Transcripts For CSPAN House Ways And Means Subcommittee Hearing On COVID-19 And Nursing Homes 20240712

Responsible for overseeing Nursing Homes to testify today. She was offered dates and times of her choice this month and next month. She was offered the opportunity to come in person or appear virtually from her desk. Administration, which seems more terrified of transparency and accountability then covid19, has declined to provide any witness with the courage to face the responsibility for the thousands of deaths that have occurred. These were send a crisis that existed long before covid19 occurred. We will learn from a nurse who took it on herself to purchase protective equipment with her own funds for her staff. Including preventing evictions and appropriate settings. Like sending nursing home residents to homeless shelters. Thousands of nursing home residents are being evicted across the country to homeless shelters and other inappropriate settings because there is a natural incentive for some homes to take more lucrative patients. We will get their perspective. Much of this crisis could have been avoided. Pandemic hasto the been denial, delay, and ongoing deception. The overall performing performance rating is a solid f. Cms waited 97 days, over three months before he published the initial data on nursing home preparedness and infection. It has become clear that this was not responsive in exposing the true scope of the crisis. As of the date of this hearing, 800 facilities still have not reported anything, including 100 Nursing Homes in texas. While we have known from the beginning that the essential tools to protect frontline workers are personal protective equipment and conference of days to it took cms 80 have a single baseline test called for. That still has not happened in some places. They did not provide the resources to do that testing. The fact that congress has appropriated billions of dollars that could be used on testing. It took fema 61 days to get out its directive regarding personal protective equipment for Nursing Homes. When the equipment finally came from fema, much of it was junk that was frequently unusable. And clothtrash bags masks instead of others. Despite warnings from early january, the a ministration not only failed to invoke the defense production pde needed they had to fight for scraps. Our hearing today is seeking some concrete solutions. We need to protect one million americans who preside in Nursing Homes. We will examine measures for accountability. Including prohibiting mandatory arbitration clauses. In some cases, responsibility for this catastrophe was shared by various failures on the state level. Texas has been hiding the identity of infected Nursing Homes and delayed testings and provisions of the. I salute those homes that are doing all they can to protect patients and staff. Many have not done that. I received a call from a mother who learns that a staffer had been infected but the nursing home declined to release any information. This congress should accept a little bit of responsibility. We knew full well that these funds would be distributed by administration indifferent to the wellbeing of residents with whom accountability is anathema. 9. 3 million was awarded, with no real strings attached, to a san antonio nursing home without a single covid case. Rating according to medicare. Gov. It received 11 Health Citations on its most recent inspection a year ago. Up in massachusetts openly fire a whistle blower who spoke about substandard conditions. We really have no idea how Nursing Homes which have received millions used those funds to ensure the protection of their residents and their staff. Hopefully todays discussion will give us more understanding. With that i call Ranking Member mr. Nunes for his opening statement. Thank you, chairman doggett. Good to see you. Today we meet to learn more about the impact on covid19 on Nursing Homes according to data from cms. Nearly 39,000 nursing home residents have lost their lives due to covid19. The analysis has found as many as 43 of u. S. Covid19 deaths have occurred in assisted living facilities. In my home state of california, we have seen nearly 1677 deaths in Nursing Homes. About 30 of our states deaths. Dozens of staff millibars have been infected. This is a tragedy. Many continuing to live in their state homes. Life is different. Windows come between moments of personal connection. We have been touched by workers who sacrificed by isolated together in an attempt to keep covid19 at bay. We must act quickly to get this vulnerable aging population and workers what they need to stop the spread. This congress has worked and to increase testing for all americans. While some governors increase the risk for our seniors by requesting Nursing Homes to take in residents that are positive. The administration has taken aggressive steps to protect nursing home residents and staff and issued guidance to increase testing in these facilities. Limit visitors. Protect the financial interests of nursing home residents. Report cases of covid19 to their families and directly to the cdc. This committee can and should provide a path forward for the immediate future and longterm reforms to prevent utbreaks from happening again. When we have a vaccine, vulnerable seniors and healthcare workers must be at the front line to receive this vaccine. Scientists must keep their feet on the gas to tell us what if any immunity they provide. Before we hear from our witnesses, i would like to make one point today. There are six witnesses invited by democrats. Only one invited by the republicans. Given the circumstances under hich were operating we can see a more balanced ratio. Appreciate it, mr. Chairman. We look forward to hearing from our witnesses today. Ill be pleased to work with you on that witness issue. Were fortunate to have mr. Neal here. I would like to call on him. In preparing for this hearing which i think is critical to all embers of. I worked hard to get the administration to address gaps in oversight. The dip has drawn to light the many challenges. I wanted to take part in this discussion today to speak to the desperate need for urgent action. Nursing homes have been the epicenter of this crisis since the first outbreak in a Washington State facility claimed the lives of 30 resident and Staff Members. In total tens of thousands of lives in Nursing Homes and staff has been lost around the nation. Given the lack of adequate testing, these figures are likely to be gross underestimates. In any district lack of testing and quality issues led to an explosion in deaths. 76 veterans died at the holy oaks home. More than 100 were infected including my uncle bob garvey. Yesterdays Investigation Report into this tradget made clear that there needs to be whole scale accountability. I certainly endorse and embrace plans to ensure it is treated with the same equity as its counterpart in chelsea, massachusetts. Im going provide resources so our state can move forward to rebuild these facilities and create a more transparent, healthy environment for our veterans who served this makings with such valor. We have a number of suggestions which i fully embrace including the soldiers home needs to maintain the current number of beds at the facility. We are strongly opposed to attempts to downsize the facility and there needs to be adult day care facility established on site and they need to have a discussion about the future of the facility and making sure not all decisions are exclusively made in boston. Staff report they dont have access to tests or personal protective equipment they need. There have been reports that p. P. E. Happen to be inadequate. It has underscored the vulnerabilities in our Nursing Homes. The New York Times recently found 50 of the facilities where at least a quarter of the population was black or latino, the covid19 rate of infection was double the rate for residents made up 5 of the population. This is hugely devastating but we all know it is not a new problem. Make no mistake, whats happening in Nursing Homes, soldiers homes across the country is no coincidence. It is the outstanding and long standing deregulation campaign the Trump Administration has waged against nursing home care for years. Their policies have exacerbated the safety threats to these residents and thousands have died because ofette. This administration has we go aened Safety Standards and made residents more at risk to Infectious Disease outbreaks. While they have taken some action to contain the virus and protect the patients and workers, they have not done nough. It includes responsibilities for provisions of safeguarding quality of nursing home care during the pandemic and strengthening protections for workers and patients. Advocates and Healthcare Professionals alike agree that the administrations inaction earlier this year has worsened the outcomes and fatality rates in Nursing Homes. We are ready to hold this Administration Accountable and to protect the health and wellbeing of all americans. I yield back the balance of my time and thanks to the subcommittee for undertaking this. Without all objections all members who have written Opening Statements will be part of the record. Ill be making as part of record several statement thats we received in writing including one from sisy sanders of austin who led the fight to ensure that staff and residents are regularly tested and has expressed great concern about the reckless action from the Trump Administration in this regard. A former only budsman from the state of ombudsman from florida has been pushing for Greater Transparency and oversight, from the National Council of gray panthers, a resolution concerning the same matters. Realizing that our Nursing Homes are also residents for many individuals with disabilities and the scotion working vigorously to provide communitybased alternatives. And then calling for action on the bill. These are just a few examplesor the great interest in our topic today and of course as usual we invite comments over the next two weeks, any other written statements that any other individuals or groups may want to make part of our record. I would welcome our panel. Were thankful for them joining us today. Rst, i would like to welcome lia satterwhite wholl be sharing her Brothers Story and then melinda, from mr. Larsons district. She is fortunate to have recently recovered from covid19 but can identify some of the obstacles that she and her colleagues have faced. Were pleased to have nicole from mr. Thompsons district in california. She is an ombudsman who hased a evacuated on behalf of longterm re residents and then from toby edelman. She is a longterm advocate. After that, well hear from dr. David grabowski. A professor at harvard medical school. An expert on nursing home policy and was asked to serve on the commission for safety and quality in Nursing Homes and aarp he hasector of had years working on longterm care issues and finally the committee will hear from rebecca , the president and chief executive officer from mr. Reeds district from upstate new york and tell us how she navigated the crisis and ill ask mr. Reed if you want to add opportunity for comments from ms. Gold. H pl thank you. She is the president and chief Financial Officer of skiler skyler located in hospital in new york in our istrict. It is a hospital with a Skilled Nursing facility attached. She not only runs the place, she walks the rounds and knows those patients and we welcome you to this committee and your fist hand experience and input is greatly appreciated by i believe all of the members on this committee today. Thank you for that opportunity. Thank you. Each of the statement ovs our witnesses will be made part of the record in their entirety. I would ask you to try to summarize your testimony in five minute or less for you or your colleagues as they ask questions. Ill do a gentle tap with my gavel here as time is reached and ask you to try conclude your remarks at that point. You can keep an eye on the clock that should be on your screen. I call on ms. Satterwhite. It is good to have a portfolio texan here and condolences for the devastating loss loss of your brother. I appreciate you sharing that story. Mrs. Satterwhite. Thank you, chairman doggett, Ranking Member nunes, and the members of the committee for having me today. My name is delia satterwhite. I live in austin, texas, and my brother Stephan Morales passed away on april 16, 2020 from covid19 that he contracted while residing at riverside nursing and Rehabilitation Center here in austin. My brother had dementia and in july 2016, he went to Riverside Nursing Home to live. I would go and visit with him on weekends and sometimes would pop in to check on him during the week on my way home from work. I would usually spend saturdays with him, bringing some of his favorite foods, like tacos or menudo from joes bakery. When the Nursing Homes went on lockdown on march 13, 2020, i had seen my brother just the week before the lockdown, he was in good spirits and i had told him that i would be returning the next saturday with my son so he could get his haircut and trim his beard. That never happened. The day before my visit i was called and told that they were going to lock the facility down and no visitors were allowed. I asked if i could drop off the snacks i already bought, but they did not want to risk bringing the virus in. I understood that and wanted them to keep my brother safe. I would still visit sometimes and talk to my brother through the window, but it was hard knowing he couldnt have his family with him. After the lockdown, it was hard to reach any of the staff at riverside. They did not want to take my phone calls and would put me on hold for so long that my lunch break would be over before i could ask how my brother was doing. I would call almost every day, usually two or three times a day. No one wanted to talk to me, it felt like they were keeping a secret. No one wanted me to know what was happening. They didnt want me to know the virus was there. I was eventually contacted on april 3, 2020 that my brother was being isolated because he was running a fever and coughing. He tested positive for covid19 the following week and then developed pneumonia. I requested that he be sent to the hospital to receive the medical care that he needed. The nursing home refused, and he passed away in his room on april 16. The worst part is knowing that he died alone. I wanted to be there. His family loved him and should have been with him. When i went to pick up his belongings, they gave me a box of things for a woman who had the last name morales. It was disrespectful to the life of my brother. He was a good man and his life mattered. It took a week for riverside to find my brothers belongings and return them to me. This nursing home did not provide the care that my brother eserved. They refused to provide information about other covid19 cases and deaths and did not want to test the residents and staff. They never sent him to the hospital even after i requested he be sent. When they closed the nursing home they said they wanted to keep the virus out, but they didnt make a plan to make sure workers didnt bring it in. My brother wasnt leaving the nursing home. Him. Irus was brought to the workers were still going home and could get the virus anywhere. I dont blame the workers. They were doing their job. They should have been given the ppe they needed to keep them and their patients