leave in place at the beginning of this, then any worker who had to take care of Family Members or was sick themselves would have been able to keep their job, keep their health care and take up to three months leave that the length of an illness or sickness in their family. Without that, they have no safety net that would structurely be there for our workers when they have this kind of emergency and this pandemic is a perfect example of how it could have been used more effectively. So i want to ask, do you agree that if workers, especially nursing home and Home Health Workers were allowed to consider their health or the health of their families by having access to a comprehensive paid leaf program that that could better protect their patients and clients to slow the spread of the virus . I think a National Paid leave program could help in a number of ways. I think in a broader sense providing paid leave for Health Care Workers and Long Term Care workers would allow them that flexibility as you just mentioned. It would also allow perhaps other people the choice of taking care of their parents or another Family Member instead of putting them in a nursing home. So i think it would affect all kinds of decisions at the margin. Under this particular crisis, i think we would still have a Staffing Shortage because people leaving and having the paid leave to take care of Family Members as they leave doesnt help with staffing in Nursing Homes. So i think theres two sides to that. The other concern i have is that our Nursing Homes are still struggling to get access to testing and ppe and we know that nursing home workers and people they serve are among the most vulnerable around the country. Both doctors testimony reinforce the need for an essential worker bill of rights to protect our essential workers, including Nursing Homes and direct care professionals during this Public Health emergency. Every essential worker in our country should have access to safety and health protections. They should have access to frequent testing and ppe. They should have more robust compensation, therp they should have paid leave, they should have universeling sick days, they should have the kind of support that they deserve because they really are our frontline workers in this pandemic. Do you believe that the Health Outcome for patients are improved when we have high quality high paid workforces and do you agree that we need federal investment in direct Care Workforce . Senator, thank you. Agent care, home care, nursing home care is all about people caring for people. Thats really what matters. These are people need that tender loving care. And to the extent that we have a strong, welltrained well supported workforce, the outcomes are going to be better for patients and families. I do believe that. And im concerned about the shortages of nurses in particular because i hear our Nursing Schools are turning away half of the qualified applicants even though we have 80 million aging older adults. So im thankful you and your colleagues are thinking about the workers. I have one idea that i would like anyone to comment on. For the shortage of Health Care Workers and Home Health Workers and workers in Nursing Homes one of the things i think we should be doing is having a health force where we train a million workers in the next two months to do the Contact Tracing, to do the testing and vaccinations for any on the panel do you think training up this health force in the next two months would be able to help us have Health Care Workers in the future to we wouldnt have shortages for people who want to work in health care for older adults, whether in health care or in an ssisted living facility . Thank you, senator. I do think that having resources in place in advance of future crises is absolutely what we need. What we find is if were not ready ahead of time then we chase our tails. But we do have to invest in advance when to be ready when the crises come. So young people to get inspired and go on to become full time Lifelong Medical professionals, health care professionals, i think thats a very inspiring thought and something we should aspire to. Senator, i think absolutely getting new people into the workforce in these caring fields is really important, particularly Home Health Aides and personal Care Workforce. Theres definitely a need for more people to enter that field. Things like nursing, the nurses really are the keys to a lot of these teams and we need really smart bachelor prepared nurses. And thats something thats going to require more longterm policy making so that Going Forward that were in a better position because those cant be created overnight. The same with primary care physicians and jerttrigses. But funding could help with that. Thank you. Ill add that i think its a really good idea for both the short term and the long term. It seems like something where it could help with the urgency of this situation to increase staffing in Nursing Homes and in home health, and it could help with the pipeline problem in that we just dont have enough people coming out of Training Programs wanting to work in longterm care and getting people interested early on even as we try to improve the working conditions so they want to stay in it is a good idea. Thank you, madam chairwoman. Thank you. Senator brahn. Thank you, madam chair. I want to echo what senator scott said. Im on several committees here in the senate