American Health Care Association with us to talk about the impact of covid19 and Health Care Facilities and Nursing Homes across the country. Good morning. Guest good morning, bill. Host since the pandemic began first of all, give us numbers on how many facilities, assisted living facilities, your organization represents. Guest about 15,000 Nursing Homes in the country and about 35,000 assisted living. We represent 10,000 out of 5000 out of the 35,000. Host what are the changes you have made to address the issues, the spread of the virus, the deaths in those facilities . Guest i think the challenges really been learning about the virus. Early on nobody really knew about the virus. It was hard to control. We did not know so many people who did not have symptoms could spread it. We did not have availability of testing. We did not know what the right practices were. So it was very hard to control for the first several months. I think now that we have a better sense we are starting to get a grasp with it, but what we are learning is as the virus is in the community it spreads into the facility. Workers living at home, families are visiting, new admissions coming into the hospital bring the virus into the assisted living and Nursing Homes. Host have your facilities gotten better at taking those initial steps in addressing the things like quarantine, social distancing, and isolating people in those facilities who do have the virus . Those are stats people are taking and it has been a challenge getting those out there. The availability of resources is still limited. The number of tests, the amount of personal protective gloves,t, masks, are still hard to get. That has been a challenge. Host wall street journal this past week reporting the news that covid deaths topping 100,000 in u. S. Longterm care facilities. Despite efforts to protect senior facilities by limiting visitors and testing step or frequent, experience from the early days of the pandemic and research have shown Community Level outbreaks pose a significant risk. What next steps do you think have to be taken to try and get a handle on the virus in Nursing Homes . Guest i mean, we have been tracking it since the beginning and the amount of covid outbreaks in the Nursing Homes directly correlates with the amount in the community. If we cannot get control of it in the community, it will be hard to get control in the nursing home and assisted living. That means people need to honor the physical distancing, try not to congregate in large groups, family gettogethers are a challenge, and we are very worried that the recent holidays are going to contribute to the spread. Through the summer we saw various outbreaks in Nursing Homes that were linked back to events in the community. Host our guest is dr. David gilford, chief medical officer for the American Health association. We welcome your calls divided by time zone 202 7488000. Pacific and 202 7488001. And if you have somebody close to you in the nursing home, the line is 202 7488002. We also welcome your comments by text at 202 7488003. Gifford, have you been able to, at your facilities, been able to provide the personal protective staff as, been able to well as you had been hoping to . Ppe has gottene better, but the challenges been the n95 mask and the gloves. Those are made overseas and as we have opened up and the virus spreads again everybody is competing for those. We need to really ramp up local production help with that. We are not a priority, we competing with everybody else. The same with testing. We got tested supplies and testing equipment but not enough. Turnaround times for testing can longerake 3 to 5 days or and the virus can spread. Host moderna is going to ask the fda for emergency approval. What is the plan in Nursing Homes across the country . How will the vaccine be administered . Guest we are very excited with the prospect of the vaccine. I think that is going to help of the residents and staff in these facilities. The federal government has really been working on a robust plan where they will work with walgreens and cvs to come in and administer the clinics. Or with some longterm care for pharmacies. Formerhis is from head of the cdc who says an effective vaccine will come in the coming months and that is why it is important we slow the spread. Let us hold until vaccination is widely used. Physical distance, masks, isolation of infectious people are key. How about the intake of new patients into Nursing Homes . How has that changed during the pandemic . Guest when they come in they usually are kept in a single room and treated as if they have covid. Standpointeraction for the first two weeks. You will forget that if you get exposed to the virus and contracted, you do not develop symptoms or test positive often for a number of days, and up to 14 days, that is what everyone has to quarantine. People who will test negative and say, i do not have it. You are still in that window. You can still change. That is why we are seeing outbreaks. People are misinterpreting a negative test. When we have a new admission we have to assume they were exposed on the day of discharge from the hospital. They have to be kept in isolation for 14 days and that is very hard for them in the family. Host it must be a reall emotional toll on those that are residents and their families for not being able to see each other or see each other only from a safe distance. Do you have any sense of that . Guest no, it is very tough. Particularly for individuals with dementia who cannot remember why this is going on. Each time it is something new. It is been very tough. It has been tough in my own family. My parents are 88 and 89 and they live 45 minute away. I have hardly been able to see them. They live at home. It is the same episode. Theyre not