[Senate Hearing 116-534]
[From the U.S. Government Publishing Office]
S. Hrg. 116-534
CARING FOR SENIORS AMID
THE COVID-19 CRISIS
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
WASHINGTON, DC
__________
MAY 21, 2020
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Serial No. 116-19
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
47-030 PDF WASHINGTON : 2022
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SPECIAL COMMITTEE ON AGING
SUSAN M. COLLINS, Maine, Chairman
TIM SCOTT, South Carolina ROBERT P. CASEY, JR., Pennsylvania
RICHARD BURR, North Carolina KIRSTEN E. GILLIBRAND, New York
MARTHA McSALLY, Arizona RICHARD BLUMENTHAL, Connecticut
MARCO RUBIO, Florida ELIZABETH WARREN, Massachusetts
JOSH HAWLEY, Missouri DOUG JONES, Alabama
MIKE BRAUN, Indiana KYRSTEN SINEMA, Arizona
RICK SCOTT, Florida JACKY ROSEN, Nevada
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Elizabeth McDonnell, Majority Staff Director
Kathryn Mevis, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Susan M. Collins, Chairman.......... 1
Opening Statement of Senator Robert P. Casey, Jr., Ranking Member 3
PANEL OF WITNESSES
Mark J. Mulligan, MD, Director, Division of Infectious Diseases
and Immunology, Langone Vaccine Center, Director, Thomas S.
Murphy, Sr., Professor, Department of Medicine, New York
University Grossman School of Medicine, New York, New York..... 5
R. Tamara Konetzka, Ph.D, Professor of Health Services Research,
Department of Health Sciences, University of Chicago, Chicago,
Illinois....................................................... 7
Steven H. Landers, MD, MPH, President and CEO, Visiting Nurse
Association Health Group, Holmdel, New Jersey.................. 9
APPENDIX
Prepared Witness Statements
Mark J. Mulligan, MD, Director, Division of Infectious Diseases
and Immunology, Langone Vaccine Center, Director, Thomas S.
Murphy, Sr., Professor, Department of Medicine, New York
University Grossman School of Medicine, New York, New York..... 39
R. Tamara Konetzka, Ph.D, Professor of Health Services Research,
Department of Health Sciences, University of Chicago, Chicago,
Illinois....................................................... 43
Steven H. Landers, MD, MPH, President and CEO, Visiting Nurse
Association Health Group, Holmdel, New Jersey.................. 55
Questions for the Record
Mark J. Mulligan, MD, Director, Division of Infectious Diseases
and Immunology, Langone Vaccine Center, Director, Thomas S.
Murphy, Sr., Professor, Department of Medicine, New York
University Grossman School of Medicine, New York, New York..... 59
R. Tamara Konetzka, Ph.D, Professor of Health Services Research,
Department of Health Sciences, University of Chicago, Chicago,
Illinois....................................................... 59
Additional Statements for the Record
American Seniors Housing Association............................. 63
National Adult Protective Services Association................... 69
Community Living Policy Center................................... 71
Leading Age: VNAA Elevating Home................................. 74
Consortium for Citizens with Disabilities, letter dated May 21,
2020, with attachments......................................... 80
The Society for Post-Acute and Long-Term Care Medicine........... 97
Alzheimer's Impact Movement...................................... 102
American Association of Service Coordinators, Janice Monks
Statement...................................................... 105
Service Coorinator Response to COVID-19.......................... 109
American Association of Service Coordinators..................... 111
American Health Care Association and The National Center for
Assisted Living................................................ 114
CARING FOR SENIORS AMID
THE COVID-19 CRISIS
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THURSDAY, MAY 21, 2020
U.S. Senate,
Special Committee on Aging,
Washington, DC.
The Committee met, pursuant to notice, at 9:33 a.m., via
Cisco WebEx and in Room 301, Russell Senate Office Building,
Hon. Susan Collins, Chairman of the Committee, presiding.
Present: Senators Collins, Tim Scott, McSally, Braun, Rick
Scott, Casey, Gillibrand, Blumenthal, Warren, Jones, and Rosen.
OPENING STATEMENT OF SENATOR
SUSAN M. COLLINS, CHAIRMAN
The Chairman. The hearing of the Senate Special Committee
on Aging will come to order.
Good morning. Welcome to today's hearing on Caring for
Seniors amid the COVID-19 crisis.
COVID-19 has brought tremendous hardship and tragedy,
placing a heavy burden on the frontline workers, straining our
healthcare and distribution systems, and imposing a deadly toll
on seniors in particular. It has hit close to home for many on
this Committee, and I am sure that all of our members want to
join me in expressing our condolences to Senator Elizabeth
Warren, who lost her 86-year-old brother to the coronavirus.
Elizabeth, we are very sorry for your loss.
Restrictions on visitors to nursing homes have affected
even those families whose relatives do not have the virus. I
know two brothers from Bangor, Maine, whose father is in a
nursing home and has dementia. They have not been able to see
him for some time now, and his health is failing. They are
worried that he may not still be alive by the time they are
allowed to visit him, something that used to happen regularly.
This virus has already claimed the lives of more than
90,000 Americans, the vast majority of whom were older adults.
Adults age 65 years and older are more likely to suffer severe
complications from COVID-19 and to have more difficult
recoveries. They represent two out of every five
hospitalizations and eight out of every ten deaths from the
virus. Those in nursing homes and other congregate care centers
are especially at risk. Nationwide, nursing home residents
represent one-third of all coronavirus deaths.
In Maine, the toll on nursing home residents is even
higher. Maine is the oldest State in the Nation by median age,
and the Centers for Disease Control and Prevention reports
1,819 cases in our State, and the virus has claimed 73 lives.
More than half of those deaths have been residents of long-term
care facilities, so you can see that Maine has an even higher
death toll in nursing homes and other long-term care facilities
than the national average.
Earlier this month, Senator Sinema and I wrote to the
Administrator for the Centers on Medicare and Medicaid
outlining a series of recommendations to better protect older
adults in nursing homes. Among the issues that we urged be
considered is how long-term care facilities and in-home care
settings can access adequate testing as well as personal
protective equipment and how the higher health risks of older
adults living in nursing homes can be taken into account in the
distribution plans for any future COVID-19 treatments and
vaccines.
New diagnostic tests, therapeutics, and vaccines are moving
forward at remarkable speeds. I look forward to learning more
about this research today as well as promising treatments and
strategies that can speed recovery for the most vulnerable
populations. Through this and subsequent hearings, I hope that
we can gain insight into additional actions that may be needed
to better protect our seniors.
Congress has already taken a number of actions in response
to the pandemic. We have passed four legislative packages
totaling nearly $3 trillion to provide public health support to
States and economic relief to small businesses and families.
Phase 1, provided appropriations to supplement the Strategic
National Stockpile; to develop and purchase diagnostics,
therapeutics, and vaccines; to support community health
centers; and to help hospitals and health systems respond.
Phase 2, provided free coronavirus testing and increased
Federal funds for Medicaid and other critical safety net
programs. Phase 3, known as the CARES Act, provided additional
funding to purchase critical protective equipment and testing
for the stockpile; new resources for medical professionals on
the front lines, to whom we owe a great debt of gratitude;
direct aid to States; and economic support for small businesses
and their employees through the Paycheck Protection Program.
The CARES Act also included the Home Health Care Planning
Improvement Act. This is a bill that I have championed for 13
years to allow nurse practitioners and physician assistants to
certify home health services.
Cutting down on time-consuming, unnecessary paperwork
requirements that not only fail to improve patient care, but
also delays access to that care, could not have come at a
better time.
In addition, the CARES Act makes a number of improvements
in the delivery of telehealth. More progress is still needed,
and I plan to introduce a bill soon to create a framework to
reimburse for telehealth services provided by home health
agencies. Finally, Phase 4 provided an additional funding for
the Paycheck Protection Program, $75 billion for our hospitals,
and $25 billion for additional testing.
Much of the funding provided through these bills has yet to
be released by the Department of Health and Human Services;
therefore, I urge the Department to act with urgency so that
this funding can flow to areas where it is desperately needed.
Today we will hear from a panel of experts who are leading
the charge in supporting seniors across a variety of settings
of care, including in hospitals, in nursing homes, and in the
community.
We will be joined by Dr. Mark Mulligan, a physician who
serves as the director of the Langone Vaccine Center at New
York University; Dr. Tamara Konetzka, a professor of Health
Services Research at the University of Chicago whose research
focuses on quality of care in long-term care settings; and Dr.
Steven Landers, a geriatrician who serves as the president and
chief executive officer of the nonprofit Visiting Nurse
Association Health Group.
I am grateful to each of them for the work that they are
doing and for taking the time to join us today. Their expertise
will help us advance public policies, to slow the spread of
this devastating pandemic, and to lessen its impact on our
Nation's vulnerable seniors.
Senator Casey, I know you are joining us remotely, and I
would now call on you for your opening statement.
I also want to acknowledge that Senator Braun has joined us
in person at the hearing this morning, and as I said, there are
many that are online joining us and we expect others to be here
physically as well.
Senator Casey?
OPENING STATEMENT OF SENATOR
ROBERT P. CASEY, JR., RANKING MEMBER
Senator Casey. Chairman Collins, you can hear me, I hope.
[No response.]
Senator Casey. I will assume that you are hearing me.