and i think the best hearings have been in this committee because you generally pick a topic that needs to be talked about at that moment in time. So thank you. Thank you. So ive got several questions teed up. As a business guy and entrepreneur, when i look at trying to apply the skills that work there generally you need to be agile, you need to think out of the box. You need to do things differently if youre going to be successful in a market. And im interested, because weve made the case that disproportionately Nursing Homes have been impacted. What has been the rate of improvement in these few months that weve been grappling with it, have we seen the rated of infections and deaths come down or are we still at a level that i know its bad, but have we seen any improvement . And then the corollary with that would be what best practices, what things have we seen in the successful Nursing Homes that would be maybe of key importance, one two and three. So has the rate improved . What best practices have surfaced in this time weve been tackling it . And any on the panel feel free to jump in. Ill be happy to start with that. I think the answer to your first question is we dont quite know, because we dont have great data yet. So even for our study we had to sort of pull off the internet and do a lot of data cleaning to make sure that we were analyzing something valid. And without the data to really know exactly where the infections in cases and deaths are, we wont be able to really answer that question. I suspect were still learning as were going and that many areas will still see outbreaks in Nursing Homes. For your second question, in terms of best practices, i do think there are a few things weve learned as i mentioned earlier testing everybody in a nursing home on a regular basis to prevent asymptomatic spread. And then separating residents as possible into covid and noncovid positive parts of a facility i think has been successful in many places. Senator, i think that senator brahn. Go ahead. I just want to say that were seeing in the Home Health Setting over time that it seems like the rates of infection of our treasured workforce, it does seem to be becoming less common week by week. And so these are people working in the hardest hit areas of northern new jersey where weve seen some of the highest levels of infection the country. So i do think week by week the social distancing measures, the ppe, the expanded testing which still needs to expand further. But were certainly in a better spot than we were in, in early march where it was just there was nothing. And so we have a long ways to go but the screening and education, of the workforce, making sure they know when and how to ask for help and when to get them out of the workforce, and then also the Testing Programs for the workers is increasingly important. I think, senator, the only thing i would like to add and this gets at the innovation piece, is the research, the Clinical Trials. I agree with what my fellow panelists said about what we should be doing immediately in terms of implementing what appear to be best practices. In addition, we have to invest in research as a nation supporting the nih and doing the Clinical Trials that will help us get out of this thing as a whole. But in doing that, we will support the seniors. For example, one of the senators talked about, senator mccellies, making a moat about the seniors. If we can vaccinate the population broadly, even if seniors dont respond to vaccines, get the population immune then the workers who often bring the virus into Nursing Homes this wont happen because they will have been protected and wouldnt have become infected. So investment in Clinical Research. Thank you. This will be for dr. Landers because i think as we debrief this over time finding out what works, these best practices. But weve noticed that in florida where arguably you might have the most vulnerable populations, is there something there that we can glean . Because i think the laboratory of states gives us a much better way to learn than maybe that one size fits all, site the c. D. C. When we first looked at testing cost us 30, 40, 50 baydays because of that focus on just one way. Is there something there in florida that anybody could weigh in on and dr. Landers, do you think that this will speed the move from fursing homes to home care Nursing Homes to hoke care over time . Because it seems like youre probably more safe in your home than you would be in a place thats got a lot of folks in the same building. Thank you, senator. Theres no question that theres increasing interest in Home Health Care. And ive been in several living rooms quite frankly in the last couple of weeks with families who have brought Family Members home from facilities to continue their recovery at home. And theyve been relieved and, you know, happy to get the home health and visiting nurse support which is really critical for them being able to come home. In terms of the differences in different locations, absolutely there are weve seen geographic vare variation and we should try to learn from those. In new jersey a lot of the people we serve travel between florida and new jersey. Its a fairly common conversation for snow birds and such. And a lot of the questioning weve gotten has been around can people come back for their those people that are fortunate enough to be able to travel and such, and is it safe . And so we are all