safe. And if someone was sick, they should have been given leave to stay home. The Nursing Homes also need to be testing everyone all the time. Someone can test negative today, but have a positive test next week. If we were testing and providing ppe, the virus wouldnt have gotten to my brother. My brother should still be alive. I will continue to share his story so other families dont have to go through this. I still check in with some of the families of other residents at riverside. I want to make sure their loved ones are being taken care of. Thank you for allowing me to share stephans story today and for this important hearing so we can all learn the truth about what is happening in these Nursing Homes. You reflect the kind of pain that has affected families all over the country. We offer our sincere condolences. Ms. Haschak . Thank you for allowing me to share my story today. My name is melinda haschak. I am a nursing home worker from stamford, connecticut. Ive worked in the healthcare ndustry for over 20 years. Just in the last three years, the facility and made our lives hectic. Some of my coworkers and i decided enough was enough. We voted to unionize. Some of the things we asked for were time and a half, helping short staffing and a training fund. The pandemic has only deepened the need for what we were fighting for and made the problem worse. My facility was hit hard by a p. P. E. Shortage. We were in such short supply, we were being told to reuse singleuse gowns and masks. Just recently, the corporation that owns the facility where i work was fined for washing singleuse suits instead of replacing them with new ones at another facility nearby. It was so bad that i had to find ppe for myself and my coworkers sing my own money and the help of family friends. I couldnt bear to risk exposure to covid19 so recklessly. But unfortunately, after luckily avoiding infection from my sister who tested positive at he early stages of the pandemic, i believe that i caught covid19 at work. Being available for cpr during emergency situations, i unknowingly worked with residents that tested positive for covid19. I did not have full protection. This is how i believe i contacted covid19. I am a single mother that lived in a home with my two teenage daughters and my sister. After i tested positive, i had to stay in isolation from them. I couldnt give my children any affection. Any hugs. Or any kisses. I ate alone. My daughters had to figure out how to cook for themselves. It was so hard not being able to support them. I could not touch my kids until my birthday. I contacted contracted covid19 and i was out of work. I cant afford to get sick because that would mean i asuldnt provide for my family a worker who cares for vulnerable people, and risks my health to do it, i shouldnt have to be in this situation. This whole process took a huge mental toll on me there were many days i came home crying. Today we are still understaffed and overworked and still dont have enough p. P. E. While i appreciate the donations party, mynd the pizza coworkers and i dont need a pizza party, we need ppe. And even after my coworkers and i continue to contract covid19, communication is still a problem we face. We still dont know which residents are infected. Even though there are clean zones and a covid19 wing, we fear that there could be potential exposure because of the lack of information and protocols keep changing. Thats why our initial contract fight for familysustaining wages, tuition reimbursement, funding for training, and sufficient equipment is more important than ever. I love working with my residents because oftentimes i know its the only family they have, so not only do i owe it to them, but i owe it to my own family and myself to hold these facilities accountable thank you for your time. Thank you very much. For your testimony and your service. Chairman doggett and Ranking Member nunes, thank you for inviting me to testify before you and this distinguished subcommittee. My goal today is to help you understand the landscape of ongterm care and how covid19 left residents without protection or oversight. I hope my words are enough to help you understand the plight of those that live in nursing facilities. We are often the only place for resident and family to turn when they need advice, guidance and assistance resolving serious issues such as bedsores and intervening in instances of abuse and neglect. Longterm care ombudsmen are charged with protecting the rights of residents who live in licensed longterm care facilities, including Skilled Nursing facilities as well as other congregate settings, including what is commonly eferred to as assisted living. Assisted living costs at least 5,000 a month. Pricing many out of access. These residents are often in dark contrast to medicare patients who are only there for a short stay following hospitalization following therapy and care along with visits from family and friend. Medicare patients receive the lions share of attention. They are billeded a 600 per day. Even the layperson can see the strongest vare in payment. Vary in payment. A particularly callous administrator said they could make more running a doggy day care than with medicare patients. They are more likely to choose what is assisted living that does not provide medical care. They often have the same levels of impairment as those that live in Skilled Nursing facilities. The nursing home where is at least a quarter of the residents at black and latino have least ones coronavirus case. They live together in aging buildings without appropriate isolation capabilities and under the management of companies unable to adapt to rapidly changing care conditions created y this pandemic. They are basic issues about training and adequate staff. California facilitys with one or more patient with a covid19 ase had on average 25 fewer nurses per resident. They had a prior violation prior to the pandemic. Hey are not egregious. Poor staffing in longterm care facilities was the gasoline to ovid19s match. Within the longterm care industry, direct care workers, on average, earn only one to two dollars more per hour over the state minimum wage, forcing these dedicated people to work 6080 hours per week, at multiple locations, to pay the most modest of rent expenses. Meaning, you could have a caregiver that works at one facility where there are active covid19 infections, yet, is forced to work at a second location and may transmit the irus to residents. Now facilities did not cause this disaster, their response has been substandard, and they did it with the peoples money. A Skilled Nursing facility can choose to be private pay, and some do, but largely they do not because the lucrative and reliable stream of medicare dollars is highly attractive. In exchange, they care for a few medicaid residents along the way but they will take the first opportunity to discharge that esident. Sadly, some facilities have exploited the pandemic and the lack of oversight to evict residents without notice, sending them to homeless shelters that cannot provide proper care. This is not a new practice, but with facilities locked down, it is difficult for ombudsmen like me to assure proper accountability and intervene on behalf of residents. This crisis is the direct result of inadequate resources, staffing, and regulation to protect these precious lives. In order to address these critical issues, i respectfully equest that you consider the recommendations i have made to you in writing. Thank you. My name is toby edelman. Im a policy attorney. A nonpartisan Nonprofit Organization that works to ensure fair access to medicare and high quality care. I have advocated for residents at the National Level for more than 40 years. I want to acknowledge the deaths of more than 50,000 nursing home residents and hundreds of nursing home staff from covid19. We grieve for residents, staff, nd families. These past several months have brought to fuller Public Awareness the deadly consequences of poor care, inadequate Staffing Levels, and treatment of regulations intended to ensure good care for residents as burdens on facilities that need to be eliminated. Although many of these problems in nursing facilities have been identified for decades, they have been made worse by recent deregulatory actions and the oronavirus pandemic. Now, during the coronavirus pandemic and National Health emergency, the administration has unilaterally decimated longstanding statutory and regulatory protections for residents. [no audio] i cant hear. Can you hear me now . Is this ok . We missed about 30 seconds of you. Ok. Law that governs nursing the facilities that voluntarily choose to receive reimbursement from the medicare and medicaid programs. Nearly every facility in the country participates in one or both federal payment programs. The reform law made fundamental changes to all three components of federal law the standards of care that nursing facilities must meet called requirements of participation in order to be certified for participation and reimbursement; the survey process by which state Health Departments determine whether facilities meet federal standards of care; and the enforcement system, which authorizes a range of penalties for violations of federal care standards. In 2017 the administration placed obamaera guidance documents for surveyors with guidance documents of its own. It has Less Authority to make unilateral changes to the requirements and to the survey process, but it repeatedly asked Nursing Homes what they want and clearly signaled its intentions. It proposed and, and in some instances, made, changes. It delayed enforcement of new requirements and, in july 2019, published proposed changes to weaken the care standards; those proposed rules have not been ade final. It asked Nursing Homes what they wanted and signaled its intention to accommodate them. Requiring facilities to build up care plans when people were admitted, not later. Last july, they proposed watering down other care standards. The from postal used the word rden or burdensome more than 100 times in 32 pages. Since the pandemic, the administration has unilaterally suspended parts of federal law ntirely. Cms waived transfer and discharge rules. They waived the rirlte that the facility use nursingst to complete a 75hour training program. They hire people with as little as eight hours of trainings. Suspended enforcement for all violations except those classified as immediate jeopardy. They must reinstate it. For the longer term, four changes are essential. First all facilities must have sufficient numbers of well trained, well supervised and well compensated nursing staff. Secondly, they need to be strengthened and enforcement needs to be implemented on a corporatewide basis. They must establish meaningful standards of who is eligible to operate the facility. And we must spend a reasonable proportion of the billions of dollars they receive each year for the care of residents. The pandemics have made all too visible the lethal consequences of no care. We can and must learn from what was done wrong and do better in future. Thank you. Thank you very much. Dr. Grabowsky. Thank you. This ou for convening important conversation to examine the covid19 nursing home crisis. I want to emphasize a simple point at the outset it didnt have to be this way. What do i mean . Much of the negative impact of covid in Nursing Homes could have been avoided with increased federal leadership, resources, and attention. We lost over one in 10 nursing home residents. Think about that. One in 10. Isitors are not allowed. New federal covid data suggest over 500 staff nationally have died from covid. Higher delt rate than commercial fishermen. They are experiencing severe Staff Shortages as many individuals are unable or unwilling to work in these conditions. We hear a lot about the heroes working in hospitals. These individuals working in Nursing Homes and making close to minimum wage are risking their health and are heroes too. In many respects covid is to quote a colleague, a crisis upon a crisis. What do we do about all of this . We need to determine why covid has entered certain nursing omes and not others. This is not what my research or the independent research or independent research of other academics suggest. We posted an oped on this issue today. We find cases are concentrated wherever covid is in the community. Visitors have not been allowed in most facilities since march but staff unknowingly bring the virus from the community into the facility. As a result, covid is soon knob the nursing home where they work. This is to suggest covid is not a bad alps problem. It is a time to support all of our Nursing Homes. What should we do . Staff and residents are in desperate need for testing. Until we get Rapid Testing wont be able to contain covid. We need programs that rapidly test staff. The virus spreads because staff lack p. P. E. There is a huge shortage of masks, goggles, gloves and gowns. The federal government needs to take ownership of this issue. The fal federal government should set a consistent policy across all u. S. Nursing homes and provide them with the resources to achieve it. If we have testing and p. P. E. In play, we would be able to open testing at Nursing Homes to Family Members. Nursing homes need higher reimbursements for covid cases. Staff deserve a wage that is commensurate with the risks they are taking. The federal government needs to put dollars in play directly to workers in terms of hazard pay and other benefits. I want to conclude with a simple statement. It didnt have to be this way. Much of the negative impact could have been avoided, however rather than prioritizing the safety of the 1. 