Chairman Collins, thank you for convening this hearing. Our
Nation at this point in our history is facing the greatest
public health crisis in a century. This terrible virus is
causing death and destruction at lightning speed.
For seniors, the only thing that is moving faster than the
virus itself is fear: the fear of being alone; the fear of
contracting the virus; and of course, the fear that comes from
isolation and that has every single member of the family
worried, worried for our seniors.
Thousands of seniors in hospital ICUs and nursing homes are
dying scared and alone, with no family and no friends to
comfort them in their final moments. Millions of seniors more
are at home, isolated from their loved ones and scared to death
often to leave the house even to get a bag of groceries.
This unprecedented challenge calls for equally
unprecedented action. The administration has to do more.
Congress has to do more to help our seniors and our families at
every turn.
It is now May the 21st, and we still have no national
testing strategy from the administration.
The lack of personal protective equipment continues to put
our health care providers and other frontline workers at risk.
In turn, this puts every single person they come into contact
with, and it also puts at risk the entire community.
Nursing home residents make up 0.05 percent of the
population, and yet deaths associated with nursing homes and
other long-term care settings account for over one-third of all
deaths from COVID-19, as Senator Collins just outlined, 0.05
percent of the population yet one-third of the deaths are
nursing homes and long-term care settings.
Still to this day, we are trying to help those residents
and workers in nursing homes with one hand tied behind our
backs because the administration is not--is not releasing data
on outbreaks in these facilities. This is unconscionable, and
the administration needs to act.
We have heard promises that by the end of May, they will.
We need to see specific evidence that they are changing policy
to give families, residents, and workers in nursing homes and
other long-term care settings more information.
Now, Congress has taken a number of steps, as Chairman
Collins outlined. We have added unprecedented amounts of
funding to purchase personal protective equipment to keep
workers from contracting and transmitting the virus. We have
funded efforts to help health care workers and health providers
help patients in those settings. We have provided dollars to
ensure that seniors have access to proper nutrition at home but
not nearly enough.
The policies and funding in these four bills that we have
passed into law only begin to scratch the surface. Congress has
to do more.
Just last week, the House of Representatives passed the
HEROES Act, and that legislation, among many things it does,
calls for policies that I have been calling for since the
beginning of this crisis, especially as it relates to seniors.
It would require, the bill would, nursing homes to collect data
on the impact of the virus on residents in nursing homes and
other long-term care facilities so that we know how to
distribute resources. The bill would also provide those nursing
homes the dollars they need to contain the spread of the virus.
The bill would also invest in home-and community-based services
for seniors and people with disabilities, especially the
800,000 seniors and people with disabilities on waiting lists
for care so that they can receive the services and the supports
that they need to keep them out of congregate settings. This
bill would also pay our essential frontline workers for leaving
the safety of their home to care for our aging loved ones.
For the generation that has fought our wars and worked in
our factories and taught our children and build the middle
class, built the Nation that we have, and gave each of us life
and love, we have to do more for our seniors. We cannot stop
working. We cannot stop legislating. We cannot stop
appropriating dollars to help our seniors. We owe it to them to
do everything we can. There is no such thing here as doing too
much for our seniors in the grip of this pandemic.
Chairman Collins, I want to thank you for convening this
critically important hearing, the first hearing in Congress on
the impact of COVID-19 on seniors, and I look forward to the
testimony from our witnesses as well as the questions.
Thank you.
The Chairman. Thank you very much, Senator Casey.
For those of you who are watching us on C-SPAN, I want to
explain that this room is specially configured in line with the
social distancing recommendations of the CDC, which is why you
see so many blank spaces, and again, we have several members
who have already joined us remotely. I see Senator Josh Hawley.
I see Senator Rick Scott, and there are others as well, some
more who will be coming physically as well. There are also many
other members whose pictures I cannot see but who have joined
us at the hearing. I wanted to explain that this is one of only
three hearing rooms that is configured to allow us to hold
hearings. I see Senator Blumenthal has also arrived, and I want
to acknowledge him as well.
We are now going to move to our witnesses. Our first
witness, Dr. Mark Mulligan, is joining us from New York
University. Dr. Mulligan is the director of the Division of
Infectious Diseases at the NYU Grossman School of Medicine, and
director, as I have mentioned previously, of the university's
Vaccine Center. He is a professor of medicine and a professor
of microbiology at NYU. As the chief infectious disease
specialist for NYU, he oversees the treatment of COVID-19
patients at the university's health system hospitals in
Brooklyn, Long Island, Manhattan, Bellevue, and the VA.
Next, we will hear from Dr. Tamara Konetzka. Dr. Konetzka
is a professor of health services research at the Department of
Health Sciences at the University of Chicago. Her research
focuses on the relationship between economic incentives and the
quality of care in long-term care facilities. She is leading
work to untangle factors associated with the disproportionate
impact of COVID-19 on nursing home residents and staff.
Finally, we will hear from Dr. Steven Landers, the
president and CEO of the Visiting Nurse Association Health
Group. VNA is the Nation's second largest not-for-profit home
health care organization in the country. Dr. Landers is a
family doctor and a geriatrician with a special interest in
home care, hospice, and palliative care. He focuses on home
visits to low-mobility older adults and has played a critical
role in caring for seniors during this pandemic.
Dr. Mulligan, we will begin with you. Thank you all for
being here.
STATEMENT OF MARK J. MULLIGAN, MD, DIRECTOR,
DIVISION OF INFECTIOUS DISEASES AND IMMUNOLOGY,
LANGONE VACCINE CENTER, DIRECTOR,
THOMAS S. MURPHY, SR., PROFESSOR, DEPARTMENT
OF MEDICINE, NEW YORK UNIVERSITY GROSSMAN
SCHOOL OF MEDICINE, NEW YORK, NEW YORK
Dr. Mulligan. Well, good morning, Chairman Collins, Ranking
Member Casey, members of the Special Committee on Aging, and
fellow witnesses.
I also wanted to mention I am an NIH-funded investigator
working with the New York University Vaccine and Treatment
Evaluation Unit, part of a new NIAID-funded network, focusing
on infectious diseases, clinical research, and including work
on seniors. This is a very important part of the work that I do
as the clinical investigator.
This novel coronavirus emerged 5 months ago in China and
rapidly led to the global pandemic that we now find ourselves
combating. The human population, unfortunately, is highly
susceptible; that is, we are non-immune to this virus. Most of
us have been exposed to four distant cousins, seasonal co-
viruses that are also coronaviruses, but unfortunately, they do
not provide cross-protective immunity against the current
virus.
For physicians, scientists, and leaders, the virus has
continued to humble us. There is so much we do not know yet
about diagnosis prevention and treatment, about medical
countermeasures that will keep us all safe, but that is an
important part of what I will be discussing today.
Seniors are at increased risk due to the inexorable waning
of the immune system, something called ``immunosenescence.'' It
is not only their age, however, that renders seniors less able
to mount protective immunity against microbial threats,
including this coronavirus. It is also the chronic health
conditions that are present more frequently in seniors such as
cancer; immunosuppression; chronic heart, lung, and kidney
diseases; and diabetes. The highest risk for critical disease
due to this coronavirus is seen in the frail elderly, those
that reside in nursing homes and long-term care facilities.
The nurses, the doctors that I have worked with in the
hospitals since late February taking care of patients are
incredibly dedicated and caring. It is very moving to see how
much they put into their jobs to help their patients, and yet,
it has been a struggle. They have not had the medical
countermeasures they have needed, particularly to help seniors
fight this virus.
Certain work for residential settings with less effective
social distancing, the long-term care facilities we have talked
about, factories, have had the worst outbreaks of COVID-19, and
we have heard that while just 11 percent of COVID-19 infections
in the U.S. have been in nursing homes, one-third of the deaths
or perhaps more once we get good data have occurred in nursing
homes or nursing home residents.
Our main weapons to fight the virus continue to be non-
pharmaceutical interventions, all of the social distancing. We
know that these work, and they are effective, and they have
provided a strong benefit to society and individuals by
reducing spread of the virus. However, they come as a cost to
the economy, to society, and to the human existence. Therefore,
a very important additional category are the Medical
Countermeasures, which I will now talk about.
A vaccine holds out the promise of immune-protection; that
is, producing an immunity within our bodies that will protect
us against the virus upon some future exposure with the virus.
Safe vaccines have always been our most important weapons to
battle infectious diseases with public health importance.
Just 2 days ago, the first early report of a COVID-19
vaccine appears, and thank goodness, it was promising. There is
a long road ahead for development of safe, effective COVID-19
vaccines, but it was great to have a very positive early
signal. Seniors will be included in the all-important efficacy
trials that are planned to be supported by the U.S. Government.
However, the elderly do not respond as well to vaccines as
younger adults do, so the approach of providing a monoclonal
antibody as a pre-formed drug for treatment or prevention in
seniors is one that is attractive. One U.S. Government and
industry partnership that is under way is to move as quickly as
possible with a randomized controlled trial of a monoclonal
antibody that would be delivered to nursing home residents and
nursing home workers in order to try to get control of
outbreaks.
The highest-quality medical research comes from randomized
controlled trials. They provide the answer: Does the treatment
work? For one antiviral drug, remdesivir, preliminary
information from a randomized controlled trial of remdesivir
versus placebo in hospitalized COVID-19 patients, including
seniors, revealed a modest benefit, a 31 percent reduction in
time to recovery. This is modest but significant and a much
needed first signal that we have an effective approach to begin
to start to battle this virus.