able to interact and that has been very tough. Host we are showing some photos of various facilities with the staff fairly well masked up. Some workers in some states, im thinking illinois, have gone on strike demanding hazard pay. Is that something your organization has looked into . Guest certainly we have been arguing from the beginning that we need the right equipment for the staff to take care of the residents so there protected. I fully agree with that. We have also been advocating to congress to provide as much resources because not only is the cost of all of this equipment going up, so is the cost of hazard pay and salaries to the staff. Those costs are unsustainable. We certainly need Additional Resources from congress. Host dr. David gifford is our guest. Chief medical officer of the american Health Care Association and we welcome your comments and calls in the eastern and central time zones 202 7488000. Mountain and pacific 202 7488001 and if you have a loved one in a nursing home, that line is 202 7488002. Campaign hadris put out during the campaign a , the plan to make Nursing Homes and longterm care facilities safe. Some of what they say in their thansal is that more 200,000 americans have lost their lives because of covid19. The pandemic has had devastating impact on Older Americans and people with disabilities and the workers who care for them, particularly those living in Nursing Homes and other longterm care facilities. Part of what the bidenharris plan says is this. The administration will protect workers in Nursing Homes and longterm care facilities. Residentswill protect of Nursing Homes and facilities. He is providing Older Americans withpeopl and people disabilities a safe environment to live in. A couple of those points. One, to ensure pointofcare testing in Contact Tracing is available at every facility and ensure updated public guidance is followed with the frequency of testing for residents and staff. Two, require an Infectious Disease specialist and every related setting. Among the points again, ensure that all workers in residents in longterm care facilities have optimal ppe by fully invoking the defense production act to increase production. You pointed out you have a shortfall of the n95 masks and other ppe. It sounds like you would support some of this plan at least. Guest it sounds like a sound plan. We would support it. We have been an advocate for the infection prevention, or testing and supplies, we have been an advocate for n95 masks and increasing local production. I think all of those would definitely help. Host let us hear from jeanette in largo, florida. Good morning. Caller good morning. Good morning to your guest speaker. Home,in a nursing advanced nursing home, and a and gavel brought in it to the wing, ok . They put me in a covid wing and they said that i had a fever. They threw me in the covid section and then took me out of that nursing home and threw me in another nursing home. Not giving me my meds right. I am on morphine and percocet for pain. I have extremely bad pain and i also have osteomyelitis, which is a rare cancer of the bone in my leg. They cut my toes off at countryside. Guest are you currently in a nursing home . Caller i am home. Thank god. I want to be at home. These Nursing Homes down here in florida are terrible, sir. I cannot go on like this. I never want to be put back in another nursing home. I got scabies in the second nursing home. Scabies response . Gifford, any guest most people do not want to go to a nursing home and want to be at home. But as jeanette described, certain people need to be there after they come out of the hospital for some rehab and care. Others sometimes do not have family members and cannot live at home alone. It is really a last resort. We understand that. They are very sick and disabled as you can hear from jeanettes story. I think during this pandemic it has been a little bit chaotic with having to move residents around and try to shuffle them into covid wings in different buildings. That guidance has been everchanging as we learn more. Early on, as she described, we were moving people based around symptoms. In retrospect, we learned that is not necessarily the right thing. I think those are good points you raised. Host in general, wears most of the guidance coming from . The cdc or to most Nursing Homes follow the state and local guidance on their operations . Guest most of the guidance has been coming from the cdc. Pace in need of getting information out there, there has been a lot of state guidance and local guidance. Frankly, at times, it has been confusing. Some states were saying, do x but do not do y and other saying do y but do not do x. That is very confusing. I think we are starting to see some reconciliation on that, but we do need consistent guidance. Host let us hear from alice in new jersey. Air. , you are on caller thank you. Cspan ini listen to the morning and i get so aggravated. I am so glad i finally got through to you this morning. What i want to know is how is joe biden going to do all of these things that you say, especially today, when he has dementia . Everybody knows he has dementia. How long is he going to last as a president . Host dr. Gifford, in earlier caller mentioned that she was not able to get her medications. How has the pandemic made that a challenge for your residents nationwide . In addition, not being able to get out and see specialists and things like that . Guest the nursing home and assisted living usually work with a longterm Care Pharmacy that will ship the medications directly there. A few rely on trying to go out and get medications from a local retail pharmacy. But if you work with a longterm Care Pharmacy, you should be able to get the medications. We have not seen a shortage of medications in