3 million individuals that live in Nursing Homes and the staff that care for them, we failed to invest in testing, p. P. E. And the workforce. We allowed a problem that could have been contained and now growing into a national crisis. Now that were here, it is time for the federal government to make the necessary investment to mitigate the spread of covid across all u. S. Nursing homes. We owe that to our parents and grandparents and the individual who is care for them. Thank you. Miss kennedy . Thank you, chairman doggett, Ranking Member nunes, and members of the subcommittee. Im the state director for aarp arizona. On behalf of all of our 38 million members, including over 890,000 in arizona, and all Older Americans nationwide, aarp appreciates the opportunity to provide testimony at todays hearing. We are calling on congress and the administration to take immediate action to stem the continued loss of life and improve conditions in these facilities. You have heard the high number of deaths. In arizona, 65 of deaths are from people who lived in longterm care facilities. These were moms and dads and grandpas and uncles and aunts. Here is one story from an arizona family. Norma moved to a nursing home after having a stroke. Her son visited his mom regularly. He thought his mom looked tired and sick. He reported the symptoms and then was denied access to the facility. He tried to see his mom or call the facility. H only got voicemail. She had been transferred and put on a vent lator. The hospital asked for permission to pull the cord. He denied the request. She died a week and a half later. The aarp urges action on a fivepoint plan to slow the spread and save lives. They must have the p. P. E. And testing they need to identify residents in staff cases. They still report they dont have adequate p. P. E. 15 weeks after not allowing families to isit and this is unacceptable. Testing is not available in many longterm care facilities. In arizona they have done one round of tests in of staff and residents and dont plan to do any more testing. Facilities have yet to do even one round of testing. This is outrageous. The only way to protect them is to have regular testing in accordance with the cdc guidelines. Two, there must be adequate staffing to provide necessary care. Longterm carom budsmen must be llowed to visit in person. In addition ombudsman play an Important Role advocating for residents and their family. They are unable to conduct in person visits. We urge this restriction to be ifted. Residents and family need information. The Community Needs information. And when there are discharges and transfers. We appreciate the action that takes steps toward more transparency, however more must be done. Reporting is still not happening consistently and reporting generally does not include demographic data. We need oversight accountability as billions of taxpayer dollars are directed to Nursing Homes. We urge congress to ensure such funds are use for testing, p. P. E. , staffing, virtual visitation and other items that directly relate to resident care, wellbeing, treatment and prevention. Virtual visitation must be made available between residents and their families. Congress must require it using readily Available Technology like were using right now. We also urge congress to provide funding for technology, equipment and support for virtual visits. Hats why amp arp supports the bipartisan access act. The pandemic has put residents health, safety and quality of care at unprecedent risk. We know that many longterm care facilities are doing hero eck work, putting their health on the line for others but sadly many families who have contacted us have lost ones who were not treated with the compassion or dignity they deserve. Aarp strongly urges congress to protect the safety of residents by maintaining the right to seek legal dress when residentses are armed, neglected or abused. It is of last resort. Congress should not strip away the rights and protections of residents. Families nationwide are looking to congress and the administration for swift action to protect the health and safety of their loved ones in longterm care facilities. Thank you and im happy to answer any questions. Thank you so much. Miss gold . Thank you. For allowing me to come today and share my perspective. We are at a hospital that has a 120bed Skilled Nursing facility attached. We are a little bit different than some of the stories you have heard here today. Our situation is different than being in new york. I want to let you know about the hardship that were facing here. Being in a Nursing Home Administration position, the regulations have been changing constantly. It is difficult to comply with them. The penalties equal a misdemeanor or loss of your operating certificate. It would mean loss of your career basically in the future. So the other thing that happened here, on march 25, 2020, Governor Cuomo issued an executive order that prohibited Nursing Homes from denying admission based on a confirmed positive covid19 diagnosis. We were lucky and thankful to be part of a Health System and we knew from the beginning that would have a devastating effect on our nursing home and we worked in order to ensure that we actually would never admit a covid19 patient into our nursing home. I think this is something that could be regionalized in new york state and elsewhere as well. If they were going to be admitted to the nursing home, we kept them until we could confirm they were not positive covid19 patients. We have not had a positive covid case in our nursing home. Another issue that we faced that we talked about already here is staffing. We had a nationwide shortage of registered nurses. Pay is part of the reason that we talk about that. But that we had to reassign those Critical Resources that we had to other duties. They have been reassigned to screen people as they come into our facility. This leaves our residents less facetoface time with the gary gives. Care givers. Quality of life is another issue that has been faced here. We derstand the need would respectfully request that metrics be developed to allow visitation in Nursing Homes. In our county we only have 14 cases of cove of covid today. Our residents are facing anxiety and depression. I had one of the residents grab my arm and say to me can this last forever . Can i really not see my family again . These people are distraught. We need to Work Together to find a way how we can allow safe visits in our Nursing Homes. Reimbursement is the last issue i wanted to talk about here. I am happy that we do have staff testing in our facility and we are able to detect people that have covid in our hospital but there is a cost and a price tag that comes along with that. For us it is 100 for the processing of each covid test we send to be processed. That does not through p. P. E. Cost. A month or for00 a full year, 1. 4 million. Nursing homes run on very thin margins which is why we have such staffing needs because we cant afford to pay somebody like our competitor like target does. It is not easy work. We do need to see increases in the rates that we receive. We have received i want to be fair. We have received some p. P. E. Testing, and supplies from our state but no funding directly for the testing regulation that has been imposed upon us. So i want to reiterate that we are lucky. We have not faced some of the challenges the others have talked about here today. We want to provide a safe, caring environment but i want you to understand some of the other challenges that we face in caring for the vulnerable population directly. Thank you for your time. Thank you for your insightful testimony. Without objection, each member will be recognized now for five minutes to question our witnesses. We will do it in seniority switching back and forth between majority and minority members. You are reminded to mute yourself when you are recognized for your five minutes and direct your question to a specific witness so that witness can unmute and respond. I will begin by recognizing myself and direct my first dwose dr. Grabowsky. Describe what ou the effect has been having a fragmented approach, the Trump Administration relinquishing its responsibilities telling governors to get the p. P. E. They need . It was like a game of hot potato. The government pushed it to the state and the state in turn pushed it to the Nursing Homes. No one has owned this issue. To their credit, the federal government said we would provide two weeks of personal p. P. E. Equipment to the Nursing Homes. Many are still waiting on that p. P. E. And many have received p. P. E. That is not usable. I would say that the federal government has not taken care of this issue around personal protective equipment. We should nationalize the supply chain. We should get it in all u. S. Nursing homes. Thank you. It is my understanding cms has created an Oversight Commission and that their version of oversight was to hire a continue which business to cms the select that commission. Is that correct . As you said when you introduced me, im on that cms commission. Note that im speaking for myself today. That commission, i understand has had its first meeting. Have those meetings been open like our meeting today or have they been closed . Our first meeting was closed. Is there has there been any indication that it will be open to the public . There hasnt been any indication the meetings will be public. Im looking for the main reason why cms would be unwilling to participate today other than an unwillingness to defend its sorry record. There was a suggestion they have their own Oversight Commission. I can see while it may make a contribution, it is not the kind public airing of concerns that we really need. Some of that, the best of that public airing has come from investigative journalism. Without objection, i will make a part of our record the New York Times article about the removal and eviction of medicaid residents from Nursing Homes as well as a separate article concerning some of the problems with p. P. E. And staffing issues in austin by Margaret Nicholas of the austin chronicle. I would like to ask you a little more about that. I must say i tried to follow activities in Nursing Homes for years. I was shocked to read that people are being evicted from Nursing Homes and placed in homeless shelters as if we didnt have a big enough homeless problem. But people that would be placed there without anyone to help them with their medications and with surroundings that may be unsafe for them. Have you seen this yourself and heard about this in california . Thank you, sir. Yes. This is a long standing practice where facilities who have residents for long periods of time that are homeless they feel they can no longer care for, they will attempt to discharge home to alternative care sightings, homeless shelters being one of them. That is why it is so porned that ombudsman receive notifications. However that is not happening. It was exacerbated in california where we had a program to get them into hotels. They were using it to discharge residents they did not want hoping that no one would notice. There is a requirement they notify the ombudsman when this happens. You have seen that not occur. Not occur but also changed. There has been a drast eck reduction in reductions ever changing that is very challenging to keep up with. In attempt to try to prevent ostile impactions, that is one that needs to be reinstated immediately between march, april and may, the discharge notices you received reduced by 50 going from 6,500 to 3,000. That is a significant reduction and i believe it indicates that there are residents being discharged in appropriate care settings. During that period of time, have you had any means of communicating with people in your jurisdiction as ombudsman . Yes. We have used phone, zoom, we will hang out. We use face time. For those residents who are able to connect that way, it is useful but we know there are so many who are not and like the Family Member said earlier, it has been many months without any contact. This has significant harm to residents and i think actually aids in their decline. So it has an impact in terms of social contact with a loved one. Does it also have anfect on the quality of care that they are likely receiving in some of our Nursing Homes . Absolutely. Not only do Family Members aid in care and help provide as many as, they also are on the lookout. Without eyes and ears in the facility, no one knows whats happening. While i believe many facilities are doing their best, i think there are some that may be using this time and not providing the best of care and residents are unable to speak for themselves. Thank you very much, miss kennedy, why not grant these Nursing Homes immunity. I understand this has been a tough priority of Mitch Mcconnell granth immunity in Nursing Homes is wrong. It stops residents from holding longterm care facilities accountable, including care that results in a residents death. Many had safety violations before the pandemic. According to a recent study from a Government Accountability office, eight out of 10 Nursing Homes were given citations. So many were not staffed adequately before this pandemic. Thank you. You have made reference in your testimony to the possibility of establishing a medical loss ratio for Nursing Homes. How would that work and what benefit would it have . Thank you, congressman. I think we have lost you again. Sorry. This is an important issue to make sure that facilities actually spend a designated portion of the imbursment that he receive on residents. There is no obligation they spend the money on care even though thats what the expectation is. We have experience with this kind of requirement, the Affordable Care act. They must spend a designated portion of their money on their participants. This would be useful in Nursing Homes. Ok. Thank you. Thank you very much. Mr. Nunes. Thank you, mr. Chairman. I want to yield my time to mr. Laserfocused en on this issue. I want to yield my time if that is ok. Surely. I thank mr. Nunes for yielding his time to me. This has been a priority of our office since the beginning of this crisis, the nursing home squation. I will just tell you what we really need to be focusing on today, there needs to be accountability for leadership and action for the past mistakes that happened during the course of the pam crisis but most importantly as we move forward we must protect the loss of life from occurring in the future like we have seen in particular in new york state. Since this virus reached our shores, we have known our parents and grandparents were particularly at risk. While many states chose to follow cdc guidance, cms guidance, a small group of governors made fatal errors that directly exposed the elderly to covid19 and placed our most vulnerable population in harms way. Governor andrew cuomo enacted a series of disastrous policies that directly led to the deaths of thousands of our states parents and grandparents. We know this virus is not going away any time soon. If we are to ensure our nations parents and grandparents are protected moving forward we need to fully understand why Governor Cuomo and the four other governors ordered covid19 positive seniors to be forced into Nursing Homes, exposing the entire nursing home population and staff to death. There chairman, this is a copy of the march 25 executive order from Governor Cuomo which i have ask unanimous consent to be put in the record. I assume that was a yes. I didnt hear mr. Chairman. It was muted. Thank you. It is without objks. Thank you. It is particularly importantas g remarks, this order has been deleted from the Public Record from the state of new york. I also want to note, mr. Chairman, immediately after Governor Cuomo issued his order to insert covid positive patients at Nursing Homes, in a direct written letter, warning to the governor, it is stated, and i quote, the mandate was overreaching, not consistent with science, and beyond all, not consistent with safety principles and particularly indicated that the order created significant risk of fatality of nursing home patients. I would like unanimous consent to enter into the record of march 26, the day after the march 25 executive order. Doggett without objection. Rep. Reed thank you, mr. Chairman. Instead of working together, they are almost focusing on lying to the american public, as evidenced by independent fact checkers, who did not follow federal guidelines, even know he said it was the fault of the Trump Administration. Even now, he continues to refuse to take responsibility for state care. It is offensive for those who have lost a parent or a grandparent and who just want answers, like myself. Our investigation in this committee should serve as the foundation of future nursing home policies and decisionmaking. The result should be a comprehensive strategy, mr. Chairman, to keep our nations parents and grandparents from what i fear would be a return to nursing home deaths in the fall is the virus potentially emerges. Congress must ensure that state leaders all of the best practices, taylors to the specific needs moving forward. We should be fighting for people like dawn, who reach out to my office and recently shared her