Casey pennsylvania and bill cassidy of louisiana discussing the impact of coronavirus in Nursing Homes. They look at the need for increased testing and adequate medical supplies for longterm care facilities. Hello and welcome to an axios Virtual Event. I mike allen, cofounder of axios, and welcome to my home in arlington, virginia. Im right across the bridge from georgetown and at 76 degrees in here because i dont know how to fix my thermostat. Todays axios Virtual Event is on a topic that hits very close to home to me, and a no for a lot of people in the audience. Id like to thank aarp for making this conversation possible. We are going to talk about Nursing Homes in this covid moment, and more broadly, how longterm care for people 65 plus is affected by these changes in our world. Theres no part of the covid crisis that its closer to home for a lot of people. Thank all of you who are following online. We would love for you to tweet along at hashtag axios events, and you can follow us on twitter at axios events. I would like to thank my events Team Colleagues who pulled this off and Caitlin Owens who writes a daily axios vital newsletter will be joining our conversation shortly. You can sign up for her newsletter. Thanks again to aarp. Earlier today i got to catch up with senator bob casey tricksters are conversation. Would like to think thank aarpr making this conversation possible. Our next guest is senator bob casey of pennsylvania coming to us from one of the countrys most fascinating places, scranton. Senator casey, a lawyer, is on the finance committee and on my favorite named senate committee, help, health, education, labor and pensions. Senator casey, to rejoin this axios Virtual Event. Mike, good to be with you. Thank you. Senator, which i got Nursing Homes and how it affects people in this covid moment. Theres almost no subject that hits closer to home for so many of our viewers, and you are sounding the alarm early this is going to be a problem. Mike, heres the scale of it, just give people a sense of the scale. Last i saw was 37,000 people have died in longterm care settings. When you combine the number of residents who died with the number of workers. Thats more than a third of the total death count in the country. So this is a grave, serious problem that demands urgent action. When i proposed now its way back in early march, legislation to focus resources on Infection Control and other practices that would help in the longterm care context, including home and communitybased services, a cousin thats where a lot of folks should be provided the longterm care that they receive, in a home setting in a communitybased setting where they can be provided longterm care but not have to be in a nursing home. But, of course, at that time that would include new resources for medicaid. And because of that theres a lot of republican resistance. But i want to continue to press this because i have new legislation now that focuses on resources to deal with the problem right now. Because when you consider what these individuals have come into our country, Nursing Homes are full of people who fought in wars and work in our factories and raise our children and built the greatest middle class, build the greatest country in the world, the least we could do is make sure that we dont have a repetition, a replication of what has happened over the last several months where tens of thousands of people are dying in Nursing Homes without an action plan, which has to start at the federal level. The administration and congress doing more to combat this problem. Thats a a very resident pot you make about how many life stories are in those buildings. I visited and longterm care facility in oregon, and you can pick anyone, sit and talk to them and have a great story to tell you. Senator, in addition to that emergency funding, you also been pushing for more federal oversight. We have. Way back in early april, senator ron wyden and i sent a letter to both cms, sit on Medicaid Medicare Services called cdc say why are you not providing the information on the number come on deaths and the data on outbreaks in a facility . And provided information so that not only the residents of that nursing home knows whats happening in the building they live in, but also so their family knows and the community knows. Because there is no way we unfortunately learned in a very brutal way, if you dont test and if you dont have a sense of the scale and the scope of the problem, you are not going to be able to deal with any kind of covid19 challenge. We are still waiting for that data, and the administration has said over and over again, cms especially has said were going to provide this information by the end of may, and here we are. This information is central for our ability to combat the problem, to provide better care in Nursing Homes, and to stop or reduce rated the number of deaths. Greatly the number of deaths. Something else i know youre very concerned about is what its like to be living in one of these facilities and the sense of isolation, sometimes not even have an the technology that you and i take for granted. There is new data over the last number of years just on the fiscal impact of isolation, and probably a lot of people listening to us are familiar with that. Isolation can have a physiological adverse impact on someone. When someone is in a nursing home and they are accustomed to having a Family Member come and see them on a regular basis, at least two things happen. Number one is that resident feels they are connected to something. It breaks apart that isolation, or at least reduces it. The second thing that happens is theres a Family Member or members become the eyes and ears for that person. If the care is a good or if theres something the resident has a question about by the Family Member does, they can ask those questions. Now we any circumstance