interconnected but at the same time there are differences and well have to learn from this Going Forward. Thank you. Thank you. Senator warren, i dont know whether you heard my opening remarks but i do want you to know that i know i speak for everybody member of this committee in expressing our condolences to you. Youve been touched very personally by this virus. So welcome. Thank you so much. I appreciate it, madam chair. You reached out to me personally right after my brother died. He died in a comforted setting facility in a rehab, so thank you. I appreciate it. And i very much appreciate that youre holding this hearing today. In fact, what i want to talk about is i want to talk more about how seniorings are bearing the brunt of kide. And Nursing Homes covid19 and Nursing Homes have become the epicenter of the crisis. It is important that we do everything we can, that theres testing and that theres Contact Tracing and that we get a vaccine and that we develop treatments. But one of the things we need to do is collect more data. , i want to start by asking why is it so important that Nursing Homes collect and eport in a timely manner and transparently data about covid19 infection . I think its critical for several reasons. One is just that we need to know where to direct resources. Right . Nursing homes need help when theyre having an outbreak. And so we need to know that right away. It also gives us a signal about whats happening in the communities in which Nursing Homes are located. And second, it will enable us to do research that will help us later figure out what works and what didnt work. And so that we can perhaps do better the next time. And then finally its really critical for consumers. Weve been encouraging consumers since 2009 to get on nursing home care and get information on Nursing Homes but right now they cant easily find which ones have covid outbreak. We might get them that information so they can make good decisions. Thank you i think its important. In massachusetts, for example, more than half of the covid19 deaths are directly linked to longterm care facilities. Now, the center for medicare and medicaid services, the federal entity that regulates nursing homents, is taking some important steps to ensure better data. And just last month, they started requiring Nursing Homes to report new covid19 infections, outpreaks, hospitalizations, and deaths directly related. And they have to report it to the c. D. C. Nursing homes also must notify residents and families of these infections. But Nursing Homes arent the only facilities, Long Term Care facilities, that have been hit hard by this pandemic. Roughly 800,000 americans live in assisted living facilities. In massachusetts about two thirds of assisted living facilities have reported covid19 infections. Now, residents in assisted living facilities that serve Older Americans require less frequent medical care than those in Nursing Homes and less help with activities for daily living but populations in both places are similar. Older people who need some help for care givers in order to conduct daily tasks. Dr. Mulligan youve been serving on the front lines. When it comes to the patients youve seen does coronavirus affect nursing home residents any differently from how it affects assisted living residents . Or are People Living in both settings vulnerable to the crisis . Theres no question that theyre both very vulnerable. I think assisted Living Communities and 80 of deaths are in seniors i think theres an equal number. So you are correct. Ok. That is really important. The reality is this virus doesnt care whether seniors are living in assisted living facilities or living in Nursing Homes. It can affect them regardless. Let me go back to you. Are assisted living facilities required to report the same coronavirus information as Nursing Homes like report on infections or hospitalizations or deaths or outbreaks to the federal government and to the families and to the people who live there . No, they are not. Just like Data Collection from longterm care generally we dont collect much data from assied living because theyre not as dependent on federal funding. And under the cms guidance as i understand it were also not collecting information from assisted living facilities which for all the reasons you mentioned is unfortunate. So assisted living facilities have similar populations as Nursing Homes. They face similar infection risks but arent subject to the same regulations when it comes to the coronavirus. And that is why i launched an investigation with senator marky and with congresswoman maloney into how assisted living facilities are tracking Coronavirus Infections and preventative measures at these facilities and whether they have enough measures in place. Assisted living facility residents and their families deserve to know whether or not their facilities are experiencing a coronavirus outbreak just like nursing home residents are entitled to. So i believe we owe it to our seniors to get this done. Thank you all for being here today. And thank you. Thank you. Senator rick scott had to leave and go preside. He had joined us remotely. So now well turn to senator doug jones. Thank you, madam chairman. Thank you very much for holding this hearing. I appreciate it. And thanks to all our panelists for this very important hearing. I want to follow up on not just the assisted living but Nursing Homes in particular. My