story, failing to receive a note from a single official in response to her plea for help. She was concerned for her dear aunt rita, who was unable to interact with family for months. I am pleading for you to address this. We cannot have a onesizefitsall approach. We need someone who cares enough to speak up for those who cant. We should also stand with doreen from our district, who has been unable to see her 95yearold haser for weeks, and a described the entire situation as a nightmare for her family. The American People need help, and they are relying on to act, because they have lost the ability to put their faith in us to put action in place, and i join with the witnesses here today to say we owe it to our parents and grandparents to do better. But most importantly, we shall not cast blame, we should demand justice, accountability, and take action to make sure the tens of thousands of seniors do not face the death sentence that they face regards to the march 25 order, sending covid19 positive seniors into Nursing Homes without any scientific or data to support such an agree just policy decision during the course of this pandemic. And with that, i yelled back. Rep. Doggett thank you very much. Thank you, mr. Chairman, and thank you to our excellent witnesses that are here today. My condolences to mr. Satterwhite for the loss of her brother. The work and my district has been incredibly important. Thank you for all of the important you are doing. This is an important hearing. It is a tragic one but an important one. Covid19 has ravished our society but nowhere hit harder than our Nursing Homes, and it has been exacerbated, as pointed grabowski, howell,edy, and ms. They themselves are ombudsmen for this industry and for the patients who are there. I have a woman in my district who quit a look wha lucrative jd took a job in a Skilled Nursing facility to be able to be close to her parents and watch over them. This is a very important issue. My county had 18 deaths last week, 16 in Nursing Homes. In my conversations with local Public Health officials and nursing home operators themselves, they say it has become clear first, there is still not enough ppe. Once covid is in a nursing home, it is basically impossible to stop. Third, wages for nursing home employees are way too low. Fourth, the measures to contain and mitigate covid in Nursing Homes are too expensive for many Nursing Homes to implement. They need our help. Awould like to ask ms. Howell question. You mentioned in your testimony that Nursing Homes, longterm care facility should increase wages for employees. [no audio] hear. Dir. Howell i cant rep. Thompson are we good . Exec. Dir. Howell no, you cut out for a second. Rep. Thompson employees have to work into her three different places, two or three different nursing facilities or Nursing Homes, so they bring in the infection and spread it in their many places of work, so can you talk a little bit about that and how important this is . Exec. Dir. Howell thank you, sir, i appreciate it, and i am privileged to serve your community. An importantaised issue, which is a gasoline to covid19 match. The design, the way longterm care pays for employees at the lowest possible rate and then at , weame thing says cannot receive guest staff. You pay for what you get, we need someone for care, lgbtq issues, as well as others, and effectively recruit staff. We have Staff Members working at multiple facilities that we know their active infections should not be surprised when the disease spreads. I submit to you that you as a congress did provide additional compensation and did encourage facilities to use that for staffing members, but that did has not been done. It may have been don on a modest level, one dollar an hour, but that does not compensate for the risk they are taking. So i understand when Staff Members say, no, i will not come to work. Rep. Thompson thank you very much. I also have a ppe question, and dr. Grabowski is probably the one i should direct it to. I still have Skilled Nursing facilities that are trying to track down ppe material and been way, and this has too long in the process for this to be happening. Grabowski, does the trump clearstration implement a plan for disturbing ppe . Dr. Grabowski thank you for the question. No, they did not. We should have nationalized from the beginning of this pandemic. Unfortunately, Nursing Homes and other longterm care providers back of the the line. Nursing homes simply could not afford it. It is not enough to give them the dollars to support this. We need to give them the ppe, because they cannot afford it at the going rates. We could be doing a lot more, and unfortunately, the administration did not connect the dots in terms of providing the resources and getting the ppe to the Nursing Homes and protecting our caregivers. Rep. Thompson thank you very much. I yelled back, mr. Chairman. Rep. Doggett thank you very much. Mr. Buchanan . Rep. Buchanan can you hear me now . Rep. Doggett yes, go ahead. Buchanan thank you, mr. Chairman, for this hearing today. I am in florida. As we talk about the seniors or 50 ,he country, 40 as people say, in our region, of the debts we have had, it has been 85 seniors, so it is a huge, huge issue. I have the seventh oldest district in the country, so i am very sensitive about these issues. The seniors in Nursing Homes at other facilities have been locked down for three months. The impact is enormous in terms of Mental Health. What more can we do in this state for Mental Health . Thank you. This is a complicated question. It is more about geography and what is happening in your area, and i do not think it is a onesizefitsall. New york state has metrics and criteria to determine if it is safe to have visitation, so i think that is something that you could do possibly in the summer months, maybe have it outside. I think there are a lot of things that could be brought about. We have been utilizing the telecommunication could we actually purchased ipads for our residents, but the fact that a lot of them are not come even with assistance, they are not able to use them and do not understand what is happening in that space, because it is different from what they have experienced in their life. It will take people together and coming up with commonsense know, workingou together in the chamber and also what is happening in the region. What is happening here is not also what has happened in new york city. That is important to remember. Rep. Buchanan thank you for that comment, and let me just say come i want to talk to misses kennedy and get her thoughts, focusing on Nursing Homes, primarily, but we do have a lot in our state, especially assisted living facilities. As we look at ppe, making sure resources,he proper what is your there are 65 memories who have signed onto a letter, including myself, and they asked the secretary of hhs, 175 billion dollars, but we want to make sure these dollars are also going to use other facilities that are critical to florida, and im sure a lot of different parts across the country. I would like to get thoughts on that, mrs. Kennedy. Dir. Kennedy thank you. When i talk to assisted living facilities, they are not getting ppe, they cannot secure it. They can get a 30day supply, but they will run out. Think prioritizing your funding to make sure that the beginning about these facilities are getting adequate ppe is just essential to being able to stop the spread. Rep. Buchanan what about, you know, in terms of assisted living, do you think they are getting the token amount . It seems they are getting additional dollars. Is that what you are saying . Dir. Kennedy absolutely. That is exactly what i have been saying. At the state level, they are getting resources. Are there guardrails to make sure those resources are being spent where they are being spent . That should have been the number one priority of ppe and testing in a longterm care facilities, not just [no audio] there we go. mr. Chairman, can you hear me . Rep. Doggett i can, but i cant hear the witness. Rep. Buchanan ok. Dir. Kennedy can you hear me . Rep. Buchanan there we go. Dir. Kennedy i think i had some connectivity problems. I do not know what you heard and what you did not hear. Rep. Doggett you will have to repeat, so he gets his full answer. Dir. Kennedy you asked regarding ppe for facilities, i think that is an extremely major priority, and, you know, Skilled Nursing facilities are getting some resources, but the assisted living facilities, because they are not recommended under cms, they are getting left out. And our skilled facilities in arizona, we have a one over 100 2200 skilled living facilities. That is why our numbers are so high. Again, thank you, mr. Chairman, and i yield back. Rep. Doggett thank you. Mr. Blumenauer. Are you unmute . Still cant hear you. There we go. No, we lost you again. You are on. Blumenauer thank you. I am sure a show of hands would recommend staying on mute. Mr. Chairman, i really appreciate the hearing that you put together. Aappreciate that you have longterm interest in this. I find that the more we get into this, the more unsettling i find it. It appears that the federal responsibility that we provide and for a function where we ostensibly have some oversight, have some legislative and policy guide rails, it appears as though the Trump Administration is in the process of weakening them, and the circumstances where there is virtually no oversight, there are challenges, to be sure, in the midst of covid19, but given the sorry track record, given the challenges, and given what the administration has done, i find this extraordinarily disconcerting. If ourr, first of all witnesses, dr. Grabowski, possibly you have a sense on this, or ms. Edelman, and terms of having some standards. You mentioned having some requirements, with the resources the resources,ed providing the actual care, if there is some standard that you would recommend. Data that suggests that the facilities that happen ,aken over by private equities they are doing very good financially but are reportedly not very good and terms of providing care. A special degree of standards that you propose, you could outline and some specificity . Dr. Grabowski how about i start, and then ms. Edelman can pick up after me . Needy much believe that we to run resources into the sector, but the resources do not need to go to private equity, they do not need to go to ceo salaries, they need to go to the workforce. I really like what ms. Edelman described earlier about a medical loss ratio. That is one approach. One approach we study previously is using wage where you are putting medicaid dollars directly into direct care staff, directly into wages, so i would very much encourage the congress to earmark those dollars for staffing. That is where the money needs to go, not to the private equity group, not to, you know, the salaries. We want to make certain that this gets to our caregivers. Thanks. I do not know if ms. Edelman rep. Blumenauer thank you. I think you provided where the money goes to a specific purpose. Alsopears that we are skill shy in terms of providing the necessary equipment, and there is a serious problem of testing. Do you or ms. Edelman have, you know, ms. Howell, have a sense of what we should be doing in terms of not aiding the key testing and the . Necessary equipment . Ms. Edelman this is toby edelman. I do think we need to have a mandate for testing, and we need to make sure that the tests are done on all residents. Residents whof tested positive for covid19 had no symptoms at all. They dont have high temperatures, they dont have coughs or other respiratory ismptoms, so it essential that we test all , and then we can target, not just sending it randomly around. Just want toer i conclude you, because my time is almost up. Think that isi very, very important, that we put the resources there. Have 2. 5 Million People in these facilities, either working and that isnts, before we restate the opportunities for families, and i hope that we can bulk up the support for testing and put the resources directly where we want it and not let it reach out to different patterns of ownership or management that is on the ground where people need it. Rep. Doggett thank you very much. Appreciate it, mr. Blumenauer. Mr. Smith. Rep. Smith thank you, mr. Chairman, and thank you to all of our witnesses. I certainly salute the workers on the frontlines of health care, especially those in Nursing Homes and facilities housing our elderly and the unfortunately,e, so exposed to covid, and i think we are we are learning a lot, you know, we are compiling data, and i hope that we can use that instructive lee and moving forward. I know that the hardship placed upon families and seniors themselves, as many have mentioned already here, i know, though, that the Emotional Distress, i hope, does not overcome weigh or the impact, the Emotional Distress i hope is not worse than the covid itself. So as we do sort through all of the data and information moving forward, i know that video applications have been helpful. Certainly they do not replace the family interaction and so forth, but im glad that video and telemedicine can be. I think part of our answer, including patients in place, i know i have been working s. H. Time on the r. U. Senior hospital ability act, so we can reduce andrisk facing seniors also improve outcomes for when introducing new technologies, i know we here in congress on both sides of the aisle can quickly allocate resources to areas hardest hit by covid in the vital toin areas protecting our seniors and slowing the spread of disease. One of these is the provider billions in extends aid to providers, including nearly 5 billion to Skilled Nursing facilities. I think it is important to note that i believe the assisted living facilities should be helped with these funds. They have been facing a huge burden because of the pandemic, and certainly the scope of their care is very important during this pandemic and even beyond. So the challenges posed by covid19 require significant expansions and the use of telehealth especially for seniors in vulnerable populations. Because of the highly infectious , includinghe disease diseas on vulnerable populations, when transporting them to a hospital or clinic, i was wondering what lessons we have learned so far, regarding telehealth, and the initiatives that can continue to be an asset during the remainder of the covid crisis and beyond. How important will telehealth continue to be for nursing facilities and our seniors after the pandemic subsides . Uld, would you like to start with that question . [no audio] mr. Chairman, i think you are still on mute. I wanted to say that, yes, this is something we implemented. We implemented during this covid Skilled Nursing facility, and it is a great option to protect the residents, but also it is convenient to them, so they do not have to leave their space, and i think it is going to be here to stay. I think it will be here long into the future. I think it serves as a great place for residents and as people with right to life. I think telemedicine will be invaluable. Rep. Smith thank you. And obviously, medical interactions among to treat someone is far different than other interactions. How long do you think we can go basically excluding Family Support to the cumin presence that is absolutely vital . My data shows this for many years ms. Gould my data shows this for many years, when you cannot do things anymore, how difficult