Testing must be continued and increased. It provides a
benefit. It allows us to identify those with infection. Until
they recover, it can be isolated and thereby reduce further
spread of the virus. The more we test, the more we can fight
the virus.
I will close by saying that the non-pharmaceutical
interventions we have deployed against the virus have been
highly beneficial, and this remains doubly important for
protecting our very vulnerable seniors as we await further
development of medical countermeasures, including vaccines and
treatments and broader testing. Medical countermeasures may
need to be tailored specifically for seniors, given their
differences in their biologies.
I thank the Committee for the excellent work they are
doing.
The Chairman. Thank you very much, Doctor.
Dr. Konetzka?
STATEMENT OF R. TAMARA KONETZKA, Ph.D,
PROFESSOR OF HEALTH SERVICES RESEARCH,
DEPARTMENT OF HEALTH SCIENCES, UNIVERSITY
OF CHICAGO, CHICAGO, ILLINOIS
Dr. Konetzka. Chairman Collins, Ranking Member Casey, and
distinguished members of the Committee, thank you for the
opportunity to testify today.
My name is Tamara Konetzka. I am a professor of health
economics and health services research at the University of
Chicago, and I have been researching long-term and post-acute
care for 25 years, often focusing on nursing home quality.
The central role of nursing homes in the COVID-19 pandemic
has become increasingly clear. Just a month ago, nursing homes
staff and residents were estimated to account for one-fifth of
all deaths. The estimate is now at least one-third nationally
and, as Senator Collins noted, more than half in many States.
In some ways, these high rates are not surprising. Nursing
homes provide hours of hands-on care daily to large numbers of
people with underlying health conditions living in close
quarters. Facilities are often understaffed, a situation that
has been exacerbated by the pandemic. Nursing homes compete
with hospitals for both testing and PPE, which are still in
short supply in many areas, but is the spread of COVID-19 in
nursing homes inevitable, or have some types of nursing homes
managed better than others to manage outbreaks? We set out to
answer that question using data on nursing homes from 12
geographically diverse States.
We merged State lists of reported COVID-19 cases and deaths
with data on nursing home characteristics, including data from
nursing home house car, a five-star rating system published by
CMS. We calculated the percentage of nursing homes with at
least one case or death by star readings, profit status, and
several resident characteristics.
Our analysis revealed three key results. First, we found a
strong and consistent relationship between race and the
probability of COVID-19 cases and deaths. Nursing homes with
the lowest percent white residents were more than twice as
likely to have cases or deaths as those with the highest
percent white residents.
Second, we found no meaningful relationship between the
nursing home five-star ratings and the probability of at least
one case or death. In fact, even the direction of the
relationship was inconsistent from State to State.
Third, we found no difference between for-profit and
nonprofit facilities and only a weak relationship with percent
of residents on Medicaid.
We concluded from this analysis that while some nursing
homes undoubtedly had better infection control practices than
others, the enormity of this pandemic coupled with the inherent
vulnerability of the nursing home setting left even the
highest-quality nursing homes largely unprepared, and yet the
pattern is not random. Nursing homes are often a reflection of
the neighborhoods in which they are located.
Consistent with the pandemic generally, nursing homes with
traditionally underserved, non-white populations are bearing
the worst outcomes.
Turning to solutions, it is increasingly clear that long-
term care facilities must be a top priority in fighting the
pandemic, as that is where the deaths are, and we would suggest
several short-term measures.
First, nursing homes need a direct influx of funding and
technical assistance in order to achieve adequate numbers of
staff, availability, and proper use of PPE, and regular and
rapid testing of all nursing home residents and staff to enable
separation.
Second, we need to enhance the ability of Medicaid
beneficiaries to receive home-based services instead of
institutional services. The decision between care at home or in
a nursing home is difficult for families in the best of times.
Now the risks and benefits have likely shifted. To best help
families in this situation, resources need to be directed
toward enabling them to avoid institutionalization during this
high-risk time.
Third, data collection and transparency about cases and
deaths are essential. Timely reporting enables resources to be
directed where they are needed most, and at the same time,
older adults and their families need this information in order
to make their own best decisions, decisions that may be about
life or death.
These short-term measures are urgent and necessary, but
they do nothing to change the underlying systemic challenges to
improving the quality of nursing home care and the lives of
older adults who live in them. Nursing home residents are ill-
equipped to monitor their own care, to advocate for themselves,
or to exert political influence. This makes regulation and
oversight necessary.
Some regulations have been relaxed during this pandemic,
but it will be important to reinstate them once the crisis has
passed, with increased attention to infection control
practices, but the effectiveness of regulation is limited when
the structure of nursing home payment is fragmented, uneven,
and leads to systematic underfunding of essential services.
Those of us who study long-term care are accustomed to
hoping for fundamental change and not seeing it. One positive
outcome of a severe financial fallout from the pandemic may be
that it forces a fundamental reevaluation of how we pay for
long-term care in the U.S.
Thank you for the opportunity to provide input on this very
critical issue.
The Chairman. Thank you very much for your excellent
testimony.
Dr. Landers?
STATEMENT OF STEVEN H. LANDERS, MD, MPH,
PRESIDENT AND CEO, VISITING NURSE ASSOCIATION
HEALTH GROUP, HOLMDEL, NEW JERSEY
Dr. Landers. Good morning. Chairman Collins, Ranking
Member Casey, members of the Senate Committee on Aging, I
am Steve Landers. I am a family doctor and geriatric medicine
physician. My clinical work focuses on house calls to homebound
seniors, and I serve as the president and chief executive
officer for Visiting Nurse Association Health Group. We are a
large nonprofit home health and hospice agency headquartered in
New Jersey, and we serve parts of Ohio and Florida as well.
Our team of 3,000 dedicated caregivers, they have really
stepped up during this crisis to help medically fragile older
adults come home from hospitals and nursing facilities and, in
some cases, never have to go in the hospital in the first
place.
We serve 9,000 people in our programs and services, and we
have taken care of over 650 older adults in the home care
setting with known COVID-19 infection. I have never seen the
system so stressed and at the same time never felt more proud
of the incredible people that I work with every day.
One of the reasons we have been able to keep serving has,
frankly, been because of Chairman Collins and colleagues, your
leadership, in the CARES Act, the provider relief fund. Some of
the measures that CMS have taken have been important because
our revenues have gone down because of the cancellation of
elective medical procedures, and at the same time, expenses
related to personal protective equipment, or PPE, testing,
those expenses have gone up, so that financial support has been
critical.
I want to thank you, Chairman Collins and colleagues, for
your leadership, advancing the role of nurse practitioners and
physician assistants in home-based elder care. Homebound older
adults have had limited access to medical care. COVID-19 has
made it even harder, and that extension of the team with the
nurse practitioners and physician assistants is very important
in preserving access, and also the other measures related to
the geriatric workforce that were in the CARES Act are very
important.
I have been reminded again of the incredible difference
that home health and hospice can make on quality, compassion,
patient safety, and we have seen the stress that hospitals in
terms of bed capacity, emergency rooms, nursing facilities, the
challenges that they faced and it is highlighted, the need for
a strong home care option, an option to home care really when
it is at its best working in concert with hospitals,
physicians, and nursing facilities to deliver coordinated care.
In order for us to provide that option, job number one, is
protecting our treasured frontline caregivers. We have been
able to maintain care because we have been able to maintain a
supply of PPE. Now, that has been incredibly difficult to do.
We are using, in my organization, 17,000 surgical masks a week,
3,500 N95s a week, thousands of isolation gowns and goggles,
and we have to pay seven to ten times the normal price and use
vendors really from all over the world that we could not always
vet and verify, just hoping the shipments would arrive, so
going forward, I would encourage us to look at policies that
could make sure home health agencies have the needed PPE at a
reasonable price, also important to our ability to serve during
this crisis has been our spirit of innovation. We have really
embraced the use of telehealth and virtual visits within our
home health agency in order to help people stay safely at home
during this crisis.
For the COVID-19 home-care patients, they need monitoring
of vital signs, oxygen, and respiratory assessment, and so even
though home health agencies are not reimbursed for telehealth,
we felt that that was important.
We also had seen even before this crisis that telehealth
could play an important role in home health, and we have been
trying to advance that. I think going forward, to make sure we
have a strong home health option for older Americans, that
finding a way to reimburse telehealth services within home
health agencies is really important, also preserving the
ability for physicians and nurse practitioners to do the face-
to-face encounter and certifies people for home health via
telehealth is really important.
I really thank you for including me in the hearing this
morning, and I am very sad about all the death and suffering
but also optimistic that we can strengthen home care and elder
care for older American, so thank you.
The Chairman. Thank you very much, Doctor.
I want to note that Senator Tim Scott and Senator Martha
McSally have also joined us in person physically today.
What we are going to do, because there were many people who
logged on at the very beginning, is we are just going to go in
order of seniority. I cannot figure out any other way to do
this, given the people who have showed up physically, but also
the people who have been online at the very beginning of the
hearing.
Usually, I would like to reward those who show up first,
but I think since there were people online, as I said, I cannot
figure out any other way to do this fairly.
Let me begin with my own questions, and then Senator Casey
will question next remotely.