where theres total separation, social distancing and Family Members are not able to connect with her loved ones. Senator klobuchar and diane senator ouppercaseletter have legislation called the axis act senator capito which would buy that Tech Knowledge and help the families need to be able to connect at least virtually because we cant assume every family of every residence inn nursing home has that kind of technology. So its a good bill, bipartisan and hope we can get it done. I do think in addition to that though we need an action plan and action plan should start with what is in my second bill, senate bill 3768, and that bill would work on prevention strategy so that we are providing more dollars. We know that works when you separate in our longterm facility someone with covid19, a resident come with a resident who does not have the it we alo need those dollars for testing, personal protective equipment and even search teams. You can send in medical professionals in a longterm facility might need, or doctors, more nurses, more nurses assistants and the like. We had to combat this problem with a sense of urgency. Theres no excuse for allowing those numbers to continue to grow. We need an action plan nancy penultimate question from a viewer, asks if you see more federal regulation regarding Infection Control . Well, ill say this. The administration has focused more attention on Infection Control now. Theres a debate about what happened prior to covid19 at a not really happy about the way they approached it up to now. But there focusing on Infection Control, we cannot have happened because of scarce resources to the resources go only to Infection Control. Theres still a lot that happens in a nursing home that requires oversight and regulation and vigilance really. I think we have to do everything. We have to focus intensively on Infection Control now. We also have to do other oversight, but in a case where youre trying to mitigate or reduce the likelihood of a covid19 spread, we need those search team spirit we need the new dollars. Sometimes in the facility they may want to separate people they physically cant expand or retrofit the facility to do that. We need to give them the help they need. Im proposing 20 billion in this bill. Senator casey count as a sacred but i cant let you go without asking you one question about your fellow scranton native joe biden. Pennsylvania is probably the key to sandra biden, Vice President biden becoming president. What is the outlook for pennsylvania, Vice President biden will win pennsylvania if, what . I think he will win pennsylvania, and believe he will. I think he will win it if he can combine that coalition has been successful lately, making sure that urban and suburban turnout is very high because in both instances he will get an overwhelming vote their, but what we cannot do though is allow ourselves to take our eye off the ball with regard to the small towns in the rural areas. Doesnt mean you will win them but you have got to get a certain number from those communities, and thats where 2016 didnt work out very well. And im still frustrated by that. I want to make sure it doesnt happen again. The good news is i think winter pretty good temperament 2010 when i was running and governor wilk was running. We are going to get higher numbers in his canaries in addition to suburban and urban but i think joe biden is for a strong in the state for lots of reasons, some good because hes a native son of scranton and as good roots in the state over all but i think his decency, his expense, his compassion is coming through especially in the midst and then it is of folks are looking for some especially dems have lovely nursing home or in another circumstance which puts them at risk. Senator casey can we always end up axios Virtual Events with one fun thing. These are sobering times. Would like to end on a light note and i get to congratulate you, you are a grandfather, but you havent you told me you havent yet senior grandchild, right. As i a grandson in san francisco, and thats a long way from scranton the good news is my wife is able to go out weeks before the baby was born and be there, but i but i couldnt get there some looking forward. Thank goodness for Video Technology as well as thousands of pictures. Senator casey, thank you so much for the conversation today and i look forward to being able to see you in person on the hill. Thank thank you, mike. And thank aarp. Now will go across the parkway to axios ceo jim vandehei. Thank you, mike, i thank you to aarp for making this very important conversations about Nursing Homes on the front lines possible. Its now my pleasure to have a conversation with Nancy Leamond was the chief advocacy officer for aarp. Nancy, how are you . I am fine, thank you, jim. When we think about the coronavirus, its obviously a national crisis, but when you think about Nursing Homes and longterm care, its an authentic catastrophe. Onethird of the people who died have died and longterm facilities are working in them. Is it going to get worse . You spend spent so much time tg about this and ways to prevent this. Well, youre absolutely right. Whats happening in nursing home today and other longterm care facilities is a national disgrace. On federal 29th Washington State reported the first covid19 outbreak in a longterm care facility, and here we are three months later and we still dont have a solid consistent action plan across the country. As of monday more than 36,000 nursing home residents and staff had died from covid19. Thats onethird of all deaths, and get some states like virginia, new jersey and iowa, 5070 of the covid deaths have been in Nursing Homes. Nobody should be going through what nursing home residents and their families are going through today, and we are hearing from thousands of our members about their heartbreak. We just heard the other day