it is to enjoy life, and what i am seeing in our residents when i walked down there and the conversations that i am having with them as they are feeling this very much right now, to have someone, you know, grab my arm and expressed to me how they need to see their family is incredible, and we are trying to do the telehealth visits, and some of the residents have actually had the Family Members decided they do not want to do the tele visits with them, because it makes the resident more agitated. They are actually more upset that they cannot see their Family Member. We are trying to do something good, but sometimes we find that the reaction is actually adverse could i think it is residentdependent, but i think the sooner we can make comments to bring people into Nursing Homes, the better, but we need to do it in a safe way, so that no one is infected, exposed, or, at worst, fatal from that type of visitation. It is taking a huge toll on the residents. Rep. Smith yeah, thank you. Ms. Gould mmhmm. Rep. Smith mr. Chairman, i could not hear you. Go ahead. Rep. Doggett i believe your time is expired, and im calling on mr. Higgins. Thank you for your questions and for the comments. Rep. Smith thank you. Rep. Higgins thank you very much, mr. Chairman. As we all know, there are 129,000 americans dead from covid19. Theres no treatment, no vaccine, despite the fact that this is our nations third coronavirus outbreak in nearly two decades. The federal government failed to protect its people. The United States government ,esponse to covid19 was late sloppy, and adversarial, and in the absence of strong federal response, the nation looked to new york and its governor, andrew cuomo. The nation looked to new york, because Governor Cuomos response to covid19 was early, strong, and unified. Nursing homes and longterm care facilities are most vulnerable to covid19, because most of the people who live there have preexisting conditions. During this pandemic, the president is trying to kill the only law that protects people with preexisting conditions. Statest me turn to the and nursing home deaths. Or anally, onethird, little over 33 come of all covid19 thats are in Nursing Homes and workers who work in those Nursing Homes. In north carolina, it was 63 . In new hampshire, it is 77 . In minnesota, it is 81 . In new york, it is 20 . 13 lower than the national average. 43 lower than north carolina, 57 lower than new hampshire, and 61 lower than minnesota. You speak to, can new york states response and its effectiveness relative to covid19 versus or compared to the federal governments response. Thanksbowski yeah, so, for that question. This idea come as you just described, the rates in these different states is really reflective us what is happening in the Community Around them, so as we look at new york and other states, in new york, where we saw a really big outbreaks in Nursing Homes, there were similar outbreaks in communities around those Nursing Homes, so it is really about where the staff live, bringing it into the nursing home. As i said in my opening remarks,. Do not point fingers made by newcision york state but on the other hand, the onus for the nonresponse on the federal government really lives with the federal government. Rep. Higgins yeah, dr. Grabowski, do you think there will be a vaccine by the end of this year . Dr. Grabowski i think we are putting a lot of eggs in that basket. I think we should invest in ppe. We could invest in certainty in protecting our nursing residents. We can know for sure whether our staff and residents are protected. Rep. Higgins do you know about the response to ebola . Dr. Grabowski probably a lot longer, i would imagine. [laughs] rep. Higgins it took five years. Four yearsaccine is before it is clinically trial for both safety and efficacy and then scaled to the number that is needed to deal with a pandemic, which, you know, means all of us. If theask you this federal government invested back wit wind the coronavirus in 2003 was declared to be the cause of severe acute syndrome, 17 years ago, had we made an investment in the development of a vaccine, what we have a vaccine that could be, that could be developed much earlier, scienceuse of the basic that we would have relative to a new outbreak of the coronavirus . Dr. Grabowski i think it is fair to say that we are behind in our response with covid for a long time, and, you know, you are going further back than i do, but at least i would go back to even we were seeing these outbreaks in asia and europe. We were not taking any steps to protect our Nursing Homes. We saw kirkland making steps to protect Nursing Homes. It is now june. Had we really put the protections in place for our Nursing Homes and individuals that live and work there, i dont think so. Right, this is a longstanding problem come about for the last four to five months, we have not been ahead of this. Rep. Higgins thank you. Rep. Doggett thank you, mr. Higgins. Complete, a d the share of Skilled Nursing facilities is a share of total covid19 deaths by state come as of this month, and actually, i am afraid that my home state of texas was about twice as worse as new york. We had about 43 of the share of deaths in the state for skilled Nursing Homes, and new york was at 20 . So i offer that into the record, along with an explanation of it. And with that, and ready for comment further, i am sure, we call on mr. Reed on his own time. Rep. Reed thank you, mr. Chair. Dr. Grabowski, let me cut to the chase, are you saying that covid19 positive seniors should be ordered to go into nursing home facilities, as ordered in new york state . Dr. Grabowski no, i have been clear, congressman come on that issue, i think that was a mistake, but i do want to clarify rep. Reed i appreciate acknowledging a mistake. Has Governor Cuomo or others acknowledge that is a mistake . Dr. Grabowski no, but what he has explained as it is consistent with cmis guidance, i will go back to the march 13 cms guidance rep. Reed you are also misrepresenting that it was mostly false, if you are aware of that. So cms is at fault for this, is that what you are saying . Dr. Grabowski cms guidance it clear from march 13, admitting facilities, including individuals from hospitals where covid19 was is is present. Was it a good policy . No, i think it was a mistake. Rep. Reed i appreciate it, but to try to sugarcoat the 63 hundred deaths of happened in new york, and i think the number is twice that, because we are going to play with percentages, to say that we did a great job in new york is appalling to me, offensive to me, is offensive to the 10,000 plus seniors and their families as a result of the died as a result of that order, in my humble opinion, that are trying to whitewash and sugarcoat this conclusion. I want to get to the order itself, because it is crippled to me that we understand why that happened, because we have been demanding answers on this question and to four other governors, and it seems we are now doing at the National Level. There. Ld, you live you are on our daily hospital calls. You and i were talking every day, seven days a week, during this crisis. When the march 20 for order from new york state was issued, had you or any of your colleagues in the Health Network that you work with, that we had on a call on a daily basis, were you in any way consulted in regards to the issuance of that march 25 order that since 6300 seniors to their deaths in our Nursing Homes in new york . Ms. Gould no, i was not. Rep. Reed and when you heard about that order that came out, it appears you took unilateral action, because your expertise said we should not follow that rule i believe in your opening testimony she referenced how your hospital worked with other hospitals to protect those seniors as a result of that situation. So when you got that order, how did you respond to it . Ms. Gould so we had actually talked about this before the order came out. We were actually prepared for what we were going to do if someone came to our facility with a covid19 patient. Ideo cutting out] rep. Reed you are breaking up there. I think we are having some technical difficulty, mr. Chairman. Rep. Doggett believe we are. Ms. Gould can you hear me now . Rep. Doggett yes, go ahead, ms. Gould. Ms. Gould we made the decision that the best place to care for those covid19 patients would be at the larger hospitals the b of the Medical Center, and we also knew by bringing any covid19 patient into our hospital would be risky, because we have so many shared service departments, so people who live and i also work in the nursing home. Housekeepingrk in also work in a nursing home. So we wanted to make sure that they did not affect our patients. Rep. Reed and why was that . Why were you so concerned about having covid19 coming into your facilities . Ms. Gould i think it was all of the reports of people on the cruise ships who had contracted the virus, so we were very concerned about the layout of a nursing home. A nursing home is very institutionalized, kind of like classrooms like you would see in a high school, and so it would be very difficult. Of have one who is in charge three to five residents of a time, and when people are already lowstaffed, it is hard for them to use proper ppe techniques, to make sure they are caring for Infection Control, and we felt like it was too risky. Rep. Reed and as you give that analysis, what i am hearing you testified to is you are really trying to separate separate facilities, because you just could not a covid19 population and a situation where there are negative patients who are Senior Citizens who are highly susceptible to this. So you were concerned about the location of all of this, were you not . Ms. Gould that is true, and we also felt that the best care for a covert patient would be at a Medical Center for their care as well as also to protect the nursing home residents. Rep. Reed and why is that, because of the expertise in the metal center, that they had . Ms. Gould yes. So going forward, surmising your testimony, the recommendations i am hearing from your real Life Experience is that we should make sure when the virus comes back, that we get the seniors isolated in separate facilities, and we get our grandparents and parents the best care by medical facility that can live with i care or by a skilled person. Is that your input . Ms. Gould yes, i think it would be wise to have Covid Patients cared for improper settings and try to keep them out of Nursing Homes as much as possible. Rep. Reed and would you ever consider an executive order like for them toer, going to Nursing Homes, would you ever support an order like that again . Ms. Gould i would not, and i do not think they would come either. I do not think of nipomo one, either. Governor cuomo wood, either. Rep. Reed i would hope not. And iyou, mr. Chairman, yield back. Rep. Doggett thank you. Sewell. Ms. Sewell . Well, we either have technical problems or something there, and we will come back to ms. Sewell. Ms. Chu. Rep. Chu thank you. I have seen this in california. Los angeles county, where my district lies, has had no cases despite making only a small percentage of the population. Especially high risk at this moment. And what is really disturbing is so much of it is related to staffing. Direct correlation between nursing home Staffing Levels and the covid19 infections. Nursing Staffing Levels under the recommended minimum were twice as likely to have residents with covid19 compared with those who met or exceeded minimum nursing Staffing Levels. So i was horrified by the that you described. I could not believe there was such a lack of ppe and a lack of information about who had covid19 in the facility, and i why didke to ask you the issues arise when the nursing home does not have sufficient staff . Chu. Ank you, ms. Day, itge, on a good has anywhere from nine, 10, 11 residents. When they are short staffed, they can have up to 16. The nursing staff on the floor sometimesp to 30, so the acuity does not look bad, i think residents, because they cutie, they may have to have pp any sometime. There have been plenty of times stop my own had to path to help, maybe giving that resident a shower, give personal care, be in that room with that other staff member. Theres a lot of times we do not get a break. Theres times that we miss our lunches. Wherehave been many times my normal hours are 7 00 to 3 00, theres times when i have left at 7 00 in the evening. Chu yes, what you describe is why i am an original cosponsor of the quality care for nursing home residents act of 2019, introduced by jan schakowsky, which would institute minimum staffing and care levels for Nursing Homes with medicare and medicaid. Ms. Edelman, how has the cms, under the trumpet administration, we can ban akened during the covid19 pandemic, and why is it necessary for Nursing Homes through the payrollbased journal system. What would be the downside to making the cms waiver related to staffing permanent . Ms. Edelman thank you for that question. It is, catered an extremely important. It is complicated and extremely important. What they have really shown as they are very in adequate ,umbers of staff and facilities particularly nights and weekends, but even so, the is byl staffing standard itself. It is a requirement for consecutive hours per day, requires aroundtheclock, but sufficient staff, and that is cms does not let us know how many staff were actually in the facility, if they do not require facilities to give the payrollbased data, we will never know how many staff were there. We will never know how many of the residents were assessed. We will not be able to figure out what went wrong and how to fix that, so we need to have essential support that is accurate and comprehensive. I know dr. Grabowski has been concerned about the information released june 4 about the number of cases of covid, and those numbers have felt extremely inadequate and inaccurate. We need accurate information. Rep. Chu thank you for that, and i yield back. Rep. Doggett thank you very much. Mr. Kelly. Mr. Kelly . See, mr. Holding. Rep. Holding thank you, mr. Chairman. We all know this virus has created unprecedented challenges. Elective procedures have been canceled, and Senior Citizens have been cautioned to avoid hospitals and clinics as best as possible, creating major disruption to vital routine procedures and checkups. As some of you, including my colleague, mr. Smith, from nebraska, hit on today, it has forced us to rethink how providers can most accurately treat patients and has also spurred major innovations throughout the health care space. An institution of telehealth provisions especially has not only kept vulnerable individuals safely out of waiting rooms but has expanded access for many of whoural constituents, otherwise face Major Barriers to basic care. I am proud to say that in north carolina, Many Health Care stakeholders have already begun to embrace telehealth expansion and are working to improve its implementation. Blue cross blue shield of north carolina, for example, has announced an extension of the expanded reimbursement policy for telehealth visits through the end of the year to continue collecting data for further improvements. Going forward, we need to continue these services so that groups, like Senior Citizens , can take full advantage of them. Likewise, i think media expansion is vital to protect Nursing Homes, which also house our most vulnerable populations. Seniors in Nursing Homes should be able to receive