First of all, when we hear the statistics, which are so
devastating, with half of the deaths in Maine being in long-
term care facility, a third nationally, my heart just goes out
not only to the patients, but to their families and to the
staff of nursing homes and other assisted living facilities,
congregate care settings. They are all praying that COVID-19
does not find its way into their facility.
Yesterday the Government Accountability Office released a
report that found that nearly half of the more than 13,000
nursing facilities surveyed had infection control deficiency
citations in consecutive years, which the report called an
indicator of persistent problems, yet as Dr. Konetzka said in
her testimony, even the highest-quality nursing homes have been
largely unprepared. What we have usually looked at, the ratings
by CMS, the number of stars, has not proven to be a reliable
indicator of which nursing homes are safest in this
environment, and indeed, one of the worst outbreaks in Maine
was at a nursing home that had five stars.
I think what we are learning is that health care providers
are rethinking some of their initial assumptions, and that we
need to think more about hospital discharge planning.
Dr. Konetzka, I want to have you expand a little bit more
on what we can do. I believe that you recommended universal
testing for every nursing home resident and staff, which I
think is a good idea and have been recommending. How often,
however, would you have to do that, and would that allow family
members who have been tested to finally be able to visit their
loved ones?
[No response.]
The Chairman. I hope we can unmute Dr. Konetzka because I
can see that she is responding, but we cannot hear her.
Doctor, go ahead.
Dr. Konetzka. Can you hear me?
The Chairman. Yes. Thank you.
Dr. Konetzka. Okay, great.
Yes. Thank you for that question. I think that we are
learning a lot as we go about how best to fight this virus in
nursing homes, and so we do not have, unfortunately, great data
yet on exactly what testing strategies have been used and how
successful they have been. A lot of what we are going on is
anecdotal evidence, but what I can say is that there have been
a few key lessons learned.
One is that it is very important to test all residents and
not wait until residents are asymptomatic--I mean until
residents are symptomatic because by then it is too late. There
is asymptomatic spread, and given the close proximity and the
fact that staff go from resident to resident every day, the
virus, until people get symptomatic, can spread throughout the
facility, so we have learned that lesson, that all residents
really should be tested, and not only tested but tested
regularly.
What I have heard from geriatricians is, generally, weekly
would be good, at least biweekly, so that residents can then be
separated, and the transmission can be stopped.
I think it might be very hard especially as we relax some
of the restrictions on visitors, which is essential, as you
mentioned, essential to prevent the sense of social isolation
among our seniors. As we lax those restrictions, it is going to
be very hard to prevent all cases in the nursing home. The key
then is sort of a rapid response to prevent transmission to the
rest of residents and staff.
The Chairman. Thank you.
Dr. Landers, I appreciate you talking to us about the
importance of home care, and that can help people be safer. I
have always been a strong supporter of home care.
One issue that we have is that people who are older are
being increasingly isolated, and that too can have a very
detrimental impact on their underlying health and, thus, make
them more vulnerable to the coronavirus.
Could you comment on how home health visits can help keep a
senior more connected and less isolated?
Dr. Landers. Chairman Collins, absolutely, home health is a
way to show people that they are known and worth something,
that they are valued. It is an act of humility, really, and in
this crisis, it has been even more important. Sometimes our
nurses are the only people that are even checking in on a frail
elder, and I have heard them tell stories of having to kind of
go out and make sure that the person had a food supply or
undergarments or other things that are essential, so the
isolation is critical.
I think your focus on telehealth also adds, although it is
not perfect, making sure that those people that are homebound
and need home health also have access in between the visits to
some interaction via telehealth but also improve the amount of
attention that our older patients are getting. It is a really
crisis in sort of loneliness and isolation, so we are trying to
do all we can.
The Chairman. Thank you.
Senator Casey?
Senator Casey. Chairman Collins, thanks very much.
I wanted to start my questions with Dr. Konetzka. I have a
particular question for Dr. Konetzka regarding nursing homes.
We know that nursing homes have become, unfortunately,
Ground Zero in this pandemic, and yet there is still no
national strategy. I believe and I think the testimony today
indicated in part that there is still an insufficient supply of
personal protective equipment for nursing home staff. These are
among the heroes in our society, literally soldiers on a
battlefield in a war against the virus, and they are putting
themselves at risk for the disease, contracting the virus. They
are also putting themselves at risk for death itself, and that
includes their families. The word ``hero'' definitely applies
to these health care workers.
They need, I believe, simply more leadership out of the
administration and Congress, more help. They do not need pats
on the back only and expressions of gratitude and acclamation.
That is nice. What they need is direct support and more than
that.
I will start with the support for what they do on the job.
The most important thing, one of the most important things we
can do is to help them implementing what the public health
experts tell us are proven practices.
I have been asking the administration, first and foremost,
for data. The Centers on Medicare and Medicaid Services and
CDC, of course, are the ones that would have to transmit this
data to the American people. We are talking about basic
information on case counts, basic information on deaths, so
that we can direct and target the resources to the nursing
homes that need it the most.
Now, they have said, as I indicated earlier, that it is
coming by the end of May, but we have been hearing that for a
long time.
I have introduced legislation that would focus specifically
on nursing homes and other long-term care settings. This
particular bill, the Nursing Home COVID-19 Protection and
Prevention Act, that I introduced with Senator Whitehouse and a
number of our colleagues has as its focus $20 billion in
emergency funding to invest in what works.
We know that in nursing homes, if you have cohorting, you
separate the residents with COVID-19 from those who do not have
the virus. That is a good practice, but that costs money. We
have got to help them with that.
Other uses for the dollars could be charging of medical
expertise into a nursing home.
Dr. Konetzka, I would ask you, I guess, two basic
questions. Why is it so important that we have basic data on
COVID-19 in nursing homes? That is question number one, data
and question number two is, What are some of the policies that
we can use to help nursing homes put in place information, this
information in the ample resources?
Dr. Konetzka. Thank you, Senator Casey, for that question.
As I touched on in my responsibility, I think data and
transparency are critically important in this crisis. I think
often during a crisis, we are tempted to downplay the need for
a collection of data and prioritize other actions, but it is
essential in this case for three main reasons.
One, we do need to know where resources need to be
directed. We know where there are outbreaks in nursing homes.
We can direct resources to them, but we can also identify the
communities in which the virus is probably spreading.
Second, as we look back on this crisis, we need data in
order to do the hard research to figure out what works and what
did not work so that we can make better policies in the future,
and, third, consumers and their families really need to have
this information. Anybody looking for a nursing home placement
right now or worried about their loved one in a nursing home
right now really needs to be able to know what is going on in a
very timely way so that they can make their best decisions.
In terms of the exact resources, I think a lot of it is
about staffing, and we have had a problem with chronic
understaffing in nursing homes, and the kind of resources that
could help most on an emergency basis for a facility that has
an outbreak is to strategize to ensure enough staff. This means
providing paid sick leave. This means providing adequate PPE,
basically putting nursing home staff on a par with what we
naturally want to provide for hospital staff. It is the same
situation.
Senator Casey. Well, thanks very much.
I know I am almost out of time, and Chairman Collins has
been generous with our time.
I will just ask Dr. Landers a quick question about our
frontline heroes. A number of us in the Senate--and I know this
is true in the House as well--have made it a focus to create a
Heroes Fund, some manifestation of our gratitude for those who
have put themselves at risk on the front lines.
I know that in the case of Dr. Landers, I am told that you
have, in fact, kind of stood up and taken a lead on this, that
approximately 50 of your employees have volunteered to help
care for patients who have tested positive for COVID-19, and I
understand in recognition of their work, you are providing
these individuals with additional compensation, so we commend
you for that.
I guess the basic question is simple. It is a yes or no
answer. If the Federal Government provided you with the option
to receive funding to provide what we can pandemic premium pay
for essential workers and the work they have done in this
pandemic, would you apply for the funding?
Dr. Landers. Senator Casey, thank you.
Yes, we are trying to do all we can to support our
frontline heroes, and if there is something we were eligible
for and the criteria were appropriate, we would certainly do
so.
Senator Casey. Thank you.
The Chairman. Thank you.
Senator Tim Scott?
Senator Tim Scott. Thank you, Chairman Collins, Chairwoman
Collins. I will say this. Your leadership, Chairwoman, has been
spectacular.
The Chairman. Thank you.
Senator Tim Scott. From the aging community to the Paycheck
Protection Program and to this hearing, you consistently show
up for the seniors in Maine and the seniors in America, for the
small businesses. How you accomplish all that you do, I am not
sure, but you are one of the hardest-working, most dedicated
public servants I have met. Thank you for this hearing and the
opportunity to discuss this incredibly vital issue of
protecting our aging communities, which I am closer and closer
being a part of, so thank you very much.
The Chairman. Thank you so much for your kind words.
Senator Tim Scott. To the panel, I will just say this, that
without any question, if you are in South Carolina or most of
our States, what you will realize very quickly is that those
diagnosed with COVID-19 on average is just over 50 years old
who are hospitalized, and those who die from the disease in
South Carolina is just over 50--over 75 years old.
In fact, nearly 90 percent of fatalities in my State, South
Carolina, have been from those over the age of 60. It is one of
the reasons why I highlighted Senator Collins' dedication to
this issue because one-third of all COVID-19 deaths in South
Carolina happen in a nursing home or another senior care
facility. This is an incredibly important issue and an
incredibly timely hearing.