from a person from georgia who told us about our mother in law, ava, who died in the hospital 30 hours after she was transferred from the nursing home. The nursing home never told her that her motherinlaw was that sick or had covid. Its just devastating what families are going through. Is essentially a national emergency. What more could the federal government, state government, what more could we be doing to help these facilities . Its soon going to spread to Rural Communities that my that even have as good facilities as some of the facilities that a been hit in big cities. What should we do . What can we do . Absolutely it is going to spread at it already has. We did a apprehensive plan to protect residents in Nursing Homes, no matter where they le comprehensive plan. Aarp is called a Nursing Homes, the congress and administration to take action. First, in terms of Nursing Homes we know they need to be doing far more testing of everyone and providing personal protective equipment for anyone who works in a nursing home. We heard last week from people who went to see their loved ones and saw some of the people that work there wearing garbage bags because of the death of the kinds of protective equipment. So thats a job one, testing and making sure people have the right protective equipment. Second, we know that Nursing Homes need to report every single day to help authorities how many cases they have and what they are doing to manage those. Communications not just to help officials but also to Family Members. And finally we have been working very hard to ensure that Nursing Homes provide opportunities for virtual visitation to Family Members and their loved ones. We understand theyre trying to limit the number of people going into the nursing home, but you dont want to cut people off from their loved ones. And then finally we know its important to make nursing home residents and their families continue to have their rights. Thereve been a little bit of a debate about whether immunity should be granted from liability for Nursing Homes. We think they need to remain dean responsible for the health and safety of the residence. What percentage of Nursing Homes, longterm care facilities do you think have an inadequate amount of testing materials or protective gear . We dont have a number right now, but we know that many, many Nursing Homes do not have adequate protective equipment and are not fully able to test. And it varies across the country. For example, the state of West Virginia was very quick to determine that needed to do testing in every facility. At the same time we know they dont have enough protective equipment for everybody who works in those facilities. Other states like arizona are very far behind. Maricopa county which accounts for roughly half of the states population, is also accounted for about 82 of the deaths in Nursing Homes. So we know it varies, and we dont have good number right now. We are working with cms and the department of health and Human Resources to make sure that people are able, the Nursing Homes, are able to get the funds they need so they can have equipment, to the testing and meet some of the standards we all expect. Whats probably most sad and scariest about what youre talking about, if you think on a spectrum, as we all return to normal, at the very end of that spectrum are People Living in these facilities that will be able to have normal interactions with Family Members, again be able to visitors, not have to fear a reoccurrence of the virus. What can the government do . What can we do to help those people who are, a lot of them lowly to begin with, i might go months without human contact from family and friends . Well, first off with to ensure that our opportunities to the virtual visitations, and technology for families to connect with their loved ones. In cases where people dont have families, members, the are a number of efforts across the country including one that aarp is sponsoring called Community Connections where volunteers are able to talk to people either on the phone or through facetime. This is an opportunity to have real connection, and as you point out, connection is going to be so important. Loneliness is almost as Serious Health issue as the virus itself. So if i wanted to or of viewer wanted to volunteer with aarp to one of these conversations by phone or soon will be just go to the aarp website and easily find out how we can help . Yes, you can go to aarp. Org Nursing Homes, and on the page will have the connection so that you can volunteer in that way. Awesome. Nancy, thank you for a very important and fascinating discussion and thank you for the work you are doing, trying to help get really for a lot of these people who are stuck in Nursing Homes and are really at the biggest threat to this virus, so thank you very much for the conversation. Thank you. Thank you to axios for pulling together such a distinguished panel so that we can shine a light on what congress is considering doing to address this issue as well. Thank you very much, and back to you, mike allen. Thank you very much, jim. And thank you, nancy. I first met nancy when is a brandnew reporter on the hill. If youre new on the beat nancy is a a good person to know. Our next guest is senator, dr. Bill cassidy of louisiana, i gastroenterologist in baton rouge. He founded a free clinic to help people get, who are uninsured, get dental, healthcare services. When i was growing up, my mother volunteered at a dental clinic. I know how important that is senator cassidy also worked to give vaccinations for people in baton rouge who needed them. Senator, dr. Cassidy, welcome to axios. Thank you, mike. Appreciate you joining us. We just heard your colleague on the finance committee and on the h. E. L. P. Committee, senator bob casey of pennsylvania, talk about this emergency in Nursing Homes facing, the need for more