an array of care and services virtually, which is why i support policies such as the access act, that provide Grant Funding to facilitate the development of telehealth capacity is in Nursing Homes. Ms. Gould, you spoke favorably experience is with telehealth and your facilities. I wonder if you could expand a little bit on that and tell us, you know, what are the barriers to using telehealth even more in your facility . Tell us anything that you think would be helpful in reducing those barriers, whether it be reimbursement rates or regulatory hurdles that you have had to face for using telehealth. I would be interested in hearing your thoughts. Ms. Gould that is a great question. Withnk one of the things telehealth is implementation, that it is used in the right way. Depending on what the patient is being seen for, it may not be right for telehealth. Reimbursement is definitely an issue for telehealth. Can you guys hear me . My whole screen went blank there. Rep. Holding yes, we can hear you. Ms. Gould reimbursement has been a barrier to some, and i think that we have enjoyed cms, thank you very much, has increased the reimbursement during this time. But i think that there are other tools. I think other people have more robust teleHealth Systems than what we probably have, being a critical access hospital, you know, our pockets are not really deep. Could programs where you buy additional tools to do telemedicine more sufficiently would be helpful. Rep. Holding thank you very much. Mr. Chairman i yield back. , rep. Doggett thank you very much, mr. Holding paradigm will go back to ms. Sewall, and in order to maintain balance, we evans, ms. Sewel, mr. Then this will loms. Wolarski. Sewell thank you, mr. Chairman. Can you hear me . Rep. Doggett yes, we can. Ewell cms, hhs, and other states must take responsibility for fixing what they need now and into the future. My Congressional District in alabama has been disproportionally impacted by the covid19 pandemic. While the 14 counties of my district make up 26 of the staples he population, we account for 40 of the states covid debts. The pandemic has laid bare the historical inequities that exist in our Health Care System for black americans. My constituency is painfully the systemic ns additional disparities we have also seen study after study over our nations Nursing Homes are not immune to these trends. They are largely segregated, and minorityomes serve populations are more likely to lowerrcrowded and have quality ratings. I would like to thank our guests who spoke about the disparity, the disparate impact this pandemic has had on communities of color in the need for National Demographic data. We need this data. It is quickly important. We know that too often our covid debts are concentrated in our Nursing Homes, and ive spoken with the nursing home administrators and my district in alabama, and it is clear to me that too many of them are not a cook with the resources they need to stop the spread of the virus. We need to provide more resources, like those in the resources act. The h. E. R. O. E. S. Act. I joined in a letter underlying the dire need. The letter asks whether hhs and cms plan to study the relationship between race and Health Outcomes and Nursing Homes that had covid19 outbreaks. As a representative of a minority majority district in alabama, i cannot stress enough how critical it is to figure out why there are disparities and what these Nursing Homes can do better to protect our constituents. If cms does not have a plan to do so, i ask that we, mr. Chairman, must have the leadership from the congressional leaders in order to do something about it. We have seen too many disparities, and enough is enough. I think it is critically important that we address it now. The h. E. R. O. E. S. Act includes a provision to help facilities manage these outbreaks, which i think is a good first step kid outside of collecting more data to underscore what we already know is true, that this pandemic has this report and only infected minority communities, what can we do, or what theseendations would witnesses advise congress to do about these Health Disparities . In particular, i would like to ask mr. Grabowski if he would address the workforce side of this. I have heard from too many of my nursing home administrators that staffing shortages are an issue, so my question is, what recommendations would you make to address these workforce challenges, as we continue to endure the covid19 pandemic . First dr. Grabowski. Dr. Grabowski thank you. Question on our workforce shortages. We are seeing that across the country, we had some of this before covid, but it has just been magnified in a postcovid period. I would point to a couple of things we can do. The first is updating the pay. That is pretty obvious. When to put more dollars in the pockets of those caregivers. Two, we need to make sure they have the right benefits, sick leave, health insurance, life insurance, making sure they have those benefits, and third, we need to recruit new individuals into this workforce and then retain them and i have been advocating really strongly that we need to go out. We have lots of individuals right now that are unemployed. We need to match those unemployed individuals with jobs in Nursing Homes and get them trained and ready to work, such that they can help out. Because we are going to see only more shortages as this pandemic continues. Of thewell would any other witnesses like to address the workforce challenges and recommendations that they could make to congress . Ms. Edelman this is toby edelman. Yes, i think we need to require specific staffing ratios in Nursing Homes. We have seen the standard of sufficient nurse staffing, and it is not enough. What we have seen a lot is that nurse aides have not just 15 people by 20, 25 residents that they are responsible for. A typical problem that i have is aabout in cases resident who needs two people to be transferred, and the aide is looking for another person, but there is nobody around the aide tries to transfer the person independently by themselves, they both go down on the floor. Considered her fall, although the reason she did it, there was nobody else around. We need more staff, and we need to mandate those staffing ratios and the professional staff, the registered nurses, to make sure the residents get the care they need and there is enough staff to provide that care. Rep. Sewell thank you, mr. Chair. Rep. Doggett thank you, ms. Sewell. Mr. Evans. Thank you, mr. Chair. You probably will think that my good friend from alabama and ir tag teaming you. I represent a district in philadelphia, and there is some commonality with what she was describing and what i am going to talk about it i want to talk about the issue of disparity with wage and income when it comes to nursing on care or have you talk about it, and really, the question is, as an action at the federal level helps to deepen the disparity come that is first and foremost. Of these with all discussions about states opening, how exactly, particularly this Committee Conducted a hearing not too long ago in terms of how the virus was affecting people of color. Can you just take some time and talk about the disparities of race and income in the nursing home area . I know there has been a lot of discussion. And has the federal government added to the problem . Dr. Grabowski sure. Thank you for that question. So we have had longterm disparities in nursing home care in this country, with Nursing Homes treating higher numbers of qualitysidents, worst outcomes, and we have seen that exacerbated under covid. Indeed, we did research to find which Nursing Homes where likely to have covid in the building. As i said earlier, it was largely location and size of the facility, but the other factor was your share of africanamerican residents, and that is because of, once again, location, and we know that blacks have been particularly hardhit in the community, and that has led to a staff bringing it into Nursing Homes. So this issue has been really critical right now, and i dont think this administration, by taking on covid, has really helped dampen these disparities. In fact, if anything, it has magnified it. When you dont provide personal protective clinic, when you dont provide testing, the Nursing Homes least able to get those will be those lowest resourced facilities. Rep. Evans in other words, those in alabama or philadelphia , there is no huge difference. Dr. Grabowski that is right. And if it is in the community, it is going to be in the nursing home, and we found that, you are right, and all sorts of states all around the country and all sorts of communities. Rep. Evans is there any specific kind of strategy . Do you have the ability to recommend the things that you thank need to happen . Dr. Grabowski absolutely. I would go back, and i know that we keep beating this drum, but it is so important, our single best weapon is personal protective equipment. It is like we have had this for three months, but we dont use them. We know it works. Lets get every nursing home in the country adequate ppe. Testing of staff and the residents is also and we talked about workforce support. I also think cohort is very important in how do we keep, when noticing home nursing have outbreaks, how do we keep covid residence from covidnegative residents . Well. S important as you state the most important thing, ppe and testing. Rep. Evans i thank you. Mr. Chairman, i yield back the balance of my time. Rep. Doggett thank you, mr. Evans. Ms. Walorski . Walorski thank you, mr. Chair. I appreciate you allowing me to sit in on this hearing. The covid19 pandemic has affected the whole world, but it has been felt more severely in some populations than others. Nowhere is that more evident than in Nursing Homes and longterm care facilities. Although nursing home residents only make up. 6 of the u. S. Publishing, they account for 43 of coronavirus deaths. Some put those percentage is even higher. It is a small population, county for 29 of coronavirus deaths in sweden and 18 in canada. Coronavirus spreads most easily indoors at close quarters and is deadliest among the elderly and those with underlying conditions. Nursing homes and longterm care facilities are the perfect storm and biggest risk factors and thus require a higher level of care. New York Governor Andrew Cuomo to,ned these facilities quote, fires in dry grass this policy effectively burning embers. Pennsylvania, connecticut, massachusetts and illinois have some form of these policies. These states account for 60 of our nations nursing home deaths. Michigan, about 5 of its resident have coronavirus. California had a transfer policy but reversed it in two days. Lost 1. 6 of its nursing home residents. Each of these deaths or a tragedy but it is clear some states ignored the warnings. Of toughe a lot questions to answer. Three days after michigan reported its first coronavirus cases, it was recommended the state use these facilities as Quarantine Centers print that was ignored. Every step tried to wish away responsibility. Now is not a time to look the other way. Now is the time to figure out what went wrong. A few weeks ago, a subcommittee held a briefing on the coronavirus in Nursing Homes. I want to know what you think. Do you think facilities should take patients the tested positive for coronavirus . I do think that forcing facilities to take covid positive patients is risky. Patients. Ns to cohort lack of ppe is a concern. Because covid is so low in our area, i think the biggest risk is someone works at the facility bringing it into the facility. They do not know they have a, they are an asymptomatic carrier and they bring it into the facility. Governor cuomos order for us to where face masks i think it does help prevent the spread. I cannot agree that covid of positive patients i know we have all talked about ppe, in the state of indiana, many manufacturers are making domestic produced ppe. For every Company Going back to work and opening up in the state of indiana, they were able to purchase through the marketplace set up in the state of indiana for manufacturers in indiana who were creating an extra amount of ppe for Companies Inside of indiana. That model to any governor. Open up and provide what is being produced inside the state inside a marketplace inside that state. Thank you. Mr. Ll be calling on horsford. , mr. Horse the witnesseso for being with us today. We have a national crisis. Problems existed before covid. Illinois, moref than 50 of covid related deaths have occurred inside Nursing Homes. In the county i represent, 47 different facilities have recorded an outbreak. There have been tragically 250 deaths. That county is not even the most hardhit in illinois. The number one issue, the number two and number three barrier this site for trouble with control ppe. It remains broken today. According to a recent survey, more than 50 of care facilities have less than one weeks supply of masks and gowns. Gown that cos a 0. 31 now cost 17. That is 10 to 15 times the price and increase is costing billions on a national scale. Or it is costing lives with people who cannot get the protection they need. Our administrations response failed to meet the moment. Recently just rooted care supplied recently care packages. Celebratedtration sending two weeks of critical supplies during a monthlong pandemic. It is worth the when the supplies arrive and they are not medical grade and are of no use. That are supposed to be n95 are made of cloth, it is useless. I raised these concerns earlier. Can you give us a brief description of how the supply chain, or the lack of , has affected your work . I, personally, have seen my timese, there have been for some of my coworkers were wearing ponchos to cover themselves. 