In other States, the numbers are even worse than in South
Carolina. That said, there have been some encouraging numbers
recently, and our Governor in South Carolina and, frankly,
Governors around the Nation--I would like to highlight the
Governor in Florida as well, DeSantis, who decided to focus the
attention on the nursing homes. It is exactly where we should
start this challenge, of how we should face this challenge, by
focusing on the most vulnerable populations.
I have often thought about how important it is for us to
recognize that nursing homes are the epicenter of activity. The
folks who take care of the patients are disproportionately
minorities, African Americans, who have perhaps the second most
vulnerable population in our Nation.
If you think about States like Louisiana, where 70 percent
of the deaths are African Americans, only 33 percent of the
population; in my home State, 53 percent of the deaths, African
Americans, only 27 percent of the population, so you have one
vulnerable community being served by another vulnerable
community, and that only highlights the importance of testing,
testing, testing in our nursing home facilities.
I am thankful that in South Carolina that the 40,000
nursing home residents will be tested between now and the end
of June. I am thankful that in South Carolina, we will have
over 220,000 tests completed in May and in June of residents of
South Carolina, 60,000 already tested so far this month.
These are encouraging numbers, and it is one of the reasons
why I have introduced legislation to make this the model for
the Nation, that our Nation should take serious, testing first
in our nursing homes and providing more resources for the
vulnerable populations in this country.
Along those lines, I have encouraged HHS to set aside a
robust share of the Provider Relief Fund that we appropriated
through the CARES Act along with $25 billion that we dedicated
to testing specifically for nursing homes and community
residential care facilities. They need the resources, the
supplies, and tests as soon as possible.
My question to the full panel, beyond funding, what steps
should we be taking at every level of government to help these
providers and communities develop the tools and strategies
necessary to detect, isolate, and address cases where they
occur without straining existing resources by increasing
administrative burdens?
Dr. Konetzka. If I may answer one part of that, I think in
addition to funding, technical assistance to nursing homes is
essential because I think sometimes just providing the funding
for it does not mean that nursing homes will necessarily know
what we are learning about the best practices in terms of
actually stemming an outbreak.
I think to the extent that local public health departments,
State organizations can provide technical assistance and as
well as the funding and the resources like surge teams to stem
an outbreak, that would be helpful.
Dr. Mulligan. Senator Scott, I was just going to add that
the importance of clinical research in seniors in nursing
homes, educating families, because they are often legally
authorized representatives, about clinical research, everything
in our medicine cabinet is there because we have conducted
clinical research, and we absolutely need to include seniors in
our vaccine trials, which we will be launching in large numbers
in July, as well as in special senior-focused studies, such as
the monoclonal antibodies, to go into nursing homes and provide
this option to participate in research.
The Chairman. Thank you, Senator.
Senator Gillibrand is joining us remotely, and she is next.
Senator Gillibrand. Madam Chairman, can you skip me? I am
having a technical problem. I just need 5 more minutes, so do
the next person.
The Chairman. Absolutely. Let me just check on your side of
the aisle, and it is Senator Blumenthal, who is right here.
Senator Blumenthal. Thank you, Madam Chair. Thank you,
Senator Collins and Senator Casey, for bringing us together on
this supremely important topic.
I was listening to my colleagues, I could not help but
remember last Monday when I accompanied Senior Pastor Patrick
Collins in a ritual that he has done literally every morning.
He places white flags on the lawn in front of the First
Congregational Church in Greenwich, Connecticut, and I
accompanied him last Monday as we together placed 69 new flags
for each COVID-19 death in the State of Connecticut.
On Tuesday, the day afterwards, Pastor Collins placed 41
more flags, yesterday 23. Right now, literally as we hold this
hearing, exactly to the moment, Pastor Collins is almost
certainly placing another 57 new white flags, adding to this
sea of markers in front of the First Congregational Church in
Greenwich.
Every one of those flags represents a life and the
thousands of lives lost around the country. Seventy percent of
them are seniors, seven in ten, and many are in nursing homes,
so the obligation that we have to these vulnerable individuals
is brought home very dramatically and graphically by that
picture worth a thousand words, literally.
That is why I have supported the hazardous duty pay, the
Heroes Fund for our nursing home workers, who all too often are
risking their lives and making financial sacrifices, and it is
more than just rewarding or recognizing them. It is also to
retain them and to recruit new nursing home workers.
Let me ask, first of all, Dr. Konetzka a question. Is not
it a fact that all too often, the employees of these nursing
homes are underpaid for the risky and back-breaking work that
they do?
Dr. Konetzka. That is exactly right. Nursing home workers,
especially nursing aides, are generally paid minimum wage,
often have no paid sick leave, and often have no health
insurance. It is natural that in normal circumstances, nursing
homes have a hard time staffing adequately, but under these
circumstances where staff are also afraid to get sick, afraid
to bring the virus home to their families, or on the other hand
may show up to work because they do not have paid sick leave,
even though they are feeling ill, I think that all contributes
to the issues we are seeing in nursing homes and the
understaffing problem in particular.
Senator Blumenthal. One of our nursing homes run by a
friend of mine, Tyson Belanger, provides living facilities for
the nursing home employees on the premises, so they are
protected. They have to live away from their families, but they
are sealed away from possible infection. The result has been to
greatly reduce the incidence of infection.
Is that kind of innovation, Dr. Konetzka, a possible
promising route that others should follow?
Dr. Konetzka. Yes, certainly. I think that nursing home
workers should have the option of having a different place to
stay, whether that is provided by the nursing home or, like
many cities have done for hospital workers, perhaps providing
them with unused hotel rooms, so that they have the choice of
not risking infecting their families.
Senator Blumenthal. Tyson Belanger, by the way, happens to
be a veteran, having served multiple tours in the Afghanistan
and Iraq Wars.
I have introduced legislation with Senator Booker. It is
called the Quality Care for Nursing Home Residents and Workers
During COVID-19 Act. It would immediately address some of these
same problems, not just more testing. In fact, it would require
weekly testing of every resident and testing before every shift
for health care workers. It would mandate that all health care
workers have sufficient PPE and comprehensive safety training
for dealing with COVID-19, and that each facility have a full-
time infection control preventionist on staff to keep residents
and workers safe. It would guarantee that sufficient staff is
available to facilitate weekly virtual visits between residents
and their families.
Those are just examples of the kinds of measures that I
hope that may reduce the number of flags, those white markers
that Pastor Collins places every morning in front of the First
Congregational Church of Greenwich. We owe it to our seniors.
We owe it to all of our families and all of their loved ones
that we do better in our nursing homes.
Thank you, Madam Chair.
The Chairman. Thank you, Senator.
Senator McSally?
Senator McSally. Thank you, Chairman Collins. I want to
echo Senator Scott's comments about your leadership and your
passion for seniors, for small businesses under your leadership
in this unprecedented challenge, so thank you, and thank you
for this important hearing and to our witnesses for their
testimony.
In Arizona as of last night, there have been 747 deaths
related to coronavirus, from the coronavirus, and 593 are over
the age of 65, so that is about 79 percent.
As I think about this, this is a cruel virus, as we all
know, and it is the cruelest to our most vulnerable, and this
is the greatest generation we are talking about. this is our
opportunity as we learn more about the virus. We did not know a
lot about it, but as we are learning more about it, for us to
do everything we can to protect the greatest generation. This
is our generation's opportunity to give back to them and there
has been an important focus on nursing homes for the vulnerable
who are in these congregate settings, but we also need to think
about those in memory care, those in assisted living, those who
are older but in independent living.
My mom is 85. She is in good health for her age. She is in
independent living, but she also has been isolated for now 2
months because she is just as vulnerable as others from this
cruel disease.
I have neighbors and constituents who are sharing their
stories of their loved ones who are in these settings, and we
need to make sure that we protect them.
As I think about going forward--and it is not a choice of
are we going to continue to protect lives or allow people to
safely return to work. As we move forward, we can do both, but
for seniors in congregate settings, we need to put a moat
around them. We need to ensure that we have high levels of
situational awareness, that anybody who goes to work there,
supports there, or at some point visits there, that we know
that they are not inadvertently bringing the virus in with
them.
We now know, unlike several months ago, that people can
asymptomatically be carrying the virus, so checking
temperatures is not enough.
I thank you for the testimony today, but I want to look
more broadly for all congregate settings. One of the challenges
we have is where there is oversight of our nursing homes in
Arizona, oversight from HHS, oversight at the State and county
level, the independent living, the assisted living, they are
usually private entities, and so they are trying to get PPE,
trying to get testing. It is not an easy top-down thing to do
with the supply chains.
We have had many innovations in Arizona. One company I
visited, AmSafe, used to make seatbelts and airbags for
airplanes. They just started making masks and gowns to support
our nursing homes in Arizona. It is just an incredible story.
More of that needs to happen. We need to bring the PPE
manufacturing home.
I want to ask Dr. Konetzka, can you share broadly, if we
are looking at all seniors in these congregate settings, what
does it look like for us to keep that moat around them? I think
it is our testing needs to be focused on staff and ideally
visitors and others who are going to go in there and high
levels of situational awareness, plus the controls that we have
learned to isolate and be able to treat quickly but what does
that look like, not just for nursing homes, but for everyone
who is in this vulnerable category in a congregate setting?