emergencies. Senator cassidy, this turned out to be an issue democrats and republicans. It does. For example, you mention what can we do about, thing is what we do about the death rate among those in Nursing Homes. Theres two issues here. There are those who are high risk of infection, and then theres those who are high risk if they get infected. In Nursing Homes folks in Nursing Homes are in the latter group. High risk if they get infected. Cdc has put out recommendations, or hhs has, that we should be testing workers in Nursing Homes once weekly for virus. I actually think that should be twice weekly. Why twice weekly . Because if you are infected, on average, five to six days later you will begin to have symptoms, but you are shedding virus for two days before you become symptomatic. [talking over each other] you only testing, you may be shedding virus before you checked again next time. So if you have a mondayfriday, you actually should catch most people prefer the began to actively shed virus, or mondaythursday mondaythursday i should say, tuesdayfriday. We do need to think through bible to nims, think population like Nursing Homes and your best to keep infection out of the nursing home so that we can decrease death rate to the defense of the Nursing Homes and also to the benefit of society. My colleague at axios bob who covers healthcare business did an article yesterday talking about how care for seniors is even more complicated than the covid era. Always a lot to get, is a lot of Financial Issues for families. Its even harder now when you cant necessarily get it in person tour and if you look at the stress on these institutions, senator cassidy, whats it going to be like when this pandemic receipts, lord willing, when where past the immediate emergency, whats the longterm changes or help you think Nursing Homes and other longterm facilities need . Well, you have to give me some specification. Do we have an effective vaccine . If we have an effective vaccine then you will be able to vaccinate folks and kind of things go back to normal. If we do not have an effective vaccine, then you have to make much greater use of telemedicine, telehealth in general. Some things dont give themselves to telehealth. What do you do about physical therapy, occupational therapy, dentistry . You cant really do those by telehealth and you cant so youre going to to think what to do otherwise. I think were going to come to the point where we know that if someone has been previously exposed, that they are immune to future infection. If thats the case you may have your physical therapist occupational therapist be those who are known to be at the body positive, and so, therefore, they can enter and you do not have to fear them infecting those who work there. That would be one thing. Dentistry, it may be that youre going to have dental units in which you have all the strict kind of Infection Control so that the person who live in a nursing home or whose otherwise at risk can go to the dentist and know that they wont be infected. Thats going to be a lot of kind of how do we prove it sort of thing. Well work it out. We work about the dentist are great at this. Dentist are incredibly detailed oriented, so we will work it out but it is something we have to think through. Something youve been on the forefront of his pushing the idea of immunity registries, and you had an opinion piece in the wall street journal where you said the young will reopen america. Tell us about your big i get. Yeah, so should be more properly, yeah, any movie registry will work. The people who are paying the highest price relative to the risk of complications from covid19 are the young. If a fiveyearold is not attend school, shes only five once in her life. Her mind is a sponge. She hears a word, a Foreign Language word in context, the definition without that definition being written down for her. Oh, my gosh. Wouldnt it be wonderful to have that brain forever . If we dont allow her in school at that critical mind is a sponge age, she loses and we lose. Because she is lost that education opportunity. Particularly for those who come from environment which are not as enriched. They dont have internet at home. They dont have the same books. The parents have to work to support the family. So my thought is, is that if you let the younger people, younger being less than 30, kind go about the life a little bit more openly, understanding that they if infected can still affect of the people, you have to take that into account, they dont have the opportunity the missing college and missing work and can also lead to weight and opening up a comment for the rest of us. We have to think that through. The penalties for shutting down the economy disproportionately fall upon the young. We should not penalize the more than have to, and on the other hand, as we give get the more m they can benefit us by by the r caregivers, working, Everything Else we need to have a functioning economy. Senator cassidy, President Trump appoint you to his task force on reopening the economy. Congratulations. I guess you could say. What is most important thing we need to do to reopen the economy or not . We have to balance safety with reopening the economy, which is to say that we need a strategy which allows the economy at testing and of limitation a strategy to allow the economy to again flourish. Ill put it carefully. If i can go safely to a tailgate before and lsu Football Game without winning a mask, we have accomplished our purpose. The flood of Economic Activity that comes when lsu wins a Football Game. Or any other school as well. The point being we are nowhere close to that. And so we have to have that sort of testing and use of testing strategy to allow a full reopening. Thats what we need. Quick question on the personal site. You are also married to a doctor, dr. Laura cassidy. What is it like a pair