mom is in an assisted living so it has been a challenge for all of us and especially her over the last few weeks we lost dad in december so the isolation has been a struggle. We lost dad to alzheimers and i think it has been particularly tough on alzheimers patients and care givers, those forms of dementia create special problems regardless. Its been sad to listen as my mom has been talking every week she will mention that she, as much as she misses my dad who she was married to for 70 years, shes also somewhat thankful that he passed before all of this pandemic hit. And in part, i think that is because of the problems that she would have faced. She used to go down and visit him every day. And thats especially troubling. My friend john who writes for al. Com wrote an article this week called coronavirus creates a special hell for Dementia Care givers and he talked about trying to imagine what its like for an alzheimers patient or care giver imagine what its like trying to explain social distancing to a person who does not share your reality. He quotes pam leonard, a Program Director at the cjfs cares program. She talked about care givers and says its kind of like being on an airplane, youve got to take care of yourself, touf put on your own oxygen mask before youre able to help those around you. So i would like to get to anyone on the panel, given the special and unique needs and challenges that were seeing, what we can do to more support individuals with dementia, both in these facilities and out, and their families and care givers, and are there special trainings that might be needed for any of these longterm care and dementia facilities in a situation like were in now which we have not seen before ut we could see again . Ill open it to anybody. Senator jones i think youve touched on something so important. I think as a society well always be judged by how we take care of the most vulnerable. And certainly our demeanted seniors at this point are among the most vulnerable. Theyre not able to express, for example, if they are becoming ill they wouldnt necessarily be able to express if they dont feel well, that they feel hot, that theyre short of breath. But they have medical as well as sort of the psychological, emotional vulnerabilities at this time of this pandemic that are unique to them i think and i dont know that i have any specific answer for you but i would encourage any effort to bring together a think tank to brainstorm about this. I think its absolutely needed. And thank you for raising it. Senator jones, thank you for raising this critical issue and i share your deep concern for the well bg of People Living with dementia and actually one of the sad parts about all this has just been hearing my staff explain whats going on when theyre doing nursing visits th older adults, with severe dementia. And in cases where theyve had nasal swab those tests, thats been fairly dramatic and upsetting because the person just doesnt understand. And so one thing in the assisted and independent living because thats been a big topic in this hearing. Home Health Agencies are able to come in as are hospice agencies to butt ress the care in those facilities. So to the extent that we can have a Strong Home Health ongs and focus on the things that senator collins is focused on around telehealth i think thats going to strengthen Dementia Care in assisted livings. And encourage people to focus on goals of care would help. But tough issue were facing. Thank you so much for both. As my time runs out, your research has indicated racial and ethnic minorities and low income individuals have been disproportionately affected with Nursing Homes that have larger minority populations are more likely to have coronavirus and deaths. Could you talk about what factors might contribute to those disparities . Thank you for that question. So disparities in nursing home outcomes from covid are not unlike disparities we see across the health care system. And its the result of many years of differences by race in health infrastructure, in resources, in risk factors of populations. What we found in our research was not necessarily that nonwhite residents were more were having worse outcomes within a facility. It was about the percent white in a facility. So to me its really about the neighborhoods in which Nursing Homes are located and staff going back and forth between those facilities and the neighborhood. So i think its a lot about where the virus is circulating and who is in those facilities and who is going back and forth. Well, thank you. Thank you madam chairman for holding this hearing. Its very, very important. Thank you. Thank you, senator. Senator rosen. Thank you senator collins for holding this very important hearing. It is incredibly sad to see whats happening in our Nursing Homes and our assisted living going on with our care givers across our country. I was a care giver for my parents and inlaws. I understand this through a firsthand perspective and it is overwhelming, frightening, and frustrating particularly at this time. But one thing that i think we really need to focus on is research. Research to fully understand how this virus works and how to best treat and prevent it. Its so critical. I recently gro introduced legislation with senator rubio, the ensuring understanding of covid19 to protect Public Health act thats going to required long tudenal study of covid19 including individuals of