Dr. Konetzka. First, thank you very much for that question
because I think there is a tendency to focus only on nursing
homes, and in many States, assisted living facilities look very
much like nursing homes in terms of the level of care needed
and provided and the vulnerability of the residents, and yet
because assisted living facilities are licensed by States and
do not receive generally a lot of Medicaid or Medicare funding,
we sort of tend to ignore them in these situations and yet they
are completely just as vulnerable.
I think your question about the social isolation in these
settings, not just assisted living, but also independent
living, is a huge challenge. I think the at the riskiest time
when we have to prohibit visitors, some things can be done in
the meantime like making sure that these facilities have
appropriate technology so that residents can at least
communicate through Facetime or other video chats with their
families on a regular basis.
In the longer run, I think it is essential for all the
reasons that you and others have mentioned that we do worry
about the social isolation and start allowing visitors, and
that is one of those things that I think we will learn as we go
in terms of how much is too much, but that balance has to be
struck. We have to limit that social isolation even as we try
to stem the virus.
Senator McSally. Thank you.
I know I am over my time, but I also want to say this.
Isolation, I have heard cruel story after cruel story--the
virus is cruel--of people fighting for their lives alone and
the amazing nurses who are with them, but not with their loved
ones and family members, people taking their last breath alone
without their loved ones and family members, not being able to
even be there for their funeral. We have got to be able to
focus on allowing people when we can as quickly as possible to
be with their loved ones safely during these times so that they
can be there.
It is impactful not just for the senior, but also for the
other family members who feel helpless, so working together, we
have got to address this issue to allow people to safely be
able to visit at the right time.
Thank you. Thank you, Madam Chair. Thank you for your
grace.
The Chairman. Thank you, Senator.
Senator Gillibrand has fixed her technical problem, and she
is next.
Senator Gillibrand. Thank you, Madam Chairwoman. I
appreciate this hearing very much.
In my State of New York, the most terrible horror stories
are coming out of our nursing homes, and a lot of the people
who have lost their lives have lost them in nursing homes.
One of the concerns I have is for the workers who work
there, and if we had had national paid leave in place at the
beginning of this, then any worker who had to take care of a
family member or was sick themselves or had a child home would
have been able to keep their job, keep their health care, and
take up to 3 months leave, so that the length of the schools
being closed or the length of an illness or sickness within
their family, and without that, we have no safety net that
would structurally be there for our workers when they have this
kind of emergency, and this pandemic is a perfect example of
how it could have been used more effectively.
I want to ask Dr. Konetzka, do you agree that if workers,
especially nursing home and home health workers, were allowed
to consider their health or the health of their families by
having access to a comprehensive paid leave program that that
could better protect their patients and clients to slow the
spread of the virus?
Dr. Konetzka. I think a national paid leave program could
help in a number of ways. I think in a broader sense, providing
paid leave for health care workers and long-term care workers
would allow them that flexibility, as you just mentioned. It
would also allow perhaps other people the choice of taking care
of their appearance or another family member instead of putting
them in a nursing home, so I think it would affect all kinds of
decisions at the margin.
Under this particular crisis, I think we would still have a
staffing shortage because people leaving and having the paid
leave to take care of family members as they need does not help
with staffing in nursing homes, so I think there are two sides
to that.
Senator Gillibrand. Yes.
The other concern I have is that our nursing homes are
still struggling to get access to testing and PPE, and we know
that nursing home workers and people they serve are among the
most vulnerable around the country.
Both Dr. Landers' and Dr. Konetzka's testimony reinforce
the need for an essential workers bill of rights to protect our
essential workers, including nursing home and direct-care
professionals during this public health emergency.
Every essential worker in our country should have access to
safety and health protections. They should have access to
frequent testing and PPE. They should have more robust
compensation. They should have paid leave. They should have
universal sick days. They should have the kind of support that
they deserve because they really are our frontline workers in
this pandemic.
Dr. Landers, do you believe that the health outcomes for
patients are improved? Do we have high-quality, well-paid, and
well-protected direct-care professional workforces? and do you
agree that we need Federal investment in direct-care workforce?
Dr. Landers. Senator, thank you.
The aging care, home care, nursing home care, it is all
about people caring for people. That is really what matters.
People need that tender loving care, and to the extent that we
have a strong, well-trained, well-supported workforce, the
outcomes are going to be better for patients and families. I do
believe that, and I am concerned about the shortages, shortages
of nurses in particular, because I hear our nursing schools are
turning away half of the qualified applicants, even though we
have 80 million aging older adults, so I am thankful that you
and your colleagues are thinking about the workers.
Senator Gillibrand. I have one idea that I would like
anyone to comment on. For the shortage of health care worker
and home health workers and workers in nursing homes, one of
the things I think we should be doing is having a health force,
where we train a million workers in the next 2 months to do the
contact tracing, to do the testing, and to do eventually
vaccinations.
For any on the panel, do you think training up this health
force in the next 2 months would be able to help us have health
care workers for the future so you would not have shortages for
people who work in health care for our older adults, whether it
is in direct care or whether it is in an assisted living
facility? You can each give an opinion on that.
Dr. Mulligan. Thank you, Senator Gillibrand.
I do think that having resources in place in advance of
future crises is absolutely what we need. What we find is if we
are not ready ahead of time, when we chase our tails, so we do
have to invest in advance in order to be ready when the crises
come in the future, so having a group of young people who might
then get very inspired by the work that they are doing and go
on to become full-time, lifelong medical professionals, health
care professionals, I think that is a very inspiring thought
and something we should aspire to.
Dr. Landers. Senator, I think, absolutely, getting new
people into the workforce in these caring fields is really
important, particularly home health aides and personal care
workforce. There is definitely a need for more people to enter
that field.
Things like nursing, I mean, the nurses really are the keys
to a lot of these teams, and we need really smart bachelor-
prepared nurses, and that is something that is going to require
more long-term policymaking, so that going forward that we are
in a better position because those cannot be created overnight,
same with primary care physicians and geriatricians, but in
terms of the frontline personal care, funding could help with
that.
Senator Gillibrand. Thank you.
Dr. Konetzka?
Dr. Konetzka. I will just add that I think it is a really
good idea for both the short term and the long term. It seems
like something where it could help with the urgency of this
situation to increase staffing in nursing homes and in home
health, and it could help with the pipeline problem in that we
just do not have enough people coming out of training programs
wanting to work in long-term care and getting people interested
early on. Even as we try to improve the working conditions so
that they want to stay in it is a good idea.
Senator Gillibrand. Thank you, Madam Chairwoman.
The Chairman. Thank you.
Senator Braun?
Senator Braun. Thank you, Madam Chair.
I want to echo what Senator Scott said. I am on several
committees here in the Senate, and I think the best hearings
have been in this Committee because you generally pick a topic
that needs to be talked about at that moment in time, so thank
you.
The Chairman. Thank you.
Senator Braun. I have got several questions teed up. As a
business guy and entrepreneur, when I look at trying to apply
the skills that work there, generally, you need to be agile.
You need to think out of the box. You need to do things
differently if you are going to be successful in a market.
I am interested because we have made the case that
disproportionately nursing homes have been impacted. What has
been the rate of improvement in these few months that we have
been grappling with it? Have we seen the rate of infections and
deaths come down, or are we still at a level that I know is
bad, but have we seen any improvement? and then the corollary
with that would be, what best practices, what things have we
seen in the successful nursing homes that would be maybe of key
importance, one, two, and three? so has the rate improved, and
then what best practices have surfaced in this time we have
been tackling it?
Any on the panel, feel free to jump in.
Dr. Konetzka. I will be happy to start with that.
I think the answer to your first question is we do not
quite know because we do not have great data yet. Even for our
study, we had to sort of pull State lists off the Internet and
do a lot of data cleaning to make sure that we were analyzing
something valid, and without the data to really know exactly
where the infections and cases and deaths are, we will not be
able to really answer that question.
I suspect we are still learning as we are going and that
many areas will still see outbreaks in nursing homes.
For your second question in terms of best practices, I do
think there are a few things we have learned, as I mentioned
earlier. Testing everybody in a nursing home on a regular
basis, to prevent asymptomatic spread, and then separating
residents as possible into COVID-and non-COVID-positive parts
of a facility, I think has been successful in many places.
Dr. Landers. Senator, I think that----
Dr. Mulligan. Senator Braun--go ahead.
Dr. Landers. I just want to say to the Senator that we are
seeing in the home health setting over time that it seems like
the rates of infection of our treasured workforce, it does seem
to becoming less common week by week. These are people working
in the hardest-hit areas of northern New Jersey where we have
seen some of the highest levels of infection in the country.
I do think week by week, the social distancing measures,
the PPE, the expanded testing which still needs to expand
further, but we are certainly in a better spot than we were in,
in early March, where there was nothing, so we have a long ways
to go, but the screening and education of the workforce, making
sure they know when and how to ask for help and when to get
them out of the workforce, and then also the testing programs
for the workers is increasingly important.
Dr. Mulligan. I think, Senator, the only thing I would like
to add--and this gets at the innovation piece--is the research,
the clinical trials.
I agree with what my fellow panelist said about what we
should be doing immediately in terms of implementing what
appear to be best practices.
In addition, we have to invest in research as a Nation
supporting the NIH and doing the clinical trials that will help
us get out of this thing as a whole, but in doing that, we will
support the seniors.