the setting. I think if you are living in the unity, that is different because it is hard to travel around as you move forward. Host how hard has it been to maintain staff in terms of the nurses, the aids, and the doctors that come aides, and the doctors that come to check up on your patient . Guest staffing was a problem before covid and we were asking for help in trying to recruit and get more staff to work in Nursing Homes and assisted living. But the staff of been tremendous. The care for the residents often like family members. Many times residents do not have family members or they live far away. They have really been fantastic with that process. Sick or whoe been have died from covid has been added stress. Many of the changes that have had to go on with the testing and the monitoring and all the equipment and keeping people in their rooms has increased the need for more staff. That has been a challenge. Host before the pandemic hit what was your organizations approach to a potential pandemic spread . What was the worst Case Scenario you may have envisioned before all this started . Guest pretty close to it. [laughs] a virus that disproportionately affects the elderly, this is a very serious virus which often lands the elderly in the hospital. We have certainly seen most of the deaths in the country being in those who are old. We take care of people mainly over the age of 80 with many chronic diseases. As jeanette mentioned earlier, that has been a real challenge. So to have a virus that affects this population and not everyone else in creating shortages like this has been a worstCase Scenario. Host lets go to james in connecticut. Good morning. Caller thank you very much. Hello, dr. Gifford. What i would like to ask you about is as somebody who is at a high medical position in the country, can you discuss the supply chain issue and getting access to masks that are made in the usa . 3m has mainnding is m plants here, but the main issue is that the precursor chemicals in the fabric that must be used has come from china. In other words, all roads lead to china even before we want to produce more masks. As somebody who is in the know can you explain to the American Population if we need to lower our epa standards to allow chemical plants to reopen in the usa so we can make the precursor chemicals that coat the fabric for the masks . No one seems to explain how these masks are really produced in a supply chain and i would appreciate your higherlevel overview. Thank you. I will take it off the air. Guest james, it that is an excellent point. Even if you were to open up and make plants in the united states, the Raw Materials come from all places around the world, not just china. Mexico has been making a lot of personal protective equipment and many suppliers have turned to mexico on this. The Raw Materials have been a problem. Early on the materials that make masks with the same used for gowns. Everyone took that to make masks and it created a shortage of gowns. N95 masks take time to build the right equipment and you just cannot turn it on and make it right away. That has been a challenge of the supply chain as well. Tohink it really speaks where we fit in the world and how we relate to all the difficult because working alone trying to do it alone, even if we made lots of factories, would not work because we do not have the supplies we need. It is going to take the world working together to battle this pandemic. Host for those of you who have a loved one, a friend, in a nursing home it is 202 7488002. On that line is diane from akron, ohio. Caller hi. My mother is in a nursing home. She did get covid, but luckily recovered. There is a lot of problems with Nursing Homes. Although it is highly rated, we are considering moving her to a different facility. I would like to know what the doctor thinks are the most important things to look for when youre trying to search for a decent place with the decent food and a good staff. I will hang up. Thank you. Host ok, diane. Guest i am glad your mom recovered and the majority of people who have gotten covid have recovered. As far as how to select a nursing home, it is very common question i get in my role and what ive been doing throughout my career. The first question i ask is why does someone need their nursing home . Are they going there for rehab care right after being in the hospital . Are they going there to live . Do they have dementia . How mobile are they . You want to match up the needs of the individual with the facility. The other issue is there is a the federal government collects a lot of different information on survey inspections on the Staffing Levels and other critical outcomes. Again, i would look at that. I would not just look at the overall rating, whether it is fivestar, threestar, two star whatever, i would make sure the areas of need are doing well. If theyre going there for a short stay, i want to focus on that aspect. If they are going there for dementia care, i want to focus on longerterm aspects. I find that is the best source for looking for information. Certainly you need to visit the facility and see what is going on. Are the staff interacting with the residents or are the residents napping interacted with . It is a little harder to do that visiting because of covid. But that is something i would also do. I think people often try to pick the facility closest to them so that they can visit more frequently. That is an important aspect, but proximity to you may not be guaranteed the best facility and you may have to go a bit further to get a better facility. That is a balancing act that many people have to balance is the pickup facility. Host the next is john in philadelphia. Caller all right. Good afternoon. Sorry to get started a little late. We have voting going on