all ages along with gersty and race, ethnicity, gender, geography, Underlying Health conditions. We need to understand why the virus impacts some people like our seniors differently than others. We need to understand what the presence of antibodies really means, if seniors or others who get sick gain an immune response or not. Thats the theory that they gain immune response but patients becoming ill a second time is really concerning and there have been recent reports of course of the group of sailors on the roosevelt getting reinfected. So doctor i have a two part question. Do you know what the latest research is or can you talk about it, the latest research thats following patients who are diagnosed a second time with coronavirus including seniors . Because it can have a further impact on our Senior Living centers. Do we know if this is a brand nu infection or if it is the original thishat do you think information, what impact it . Ight have ini think the jury is out terms of formal proof, recovering successfully, certainly, most people who recover make antibodies. For most viral infections, it is true the former proof that described a study you. We have more more convalescent patients and we now study how they do over time. I think the jury is out on these reports of infections and may well present negative and positive tests as a result of their original infection. The test is not purpose not perfect. It would not surprise me that was the cause of some of those. For Vaccine Development, it is the same. I am a scientist. I want to know the evidence, if we do our studies correctly, if we are well supported, we will get the truth, the answer. That is what science does for us. Testimony, he said medical countermeasures may need to be tailored to seniors to optimally protect them. Can you expand that . Very happy to do that. We have a couple of special vaccines for flu for seniors. We know that seniors immune systems are weaker. Best weaker. One with a higher dose may be necessary for covid19 as well. We need to do those special studies. We want to make sure that treatments are tolerated well and save in seniors. We need to another great example is the antibody approach. The senior cannot make a nice this drughemselves, is something that will be in a nursing home setting and i think that is important. Thank you and the other witnesses for your work, your passion, your commitment. We really need you and we are thankful youre doing what you are doing. Please stay well and be safe. Thank you. I want to follow up on the questions you are just asked about your work on vaccines. You make an important point that older adults do not so do not but thatnd to vaccines have a herd immunity, to help protect distinguish about different kinds of vaccines. Could you describe the two vaccine trials that i understand you are involved with, and whether or not you have seniors enrolled in those trials . Your. Question and the healthy and younger adults, with one candidate vaccine. We see in the trial that the vaccine is tolerated adults, in the younger we will go to a second group, including seniors. Make sure in the firsts human that a new treatment and vaccine is safer and tolerated before you go to a more vulnerable population. Quickly move to seniors in the trial we are conducting at our university. The second trial is a large efficacy trial supported by the in collaboration with the vaccine that has prominent reports. 18t trial will be for adults and older. That efficacy trial will and could will include seniors and do so at significant proportions, at least a quarter or more. That is encouraging to hear. Could you also talk a little that youexplain to us could have the antibodies approach . It is my understanding that when you give a vaccine, it is usually with a live virus and then your body produces the antibodies that would allow you to fight off exposure to the virus later on. But are you suggesting that an is, rather approach than injecting the virus, you antibodies . Did i understand that correctly . You did. The Standard Approach is known as active immunization. We deliver a vaccine that might be a weakened virus, or just a protein, a piece of the virus, bodyday, then we ask the to make the anybody. Seniors are not as good at doing that. An alternate is passive rather than active immunization. In that case, the anybody has a halflife of the month. Aced to tweak it where they have for a couple of months. We can get us to the worst of this when we could protect our vulnerable seniors. It has to be tested in a randomized control trial. That is fascinating. Are those antibodies produced . Are they taken from individuals who already had the coronavirus . Are they manufactured in a lab . How are they produced . Thank you. It is fascinating. I will give you one example. The first human in the states to his down the coronavirus, antibodies were cloned by a company, converted in a laboratory to a drug. You can have that available for into Research Participants of the future. Antibody that is very good at neutralizing the antibody. That becomes your drug for testing. Very interesting. Thank you. Senator casey. Sen. Casey i had mentioned earlier the wait list, the it hundred thousand individuals on a wait list for supports in their homes and communities. I get that number from the Kaiser Family foundation. That number did not arise since the crisis began. That number predated the crisis. These