For example, one of the Senators talked about--Senator
McSally--making a moat around our seniors. It made me think
about herd immunity. If we can vaccinate the population
broadly, even if seniors do not respond as well to vaccines,
get the population immune. Then the workers who often bring the
virus into nursing homes, this will not happen because they
will have been protected and would not have become infected, so
investment in clinical research.
Senator Braun. Thank you.
This one will be for Dr. Landers because I think as we
debrief this over time, finding out what works, these best
practices, but we have noticed that in Florida where arguably
you might have the most vulnerable populations, is there
something there that we can glean? I think the laboratory of
States gives us a much better way to learn than maybe that one-
size-fits-all site.
The CDC, when we first looked at testing, cost us 30, 40,
50 days because of that focus on just one way.
Is there something there in Florida that anybody can weigh
in on? Dr. Landers, do you think that this will speed the move
from nursing homes to home care over time? It seems like you
are probably more safe in your home than you would be in a
place that has got a lot of folks in the same building.
Dr. Landers. Thank you, Senator.
There is no question that there is increasing interest in
home health care, and I have been in several living rooms,
quite frankly, in the last couple weeks with families who have
brought family members home from facilities to continue their
recovery at home. They have been relieved and happy to get the
home health and visiting nurse support, which is really
critical for them being able to come home.
In terms of the differences in different locations,
absolutely, there are--we have seen geographic variations, and
we should try and learn from those. Living in New Jersey, a lot
of the people we serve actually travel between Florida and New
Jersey. It is a fairly common consideration for snowbirds and
such, and a lot of the questioning we have gotten has been
around can people come back for their--you know, those people
that are fortunate enough to be able to travel as such and is
it safe.
We are all interconnected, but at the same time, there are
differences. We will have to learn from this going forward.
Senator Braun. Thank you.
The Chairman. Thank you.
Senator Warren, I do not know whether you heard my opening
remarks, but I do want you to know that I know I speak for
every member of this Committee in expressing our condolences to
you. You have been touched very personally by this virus, so
welcome.
Senator Warren. Thank you so much. I appreciate it, Madam
Chair. You reached out to me personally right after my brother
died, and he died in a comforted setting facility, in a rehab,
so thank you. I appreciate it, and I very much appreciate that
you are holding this hearing today.
In fact, what I want to talk about is I want to talk more
about how seniors are bearing the brunt of COVID-19. Nursing
homes have become the epicenter of the crisis, and it is
important that we do everything we can, that there is testing
and that there is contact tracing, and that we get a vaccine,
and that we develop treatments.
One of the things we need to do is collect more data. I
want to start by asking Dr. Konetzka, Why is it so important
that nursing homes collect and report, in a timely manner and
transparently, data about COVID-19 infections?
Dr. Konetzka. I think it is critical for several reasons.
One is just that we need to know where to direct resources.
Nursing homes need help when they are having an outbreak, and
so we need to know that right away. It also gives us a signal
about what is happening in the communities in which nursing
homes are located. Second, it will enable us to do research
that will help us later figure out what worked and what did not
work so that we can perhaps do better the next time. Finally,
it is really critical for consumers. We have been encouraging
consumers since 2009 to get on Nursing Home Compare and look at
information for their nursing homes good care, but right now,
they cannot easily find which ones have COVID outbreaks. We
would like to give them that information so they can make good
decisions.
Senator Warren. Thank you. I think that is really
important.
It is such a serious issue. In Massachusetts, for example,
more than half of the COVID-19 deaths are directly linked to
long-term care facilities.
Now, the Center for Medicare and Medicaid Services, the
Federal entity that regulates nursing homes, is taking some
important steps to ensure better data, and just last month, as
you may know, CMS started requiring nursing homes to report new
COVID-19 infections, outbreaks, hospitalizations, and deaths
directly related and they have to report it to the CDC. Nursing
homes also must notify residents and families of these
infections.
Nursing homes are not the only facilities, long-term care
facilities that have been hit hard by this pandemic. Roughly
800,000 Americans live in assisted living facilities. In
Massachusetts, about two-thirds of assisted living facilities
have reported COVID-19 infections.
Now, residents in assisted living facilities that serve
older Americans require less frequent medical care than those
in nursing homes and less help with activities for daily
living, but populations in both places are similar, older
people who need some help from caregivers in order to conduct
daily tasks.
Dr. Mulligan, you have been serving on the front lines of
the coronavirus pandemic. When it comes to the patients that
you have seen, does coronavirus affect nursing home residents
any differently from how it affects assisted living residents,
or are people living in both settings vulnerable to the crisis?
Dr. Mulligan. There is no question that they are both very
vulnerable.
I think the assisted living facility and even the community
dwelling seniors are at equal risk. If you think about a third
of deaths are nursing home residents, but 80 percent of deaths
are in seniors, that means there is an equal number to the
nursing home deaths that are outside the nursing home.
Senator Warren. That is right.
Dr. Mulligan. Absolutely, Senator, you are correct.
Senator Warren. Okay. That is really important.
The reality is this virus does not care whether seniors are
living in assisted living facilities or living in nursing
homes. It can affect them, regardless.
Let me go back to you, Dr. Konetzka. Are assisted living
facilities required to report the same coronavirus information
as nursing homes like report on infections or hospitalizations
or deaths or outbreaks to the Federal Government and to the
families and to the people who live there?
Dr. Konetzka. No, they are not. Just like data collection
and long-term care, generally, we do not collect much data from
assisted living because they are not as dependent on Federal
funding.
Under the CMS guidance, as I understand it, we are also not
collecting information from assisted living facilities, which
for all the reasons you mentioned is unfortunate.
Senator Warren. Yes. Assisted living facilities have
similar populations as nursing homes. They face similar
infection risks, but they are not subject to the same
regulations when it comes to the coronavirus, and that is why I
have launched an investigation with Senator Markey and with
Congresswoman Maloney into how assisted living facilities are
tracking coronavirus infections and preventive measures at
these facilities and whether they have enough preventive
measures in place.
Assisted living facility residents and their families
deserve to know whether or not their facilities are
experiencing a coronavirus outbreak just like nursing home
residents are entitled to know that, so I believe we owe it to
our seniors to get this done.
Thank you all for being here today, and thank you again,
Madam Chairman.
The Chairman. Thank you.
Senator Rick Scott had to leave and go preside. He had
joined us remotely. Now we still turn to Senator Doug Jones.
Senator Jones. Thank you, Madam Chairman. Thank you very
much for holding this hearing. I appreciate it, and thanks to
all of our panelists for this very, very important hearing.
I kind of want to followup a little bit about not just the
assisted living but nursing homes in particular. My mom is in
an assisted living, so it has been a challenge for all of us
and especially her over the last few weeks. We lost dad in
December. The isolation has been a struggle. We lost dad to
Alzheimer's, and I think it has been particularly tough on
Alzheimer's patients and caregivers. Those forms of dementia
create special problems, regardless, it has been said.
To listen to my mom, she has been talking every week. She
will mentioned that as much as she misses my dad who she was
married to for 70 years, she is also somewhat thankful that he
passed before all of this pandemic hit. In part, I think that
is because of the problems that she would have faced. She used
to go down and visit him every day, and that is especially
troubling.
My friend, John Archibald, who writes for al.com, wrote an
article this week called ``Coronavirus Creates a Special Hell
for Dementia Caregivers,'' and he talked about trying to
imagine what it is like for an Alzheimer's patient or
caregivers. Imagine what it is like to try to explain social
distancing to a person who does not share the reality, and he
quotes Pam Leonard, who is a program director in Birmingham of
the CJFS CARES program. She talks about caregivers and said
that it is kind of like being on an airplane. You got to take
care of yourself. You got to put on your own oxygen mask before
you are able to help those around you.
I would like to get to anyone on the panel. Given the
special and unique needs and challenges that we are seeing,
what can we do to more support individuals with dementia, both
in these facilities and out, and their families and caregivers,
and are there special trainings that might be needed for any of
these long-term care and dementia facilities in a situation
like we are in now which we have not seen before, but we could
see again?
I will open it to anybody.
Dr. Mulligan. Senator Jones, I really think that you have
touched on something so important. I think as a society, we
will always be judged by how we take care of the most
vulnerable, and certainly, our dementia seniors at this point
are among the most vulnerable. They are not able to express,
for example. If they are becoming ill, they would not
necessarily be able to express that they do not feel well, that
they feel hot, that they are short of breath, et cetera. They
have medical as well as the sort of psychological, emotional
vulnerabilities at this time of this pandemic that are unique
to them, I think.
I do not know that I have any specific answer for you, but
I would encourage any effort to bring together a think tank to
brainstorm about this. I think it is absolutely needed, and
thank you for raising it.
Dr. Landers. Senator Jones, thank you for raising this
critical issue, and I share your deep concern for the well-
being of people living with dementia.
Actually, one of the sad parts about all this has just been
hearing my staff explain what is going on when they are doing
nursing visits with older adults with severe dementia. In cases
when they have had to do a test, those nasopharyngeal swab
tests, for example, that has in some cases been fairly
traumatic and upsetting even to do the test because the person
just does not understand.
One thing in assisted living and independent living,
because that has been a big topic in this hearing, we should
point out home health agencies are able to come into those
settings, as are hospice agencies in certain instances, to
buttress the care in those facilities, so to the extent that we
continue to have a strong home health option and focus on the
things that Senator Collins is focused on around telehealth, I
think that is going to strengthen dementia are and assisting
living and also encouraging people to focus on goals of care
and family caregiving plans also can help, but really tough
issues we are facing.