of doctors in this once the century, once a lifetime, global emergency . Its wonderful. I was actually now devotes herself, has a public charter school. This whole idea of opening schools is up in person. Working very closely together on a testing and Mitigation Strategy that allows young people to come back. My wife is so bright. She is active intellectually. Her involvement in that school informs the Public Policy for which i advocate. Its an incredible blessing to be married to her. Great. Senator cassidy, we always end our newsletters and interaxios Virtual Events with one smile to go. These are tough topics that we are slogging through together so we like to end on a high note picky make intel gets. He mentioned lsu. You are an undergraduate and a medical graduate of lsu. You are the real deal as a fan. You are actually there. What is again gay going to be like for the tigers this fall. Was well, it depends on testing. I do like to think that it is going to be something which is totally free. Imagine my wife. She is an alabama fan. [laughing] i had a cousin at alabama. I think i remember you are an alabama fan which i try not to hold against you. But on the other hand, im hoping that it is a measure of recovery that we can enjoy College Football and other diversions, and not be distracted by people fearing infection. If were able to do that, and i will enjoy alice use victory and help the Second National chairmanship in a row but i will enjoy it even more knowing that we are all safe in doing so. It sounds like you think there would be some fans in the stands for home games at lsu this fall. I sure hope so. It is a measure of success of our society if we are able to achieve that. It is not pie in a skype you look at south korea in new zealand, they have effectively eliminated the threat from public gatherings from covid. That should be our goal. We should stop we should not stop less than that. That would be, that should be the consummate we aim for. Senator cassidy, thank you much for joining axios no tigers, except when youre playing the tide. [laughing] back at you. Thank you, senator cassidy come for the great work you did we appreciate your we thank alp for make this conversation possible and enjoy now by my colleague Caitlin Owens who covers healthcare 24 7 including a lot of time on the hill as she writes our morning newsletter, axios vitals, while were doing sec football shes a north airliner graduate. Caitlin, thank you for joining us. Thanks for having me. So caitlin, as we think about Nursing Homes, and youve been covering a lot about whats inside the mind of these longterm care facilities, something youve done a lot of reporting on, its what theyre doing to prepare for the next wave. This is the heart income is we have learned yesterday we official hit at 100,000 coronas deaths in the united states, as weve talked about throughout this event a large portion of them were from longterm care facilities. As much of a a childs as thats we have learned a lot over the past couple of months. Its very obvious that its also become obvious what we can do to stop the sum happening again. A lot of it comes down to the Public Health 101 of testing, tracing, isolation. We need to make sure were testing prolifically in Nursing Homes, and once the virus makes its way into a nursing home or any kind of longterm care facility is to get into isolation measures, where the person is kept with all the other residents of the nursing home and the staff isnt double dipping, so to speak to both healthy and built residence. Thats much easier said than done. Theres some Nursing Homes of longterm professors often dont have a lot of resource, understaffed, crowded. So i think they are running against we just have to make up our minds to [inaudible] caitlin, yesterday you and i were texting about this topic and you pointed out a headline to me, and ap story based on the state by state analysis that found that most Nursing Homes in most states are not meeting white house guidelines. Whats the significance of that . Why does that matter . The white house guidelines were about testing. I think it was they wanted every resident of a nursing home, i think it was [inaudible] it goes back to resources. It goes back to staffing, tests are not necessarily cheap. And so i think why it matters is we need to test and get a baseline of where we are at Going Forward but we also need to be doing this all the time. We need to be testing routine and Nursing Homes, and the fact that we cant get this, ap reported some states not only were not meeting fiscal, were not even trying at all. I think a california was still time to put in place a plan when the ap reported this earlier this week. We are already behind the ball. Talk about things we need to do to try to keep this travesty for mapping again Going Forward, and yet if we cant do the 101 101f testing and Nursing Homes at least every couple of weeks, the test is a snapshot of typing you can do a test whats it say were good to go. Clearly this is a problem we still need to work on and were not out of the woods by any means yet. Okay. Take thank you for your great coverage. Thank you for this conversation. Thank you so much, mike. We would like to thank arb for making this focus on Nursing Homes on the front line such a consequential subject possible. Thank all of you for taking the time to join us in this conversation, for sending in your questions. I would like to thank my axios event colleagues who pull this off, a million moving pieces to bid on the attack on peoples home. Its amazing what to do. Thanks to them. I appreciate your interest in this topic, and i will see you on the hearing beginning at 10 a. M. Eastern on cspan, on demand at cspan. Org, or listen live wherever you are on the free cspan radio app. Covid19 has killed hundreds of thousands of people worldwide. The virus, unfortunately, could