are people on a waiting list that qualify for services. Funding to provide those services. Are states i know increasing direct service providers, and that is one of the steps we should consider. I have a bill that would encourage every state to do with some states are doing, to serve as a foundation for the enhanced matching is the federal government provides in their late recent legislation. Can you explain the importance of addressing the wait lists for what is known as home and communitybased services in the context of the current pandemic . I would be happy to talk about that. It is a little bit difficult. For programsists under the medicaid program. Each case doesnt differently. It sounds like a lot but in some states, they do not use waitlist. Underestimating who need services there. In other states, they do not before putting on the wait list. They are huge and those. There are can agree probably many more people who can benefit from the services that are not getting them. During this crisis, it essentially do what we can to enable more people to get home based services. Entering a nursing home right now has grown astronomically. Enabling more home and Community Based care right now they save lives. Sen. Casey thank you. I just want to go back to the numbers in your testimony. Its regarding ppe. Forought that you needed just a week, 17000 and i was not sure what that was. If you could repeat the numbers, and this is a colossal failure, it is not simply, we have all kind of instances where it is not enough and care settings, not to mention First Responders , whather circumstances will happen in the months ahead, it is not just a question of this month and next month, i think we do not have a sense yet of the numbers on the scale of the problem. I just wanted to provide an emphasis on one provider and one care center setting. Our current bond rate is the term being used in terms of how fast we are going through ppe as , just over 17,000 and over 3500, n95 masks every week. I moved to our chief financial officer, responsible for procuring this stuff, that is what theyre trying to find on the market, vendors and it still remains a challenge to track down enough vendors. I am thankful and we continue to serve by having that equipment. I think a little warm last week, i was at an Apartment Building that was not well ventilated. Iwas sweating and realized need to change my mask. My mask was getting soaked. We have to remember that sometimes these get soiled. There are a lot of needs so thank you for looking out for that issue. Thank you, chairman collins. Thank you. Your concern about the availability of ppe, for our Home Health Agencies, that has been a problem in the state of been as well that i have working on personally to deliver some ppe to our Home Health Agencies. It is something that they fit very difficult for them to do their jobs without it. Terrific thank our witnesses for being with us today and for their work and their research. It really makes a difference. I want to thank staff for figuring out how we can safely and observearing social distancing, which we did throughout. I would note that virtually every member of the committee joined the hearing either in person or in the hearing room or remotely. I am very pleased with that and i think it shows how many people care about the issue. I also want to give a special shout out to the technical experts who made this possible. When you have that many senators joining us remotely, senators who are joining us here, and witnesses in three different places in the country, it is that our technical experts were able to make everything go so smoothly and i thank them. Week, from the covid19 virus, surpassed 90,000 people. Or older adults. This means that we have lost more than 72,000 older adults to this pandemic. The hearing,ing of i remarked on the enormous challenges and tragedy that covid19 brought to our country. It has also brought countless courage andgreat selflessness from those on the front lines of the pandemic, including our medical personnel and our direct Care Workforce. But they are not the only once. We see at the grocery stores, we see it for those who are stocking the shelves and running our gas stations and other essential businesses. See it in those such as i have seen in the state of maine who are making the swabs that are essential for our testing. All over our country is people step forward and businesses step up to convert and do their part. I appreciate that sacrifice, that passion, that effort. I also want to pay special witnesses today. I thought it really increased our understanding. Dr. Mulliganss leadership on Vaccine Development houses vast medical countermeasures for i appreciated and his giving us a great education today. Us betterch helps inform our efforts to protect the residents, not only of those animals put of housing that our seniors have been other congregate care facilities. Dr. Landers focused on Home Health Care, which has been a andial passion of mine technologies such as telehealth helps us to improve care of older adults in our home and that is where most older adults want to be. They want to be in the privacy, security, and comfort of their own home if they can be. This committee will continue to explore potential solutions to the challenges discussed in this hearing as well as other impediments to the health and safety of our nations seniors. This week, members of the aging