95 masksearing our n weeks at a time. The residents, they are starting to recently allow them to come out of their rooms. They need their masks. It is very frustrating and difficult because we have to fight with them. The ppe . We are trained to protect ourselves, we are trying to protect our residents. It is frustrating. It really is. We are not fighting a winning battle. The administrations response and what you think congress should be assuring we have the ppe today in the current crisis, as it looks there is a spike. Dr. Grabowski absolutely. Homes orve nursing states bidding against each other or bidding against hospitals. We need to consolidate and purchase collectively. I would prefer a process where the federal government was doing the purchasing and then providing the Nursing Homes directly for those two weeks, which ended up not going the way. E hope, with unusable ppe in one case, i read in the wall street journal that they were glorified garbage bags. That should offend all of us. We need to make sure we are getting top ppe to Nursing Homes. This is where covid is at its most dangerous. Lets get our nursing home the workers need and deserve. Myi will share that with colleague, katherine clark, a supply chain coordinator to make sure we are getting the supplies where we need it. Thank you. Such ansford this is important hearing. Thank all of the witnesses for sharing their expertise. Providing quality cares to seniors is a deeply personal issue to me. When i was nine weeks old, my grandmother suffered a debilitating stroke that put her in a coma for six months and left her paralyzed on the left side of her body. She needed aroundtheclock care and relied on support provided through medicaid. Because of her stroke, she spent 27 years of her life in a nursing home until she passed away. I spent much of my childhood and early adulthood in those Nursing Homes, visiting my grandmother every week. 8remember as a boy that was years old, i said one day i would be in a position to raise the issue of lack of care and today is that day. I can only imagine how heartbreaking it is for people who have loved ones in Nursing Homes who are not able to make those weekly visits because of the coronavirus pandemic. Yesterday, i conducted a telephone town hole and i spoke with deborah from las vegas, who before the pandemic visited her brother and a nursing home five or six times a week. It is now been four months since she last saw him in person. She is constantly worried about her brothers safety and health. I have heard stories about how lonely and depressing this experience has been. To the front line doctors, nurses and Health Care Workers, i have heard how trying the time withppe, testing and staying healthy. With all due respect to my colleagues on the others of the aisle, there has not been a strategy from this administration. The ppe that has been delivered has been hoarded and is not trickled down to the Health Care Workers who need it the most. To the front line workers, i want to say thank you for adhering to these tough guidelines and fighting for our Family Members in these situations. I know you are working hard and i know we can Work Together to address the troublesome changes that are being discussed in this hearing and it is quite frankly outrageous that our Family Members and those living in Nursing Homes are in these conditions. I want to begin with a question howell, who is a graduate from the diversity of nevada, who is on our panel, go wolfpack. You shared facilities with a significant number of africanamerican residents. Ase locations are twice likely to have Coronavirus Infections as opposed to those facilities with residents who are white. Can you discuss these Health Disparities and how covid19 can impact their Life Expectancy . Can you touch upon the reporting challenges in those facilities . Grandmother i had a who was on medicaid and spent time in a nursing facility. I would say what happens is we have individuals who have depended on a Healthcare System for years and they simply do not have the money. They are sent to Health Care Facilities that put them directly in line with the disease. There are less expensive and more enriching places they could live through communitybased waivers that someone could be supported in the home. I think what happens is these individuals they have not served their needs. These folks are told they will have to be discharged, we cant take care of you, or you will have to stay in a facility that does not have a great rating because it was the only facility that would take a medicaid resident. I think we built and deepened a structural system were folks who are native american, africanamerican, do not have the care they deserve. Because of the continued entrenchment of the determine health outcome, they already had diseases such as diabetes that put them at risk for the disease. We are talking about reimbursement and care strategies, we need to look at the different ways that the state and federal government have unnecessary competition to incentivize. Introduced the quality reporting act of 2020 bill sponsored and that was included in the heroes act. I look forward to working with you and any members of the senate into advancing these measures. Our Family Members and those in Nursing Homes deserve nothing less. Thank you for your leadership. Rep. Doggett thank you for your work on that legislation. Mr. Kelly. Kelly can you hear me ok . Rep. Doggett yes, sir. Elly thank you for having the hearing. One thing that is tough is it turns into a political issue rather than a really good policy issue. If we had this meeting in july of 2019, i wonder if we wouldve had the same concerns about an administration not reacting to a pandemic nobody saw coming. At this point in my life, i know hindsight will always be 20 20. I dont think there was too much preparation going back several administrations to think we might have a pandemic, nobody saw it coming. Members, i mean this sincerely, thank you for taking time out of your life to come in here and talk to us. Operations, that you are doing right now, i know in pennsylvania, 67 of the deaths from covid are taking place in the nursing home facilities. Early on, it was really hard to understand, our governor told people, Nursing Homes have to take these peoplein even if they are covid positive. Then they backed it off after they saw what is happening. They said you can figure out for yourself what you have to do. It is one of those things were directing people to do things, it was like a ship without a rudder. Even our secretary of health took her own mother out of the home and put her into a hotel after this decision you have to put people into Nursing Homes. I dont want this to be political, we waste so much time bashing whatever administration is in office. Lets talk about what we can do nuven forte. Why we have to do it, and how we would have to do it. Lets talk about what we have to do moving forward. There is a possibility there relapse. A re to blame itly want on the previous administration, this administration, or any administration moving four. Should probably realize we need equipment in place. We have used other countries around the world for production. You, if you can to couple of seconds, what would you do from this point on as opposed to blaming someone in the administration of doing something that no one saw coming. 3 is not farer off. Said some of this already. Coming up with regional keep you might have to put individuals in the nursing home. It is a reality we have to accept. Differenceng the between what staff use for ppe when they do not have Covid Patients as opposed to the burn rate when you do have Covid Patients. It is drastically different based on what kind of patients you have in your facility. Need to havedo we if we have a worstcase scenario . I do think ensuring we have enough staff in order to care for those patients and provide proper care and proper training. There needs proper training for ppe, how to use proper Infection Control inside a facility. All of those things are majorly important to any type of outbreak in the future, any kind of droplet progression we might precaution we might encounter in the u. S. Ouromething else i here in rooms is we are not prepared for this happening. There are very few hospitals equipped to handle large numbers. In,ody that wants to weigh please weigh in because you are the experts. Havingnnedy i am connection problems. I would also say, we need to publicly report on a daily basis whether a facility has covid19. That goes back to the community spread. Not sharing that information or being transparent i feel has led to more spread. Chandlere facility in and saw there were three other facilities, i knew it would not be long before those facilities had covid in them. Transparency is critical. Rep. Doggett thank you, mr. Kelly. Thank you for putting this together. The members have been really great on both sides. Arc bends toward justice. It is the second time i quoted Martin Luther king jr. , i feel it is so appropriate. Residents across the country, including 6000 in new jersey have died. This is not a drop in the bucket. 123,000 covidover related deaths in the United States. Hoax, mr. Chairman. Longterm care deaths are disproportionate. Facilitys comprise 11 three cases, and one in covid deaths. These guys have gotten away with murder and we are talking about partisan politics . You have to be kidding me. Clear, this is not only because our elderly are more vulnerable for covid19, i think it goes deeper. The fact that too many facilities across our country have been mismanaged for many years. Who is in jail . Nobody. In 2008,bankers nobody. These glaring deficiencies were made worse by this administration rolling back nursing home protections. That is a fact. That is a fact. You didnt do it, members, they did it. The administration rolled back regulations. I will cite them if you want me to. In 2017, they remove standards in nursing home facilities for Facility Assessments and transfers and discharges. That as theed up on administration was supposed to under law, we would have known which places were more vulnerable to the disease we did not do that. The administration is guilty of this. The administration recklessly disregarded the health and safety of our most vulnerable neighborhoods, our most vulnerable Nursing Homes. A proposal to eliminate requirements that Nursing Homes employ Infection Prevention specialists during this pandemic. You cant make this stuff up. They doingll are over there, anyway . Dr. Ve a question for grabowski. To melindae to say haschak, thank you for what you do on the front lines. Many are responsible for the impact covid has had on nursing facilities, including Nursing Homes themselves. Yet, this administration has doubled down on his crusade to make Nursing Homes less safe. What is the most harmful impact of deregulation on nursing facility residents . Dr. Grabowski we need strong regulation. We have a lot of residents in Nursing Homes who cannot advocate for themselves. We need regulators, we need family keeping eyes on this. When the eyes are not on the building, bad things happen. We have heard about bad staffing , we need to maintain strong oversight and accountability. Edelman, senior policy attorney. Ms. Edelman yes, sir. I agree completely that we need strong regulations and the need to be treated differently. The cdc talked about what to do for covid. They said what is identical what we say about all the. These requirements are not new. This guidance is not new. Staff need to wash their hands that is the number one cited in Nursing Homes. The need to use personal protective equipment. Isolate and identify residents who have an infection or who they think have an infection. This is the number one violation in Nursing Homes. Thank you. Can i make one more comment before i sign off . Rep. Doggett yes, go ahead. Oversight, where it is coordinated oversight with the individual states, each of these homes each of these Nursing Homes gets a report card. Done with these report cards . Where are they . Know within the next us what yous, give have done with these report cards, or almost everyone of you should be fired from the top to the bottom. I have relatives who were killed in these Nursing Homes and i am not going to leave this alone. Rep. Doggett thank you, very much. Mr. Davis. Rep. Davis thank you very much. The opportunity to participate in this hearing, anything that has to do with health is always of great interest to me, even though i am not a member of the committee. Likee a question i would Illinois Department of Health Posted data that over 52 of the States Coronavirus deaths are tied to longterm care facilities. Assisted living establishments and other homes. The highest number of deaths have occurred in cook county. There are multiple agencies in certified Nursing Homes in the state, including the Illinois Department of Public Health, the u. S. Department of health and Human Services center, the medicare and Medicaid Services. Could you speak to where the gaps are in inspection, surveillance and enforcement, education and guidance . Ms. Edelman thank you for your question. For the last three month, cms has said to states, do not do surveys except for deficiencies, which are 1 of the problem, or targeted Infection Control surveys. They did Infection Control surveys. They released 5700 and we look at them. Cited any deficiencies and they called them no harm. How in the middle of a pandemic when people are dying every day that we find facilities not having any problems. The number one problem is widespread persistent way before the covid19 problem. We do not have good oversight. Problems, and the even if we do, we dont do anything about them. That is the real problem. We let these these issues feste. Handwashing is not just a trivial matter. People are dying in Nursing Homes because the staff are not washing their hands. Part of the reason they are not doing that is there are not enough of them, so people try to cut corners and do as much as they can. We need better enforcement of these better standards. Rep. Davis thank you very much. Could you discuss the impact of the separation of ownership of the real estate and the operations of Nursing Homes on the quality of care received . I asked that question because there are some who believe that private Equity Investment in health care does not always and that hasatient impact. Site effect or can you explore that with us . Dr. Grabowski sure. This has been a trend in Nursing Homes, to separate the real estate from operations. We have seen how that can be a really risky separation. The most valuable part of a nursing home from the asset perspective is real estate, so the operator still has to to pay their least to that owner while they are not taking in patients like they were before covid. So it has become really challenging for a lot of Nursing Homes, operators, to pay their bills right now. Equity groups are kind of protected while the operators are challenged, so exactly as you describe, congressman, we always worried about the accountability and transparency of these deals and the quality. I think we have seen that come to light with covid, where it is a risky proposition to separate ownership from operators and thinking about who is accountable all the time but especially during a pandemic. Rep. Davis if i could ask you quickly, ive have always had some affinity for operators of Nursing Homes. There are a number of them in the community where i live. I used to be on the board of one , that was notforprofit built and operated for a number of years. And trying to operated and maintained the standards that we wanted to have would you say in any way that perhaps the Nursing Homes have been underfunded . Or the reimbursements that they get are attributed to the quality of care that they sometimes provide . Dr. Grabowski absolutely. Are there Nursing Homes out there . Definitely. But it is hard not to argue that low medicaid reimbursement has not contributed to low quality. We have done a lot of studies supporting that. Going forward, we need to make certain that we are adequately finding Nursing Homes. Dollars inget those the pockets of the workers, not ceos, not private equity groups. Rep. Davis thank you. I yield back. Rep. Neal thank you. Rep. Wenstrup thank you mr. Chairman, thank you everyone. I really appreciate it. I am glad we are having this hearing had a lot ofave people very committed to taking care of our Senior Citizen facilities. They sacrifice being or from their family for over two months to make sure that they are protected, so that speaks a lot to their caregivers which, obviously, we need more of, at every level in health care today. They put their own safety at risk and are out there protecting the most vulnerable. Nursing homee ohio provider, who spent time one morning buying rain ponchos on ebay to serve as ppe for providers. This is unacceptable. We should take a look at this after action review find out where we can do better. Bound toblame, that is happen. That is not a solution, and that is why i prefer to work on. I asked secretary azar for additional funding for nursing facilities, and i am glad to see t theking as a doctor, practice of isolating sick patients is not new. Some states mandated that covid19 patients be sent back to their Nursing Homes. One in 10 nursing home patients died in new jersey, one of those states. New york had access to the u. S. And theip comfort Javits Center and still sent nursing patients home. These were not federal mandates to do that. These were state mandates. This is a federal late and stoical a federal, state, local problem. Especially if one of their Family Members is the most vulnerable, so i am curious what the advice was for that. And the ppe problem, that is a problem, and i do not know that that problem was better under the last administration or the administration before that. Think that any of them would have been in a better situation. We were in a bad situation. Why . Because we do not have enough domestic source for these types of things. I am working hard on our edifying on identifying where our critical needs are. Things to produce these domestically and have the minimum amount required. In my hometown of cincinnati, we have a Health Collaborative amongst our hospitals. They were ready to go to our Convention Center to build a hospital there, at all of the hospitals had a role in addressing this. These are the types of things we need to be ready for. These other types of things we need to talk about. But we see the majority of poor deaths occurred in performing Nursing Homes. There are universal precautions for infection, there always have been. Cms required facilities to have Infection Control in place. Had our Infection Controls in place. Wille i came to congress, i served in a board where we would evaluate best practices among those in our Community Taking care of people. We need to take a look at Nursing Homes and see what succeeded with Infection Control. So this is the path forward. Fingers and come up with solutions to make sure that we are addressing problems as a nation that affects everyone. There are Things Congress should do. Gould whatmrs. Do you think congress should do in order to improve the quality of the poor performing Nursing Homes . And i yield back. Rep. Neal i am not sure she heard. Her givehe will let her answer for the record, and i will call on mr. Beyer. Rep. Beyer thank you all for this important hearing. When this first cut our attention, it was back in february, and we knew at the time it was likely going to disproportionately affect older adults. Tingere having trouble get young people taking it seriously. It was not until midmay that cms required Data Collection in Nursing Homes. We were talking to our governor every week about what is happening in the Nursing Homes, let us know, the families want to know it was a complete shutdown of information. Is in a democracy that dependent on transparency, dr. Grabowski, do you have any sense on what this delay in data transparency has meant to the situation that developed in Nursing Homes . Dr. Grabowski thanks for that question. It has caused to problems. First is that it did not allow us, in a timely way, to know the extent of the problem. We now know that a number of the fatalities are located in Nursing Homes, but we had this situation in kirkland but did not have the broader data to say this is where we should be directing a lot of our resources. The other problem with not having early data, not being able to learn about which facilities have cases in which do not, what is working in terms of best practices, Infection Control, Public Health, infrastructure this is just good Public Health, that you have data that you are learning from both your successes and failures. This really prevented us from any type of learning. Rep. Beyer thank you. Your testimony was fascinating. You got the sense that trump is doing the bidding of any industry, eliminating any regulation on industry wishlist, so we are paying for that behavior now. 2013, the center for medicare and Medicaid Services recommended updating emergency preparedness, and it was all rolled back. Can you tell us, concretely, how much the rolling back of these regulations may have had an impact on this crisis . Thank you. I think the rollback of the standards of care, the complete lack of information, and no oversight that has been no one in Nursing Homes for three , nots, not families ombudsman, like ms. Howell. There has been nobody looking at what is happening. Now we see the results of what has happened to rolling back. We are not enforcing standards of care that we have had in place for decades. Rep. Beyer ms. Edelman ive been a small businessperson person all my life, so i am very sensitive to the cost burdens of ppe, attracted test employees, like ms. Gould said. How do you sort out how much of this cause pressure in their Nursing Homes is because of too small medicare and medicaid reimbursement payments versus the private equity takeover of what used to be familyrun, small businessrun homes . Elman private equity involvement has been a serious problem. They would immediately cut staff which was good for investors but terrible for care of residents. What private equity firms have also done is sold the real estate that is the most valuable part of the nursing home business, and they have sold real estate to Real Estate Investment trusts, then the trusts raise the rent, so the reimbursement paid to Nursing Homes was not as available for staff or food or supplies, all the things that residents rely on. Instead, money went to the Real Estate Investment funds so they kept raising the rent and actually bankrupted the facilities. So that has been a terrible situation. But generally, we just do not require facilities to be accountable for the money we give them, and i would give an example of medicare medicare is the highest payer. 500 up toge rate is 1000 a day. The Inspector General looked at all residents admitted to Nursing Homes under medicare and 14 andmonth period in 20 found more than one third suffered harm. They had all kind of problems. There were hospitalization problems not we have to make sure the money goes where we want it to go. Moneys to make sure that is part of care for residents. Rep. Beyer thank you very much. Rep. Neal thank you. Mr. Panetta. Thank you. A appreciate that. To thank the witnesses for providing your testimony, your preparation, and your experience and sharing your experiences with all of us and with the nation, so thank you very much. Nursingy, our nations homes, the residents and staff, clearly, have been at the epicenter of this crisis. As someone who grew up with a loved one in anderson home, i am familiar with the General Dynamics of a nursing home. I am familiar with the care that is provided for residents that is necessary. I am familiar with the love shown by many employees at these Nursing Homes for their residents. But also, and sometimes, i am familiar with the lack of love and care that can be shown to residents as well as the isolation residents can deal as well. I believe this pandemic did more than take advantage of these types of conditions that our Nursing Homes. I believe it has ravaged our residents and went after the employees. As we have heard and as you know, as many as 9600 nursing other lawncare settings in the u. S. Have had at least one covid19 case. There have been more than 50,000 residents and workers in longterm care settings that have died from covid19. And as my good friend mr. Pascrell said, that is one third of all deaths. And the Administration Limited options for patients and families who seek justice through the legal system. Those types of decisions have exacerbated the vulnerability of nursing home residents and staff of many Nursing Homes miserably. That is why i believe Congress Needs to hold bad actors accountable at all levels, so they can continue to live and love and be loved. I introduced the sos act, legislation that would find Nursing Home Strike teams, teams for additional nurses to visit facilities during the covid19 pandemic. Forassist with staff residents. It is deployed mainly for Nursing Homes that have a hard time dr. Grabowski, i will not ask a question, because you have been getting a lot of questions but i kennedy, prior to the point of getting strike teams in, is it Anything Congress can do to incentivize staffing at Skilled Nursing home facilities . Ms. Kennedy thank you. Arelieve some facilities offering hazard pay, and i think that is definitely something to consider. Especially in times of crisis, being able to offer an incentive for staff to be able to get a little bit of extra money is help will in times of crisis. Rep. Panetta dr. Grabowski do not take it personally. You have done a really good job and there is a lot you know. I appreciate it. By want to get to someone who has not talked much, mrs. Satterwhite. Mrs. Satterwhite, thank you very much for what you have said. I appreciate you being here. And, obviously, sorry to hear what happened to you and your brother. What should Congress Know about your experience with your brothers nursing home, as we patient ways to prevent harm in Nursing Homes moving forward and even during and after covid19 . Satterwhite thank you for the question. I think if we could get more testing done, like there should home for mynursing brother, they just tested the staff and the residents a few weeks ago. My brother did not get tested he was running a fever and coughing. Definite must in these Nursing Homes. They need ppe. Workers need to be protected. They cannot do their jobs if they get sick. Cannot takedents care of themselves, so they need the workers there to help them. But testing definitely has to be done more frequently for workers and residents. Rep. Panetta thank you. I yelled back. Rep. Doggett i yield back. Rep. Doggett thank you. Mr. Estes, thank you for waiting. Please proceed. Rep. Estes thank you, mr. Chairman, and thank you all of our witnesses for joining us today. This is a very important topic. Every day, medical professionals put themselves at risk to serve their community and battle against the Current Health crisis. Needng homes especially assistance as they determine how to prevent the quick spread of while also maintaining the high quality of care for residents. Our medical community should be prepared for future epidemics, and it is imperative that Nursing Homes have the ability to better protect our seniors. Across the United States, Nursing Homes and assisted living facilities have unexpectedly unacceptable high levels of death. We have seen troubling actions from public officials. I am especially concerned that several governors actions, including Governor Cuomo, insist that Nursing Homes take covid19 positive patients. It is an issue that makes it worse for so many people. Most Nursing Homes do not have the tools our capacity to handle these patients, leading to devastating consequences. However, i want to step away from placing blame. Instead, lets focus on how to fix the issues in front of us. This hass exacerbated existing problems. To keep residents and staff safe, Nursing Homes must send Staff Members home when the exhibit symptoms of covid19. This forces Nursing Homes to ask healthy staff to work longer and more shifts. Addresses this problem. We want to ensure that the quality of Nursing Homes are upheld. Shortagess critical of certified nurses. Legislation to immediately remove to immediately resume such qualityand certify all concerns cited and fined have that weressed to ensure meet high standards without losing Staffing Levels which are critical to the quality of care the patient receives. Gould, given the staffing, would it be beneficial to remove carriers to inhouse training to cnas and Nursing Homes make more staff available to his inlities, consequential preventing the spread of covid19 in Nursing Homes . Ms. Gould that is a twopart question. Staffing is key to prohibiting the spread of covid19 in the nursing home, and like i said earlier, when you are running short or are in a hurry, you make mistakes. Having the appropriate staff on hand would be an advantage. We actually run in has cna Training Programs in our facility. It has helped with retention. Hard. A cna is batheare required to people, feed people, change them, so if you can go to someplace like target or burger king and earn a wage that is similar, it is hard to compete. We are about 90 medicaid. I hear a lot of talk about medicare dollars, but for our facility, that is not where a lot of our money comes from, so it is hard to get increases when the medicaid does not cover the majority of costs. Facilities, having a cna program inhouse is beneficial, allowing you to train people on site and it is easier to maintain them. To retain them. Rep. Estes thank you. Earlier, you talked about being able to track ppe and making sure to recognize we have a different burn rate if you have an infection of covid19 or not. Gould new york state, we are getting that data every day. We list our current burn rate and burn rate on hand, but there should probably two different ones, one is burn rate for what you were currently using and what you would have on hand if youre burn rate was that of having covid positive patients. There is a large disparity. Between 3000 to 5000 masks a week difference between if you have a covid positive patient in your facility or not. You are required to change that mask every two hours if you have a covid positive patient in your facility. That is a great question. Making sure that in your emergency per rodens stockpiles that you are prepared to move if the facility comes down with a covid crisis in their facility. Rep. Estes thank you. I yield back. Rep. Doggett i believe that concludes our questioning. I want to thank all of our witnesses for a lengthy but very insightful hearing. Really an outstanding panel. Againularly want to think thank, again, mrs. Satterwhite for being here. I know you made special efforts to get off of work to do this, and i saw the profile on you on kxan yesterday shes done great work in exposing these problems, but your personal story really adds meaning to what we are doing today. Every witness made a big contribution, and members should be advised that they have two weeks to submit written questions to people. If you are not able to get all your questions in today, those questions and answers will be made part of the formal hearing record. With that, i believe our business is concluded, although our work to respond to this is only beginning. I think each of you. That concludes our hearing. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] cspans washington journal. Every day, we take your calls live on the air and discuss policy ensures issues that impact you. Coming, the American Action forums isabel soto on the coronavirus Pandemic Impact on childcare. Iran corporations Daniel Gerstein discusses the role of the Strategic National stockpile in a pandemic response. Watch cspans washington journal live at 7 00 eastern this morning and join the discussion with your phone calls, facebook as it is, text messages, and tweets. Today, Vice President pence went to dallas, where he met with Texas Governor greg abbott, whose state is currently seeing an increase in coronavirus cases. They held a News Conference with members of the White House Coronavirus task force at the ut southwestern Medical Center. I want to welcome everybody , and i here today especially want to welcome the Vice President of the United States mike pence. Thank you for being here today