committee introduced a thisution to designate month as Older Americans month. As we work to improve care for , we also should to recognize our seniors as valued members of our society, culture, and lives. The health and wellbeing of seniors strengthen our nation as a whole, and it is the very of this committee. Senator casey, i would like to call on you for any closing comments. Thank you for this hearing on an important topic. I am grateful for the opportunity and grateful for the witnesses who bring a degree of and experience with the issues that are so important. To families when it comes to caring for our seniors in all things, we are grateful the witnesses are with us today. Reiterate that this is a technical challenge and they helped us all through this and we are grateful, as we should always commend the staff and the senate who do good work especially under these circumstances. All of thet to thank health care and Home Health Workers throughout the country, service dividers as well, caregivers, for caring for our aging loved ones all the time, but especially during this terrible virus, which has caused such devastation across the country. I think we should do more than say thanks. They are not just frontline workers, but in many cases, there at the front exposing themselves and putting themselves at risk. As nation should reward them we did returning soldiers from other battlefields in our history. Congress has done a number of things to help seniors with four pieces of legislation that have been passed. I would argue, then nearly enough. Not nearly what we must do for for our seniors. We must keep acting legislatively. I am frustrated, as a number of senators are, that the whole month of may was spent on nominations and covid19 policy or appropriations. Unfortunately, were going into that same circumstance in the senate and i think if we going to be here, we should be voting on covid19. That should be the top priority, and of course the economic consequences of the virus. More to do concerning me need to do more on testing nationally. I think it mr. Risch should. Utline a strategy at long last we mention personal protective climate for frontline workers. We cannot work on this issue enough. There is just no way to combat hand that in a nation as powerful as ours, a nation able to produce the Production Capacity to win world war i, and all the wars in between could a world war ii, the idea that the same nation cannot produce enough masks or gloves for personal protective equipment for everyone who needs it is really an appalling failure. We have to worry over the next couple of months, i know as of 8 00 this morning, in the state of pennsylvania, 64,412 cases, the death member and president it is now 4767. That is only for march, april, and may. And finally another 4700 or 5000 pennsylvanians have died. Reactive capacity and we are not doing enough as a nation and the federal government has to demand that we set forth a capacity that we need. It to an wars in the past, we can do it now to win this war. To do anistration has lot more to be sure we can. Roduce what we need we have a lot more legislating appropriating, but we are grateful, chairman, for this hearing. Thank you for giving us this opportunity. Thank you. Committee members will have submitriday, may 29, to questions for the record. If weve receive some, we will pass them on to our witnesses. I again want to thank everyone for participating in this and this hearing is now adjourn. Adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2020] congress is out of session through the holiday weekend. In return for legislative business on wednesday with proxy voting in effect for the first time. Votes are planned on the covid19 Paycheck Protection Program and possible on fisa reauthorization. On thursday, they will attempt to override a president ial veto of a measure dealing with forgiveness of some student loans. Expected to be the last day of the week for votes. The senate is meeting every few days and pro forma sessions during their weeklong memorial day holiday recess. They will return for votes on monday, june 1, with work on judicial nominations as well as the Inspector General for pandemic recovery. Watch live coverage of the senate on cspan2 and legislative debate in the house on wednesday, starting at noon, on seesmic on cspan. Returns wednesday and thursday for legislative business and to vote on the pfizer reauthorization bill. The bill extends pfizer surveillance authorities through december of 2023. It has been amended by the senate and will require house action. With house rules in place to allow for proxy ruling, house members beginning wednesday can not present during for votes. On cspan,house cspan network, or listen on the go with the cspan radio app. Liftoff. This week, watch live coverage of spacexs commercial crew test flight. Stronauts on american soil tuesday at 10 00 live on cspan. Nasa administrator jim bridenstine, and wednesday, our live coverage of the spacex crew launch be in the 12 00 p. M. Eastern on cspan2 with liftoff at 4 30 p. M. The International Space station is lost. Then, a briefing with jim bryan stine at 6 00 p. M. Eastern and thursday, 11 15 p. M. Eastern on cspan2, all day live coverage of the spacex crew is it docks with the International Space station. The event between the spacex crew dragon. Cspan2,e on cspan, or listen on the free cspan radio app. Bakari sellers,