Senator Jones. Great. Well, thank you. Thank you very much,
both of you, for that.
Dr. Konetzka, real quick, as my time runs out, your
research has indicated that racial and ethnic minorities and
low-income individuals have been disproportionately affected
with nursing homes that have larger minority populations, more
likely to have coronavirus cases and deaths. I think there is
an article about that also in the New York Times.
Could you briefly share more about what factors might
contribute to those disparities?
Dr. Konetzka. Yes. Thank you for that question.
Disparities in nursing home outcomes from COVID are not
unlike disparities we see across the health care system, and it
is the result of many years of differences by race in health
infrastructure and resources and risk factors of populations.
What we found in our research was not necessarily that
nonwhite residents were more--were having worse outcomes within
a facility. It was about the percent white in a facility. To
me, it is really about the neighborhoods in which nursing homes
are located and staff going back and forth between those
facilities and the neighborhoods.
I think it is a lot about where the virus is circulating
and who is in those facilities and who is going back and forth.
Senator Jones. All right. Well, thank you, and thank you,
Madam Chairman, for holding this hearing. It is very, very
important. Thank you.
The Chairman. Thank you, Senator.
Senator Rosen.
Senator Rosen. Thank you, Senator Collins, for holding this
very important hearing. It is incredibly sad to see what is
happening in our nursing homes and our assisted livings, what
is going on with our caregivers across our country.
I was a caregiver for my parents and in-laws. I understand
this from a firsthand perspective, and it is overwhelming,
frightening, and frustrating particularly at this time.
One thing that I think we really need to focus on is
research, research to fully understand how this virus works and
how to best treat and prevent it. It is so critical.
I recently introduced legislation with Senator Rubio, the
Ensuring Understanding of COVID-19 to Protect Public Health
Act. It is going to require a longitudinal study of COVID-19,
including individuals of all ages along with diversity in race,
ethnicity, gender, geography, underlying health conditions. We
need to understand why the virus impacts some people like our
seniors differently than others. We need to understand what the
presence of antibodies really needs, if seniors or others who
get sick gain an immune response or not.
That is the theory that they gain an immune response, but
reports of groups of patients becoming ill a second time is
really concerning, and there has been recent reports, of
course, across that group of sailors on the USS Theodore
Roosevelt getting reinfected.
Dr. Mulligan, I have a two-part question. Do you know what
the latest research is, or can you talk about it, the latest
research that is following patients who are diagnosed a second
time with coronavirus, including seniors? this could have a
further impact on our senior living centers. Do we know if this
is a brand-new infection or if this is the original infection
making them sick again, and what do you think this information
might have? What impact might it have on vaccine development?
Dr. Mulligan. Thank you, Senator Rosen, for this question.
I do think that the jury is out in terms of formal proof
that having recovered successfully, one is immune. Certainly,
most people that recover make antibodies. We have seen that in
our own studies, and many others have reported that.
With most viral infections, it is true that once you have
had it, you are protected at least for a period of time. I
personally expected that should be true here as well. The
formal proof of that will be done in studies such as you
described, and I think that is a fantastic study.
We are entering a time point where we have more and more
convalescent patients, and now we can study how they do over
time.
I think the jury is out on these reports of possible
reinfections that may well represent an intermittent negative
test than a positive test that occurred as a result of their
original infection. We know that can occur. The test is not
perfect, and so that would not surprise me if that was the
cause of some of those, but the jury is out, and for vaccine
development, it is the same. I am a scientist. I want to know
what the evidence says. If we do our studies correctly, if we
are well supported, we will get the truth. We will get the
answer, and that is what science will do for us.
Senator Rosen. I want you to also--in your testimony, you
said that medical countermeasures may need to be tailored to
seniors in order to optimally protect them. Would you expand on
that a little bit in a minute or so that I have left, please?
Give us some good examples.
Dr. Mulligan. Sure, I am very happy to do that.
Maybe the most prominent example is that we have a couple
of special vaccines for flu for seniors. We have a high-dose
vaccine. We have a vaccine with adjuvant. We know, as I said,
seniors' immune systems are weaker, and they do not respond as
well to vaccines. Having a stronger vaccine, one with an
adjuvant, one with a higher dose, may be necessary for COVID-19
in seniors as well. We need to do those kinds of special
studies.
We also want to be sure that treatments are tolerated well
and are safe in seniors. Their system is different, and so we
need to be sure to include seniors in our treatment studies as
well as our vaccine studies.
Then another great example is the monoclonal antibody
approach. If a senior cannot make a nice antibody themselves,
perhaps we can infuse the antibody, this monoclonal antibody
drug, and that is something that is going to be explored in the
nursing home setting, and I think is very important.
Senator Rosen. Well, I thank you and all the other
witnesses for your work, your passion, your commitment. We
really need you. We thank you all. We are very thankful you are
doing what you are doing, and please stay well and safe. Thank
you.
The Chairman. Thank you, Senator.
Dr. Mulligan, I want to followup on the questions you were
just asked by Senator Rosen about your work on vaccines, and
you have made the very important point that older adults
sometimes do not respond as well as younger adults to vaccines,
but that vaccines can convert this herd immunity that can help
protect seniors.
You have also distinguished about different kinds of
vaccines. Could you describe to us the two vaccine trials that
I understand you are currently involved with and whether or not
you have seniors enrolled in those trials?
Dr. Mulligan. Sure. Thank you, Senator Collins, for the
question.
We are currently conducting a Phase 1 trial in healthy
younger adults, age 18 to 55, with one candidate vaccine. As
soon as we see in this trial that the vaccine is tolerated and
safe in these younger adults, we will go to a second group,
including seniors. It is not unusual in medical research to
make sure in the first in human studies that the new treatment
or vaccine is safe and well tolerated in healthier younger
adults before you go to a more vulnerable population, which
might be seniors or children or pregnant women. We will quickly
move to seniors in the trial we are currently conducting at our
university.
The second trial is a very large efficacy trial that will
be launched in July supported by the U.S. Government, NIH, in
collaboration with the vaccine that had the very promising
early report, earlier this week with that company. That trial
will be for adults aged 18 and older. From the very beginning,
that efficacy trial will include seniors and will do so at a
significant proportion. At least a quarter or more will be
seniors as it is currently planned.
The Chairman. That is very encouraging to hear.
Could you also talk a little bit more and explain to us the
fact that you could have the monoclonal antibodies approach? It
is my understanding that when you give a vaccine, it is usually
with a live virus, and then your body produces the antibodies
that would allow you to fight off exposure to the virus later
on, but if you use the--are you suggesting that an alternative
approach is rather than injecting the virus, you would inject
antibodies? Is that correct? Did I understand that correctly?
Dr. Mulligan. Yes, Senator, you did.
The standard approach is known as ``active immunization.''
We deliver a vaccine, which might be a weakened virus. It might
just be a protein, a piece of the virus. It could be RNA, as
was reported this week, and we ask the body to produce a bit of
the vaccine protein and make an immune response, make the
antibody.
Seniors are not as good at doing that, and so an alternate
is what is called ``passive'' rather than ``active
immunization.'' In that case, you actually infuse the antibody,
and the antibody has a half life of a month. There are ways to
tweak it where it could even last for a couple of months. It is
an interim approach, perhaps, to get us through the worst of
this where we could protect our very vulnerable seniors, and it
has to be tested in a randomized control trial.
The Chairman. That is fascinating.
Where are those antibodies produced? Are they taken from
individuals who have already had the coronavirus, or are they
manufactured, if you will, in a lab? How are they produced?
Dr. Mulligan. Yes. Thank you. It really is fascinating.
I will give you one example. Actually, the first human in
the United States to come down with coronavirus, his antibodies
were cloned by a company and created--converted in a laboratory
to a drug. You can mass produce the antibody molecules and then
have that available for infusion into research participates in
the future, so you take--and you pick an antibody, I should
have said. You pick the antibody that is very potent at
neutralizing the virus, so you pick basically the champion
virus and then champion antibody, and then that becomes your
monoclonal antibody drug for testing.
The Chairman. Very interesting. Thank you.
Senator Casey?
Senator Casey. Madam Chair, thank you very much for the
hearing and also for the brief second round of questions.
I just have two. I want to start with Dr. Konetzka. I had
mentioned earlier the wait lists, the 800,000 individuals who
are on waiting lists for both services and supports in their
homes and their communities. I get that number from Kaiser
Family Foundation. It is an awfully big number.
That number did not arise since the crisis began. That has
been a number that predated the crisis, but I want to emphasize
these are people on waiting lists that qualify for services but
there is insufficient funding to provide those services.
We have some States, I know, that are increasing pay for
direct-service providers, and that is one of the steps we
should consider.
I have a bill that would encourage every State to do what
some States are doing, which has served as a foundation for the
enhanced matching dollars the Federal Government provides for
Medicaid in their recent legislation.
Dr. Konetzka, can you explain the importance of addressing
these wait lists for what is known as home-and community-based
services in the context of the current pandemic?
Dr. Konetzka. Thank you. I would be happy to talk to that.
First, I should note, though, that interpreting these wait
lists is a little bit difficult. These are wait lists for home-
and community-based care waiver programs under the Medicaid
program, and each State does it a little bit differently, so
800,000 sounds like a lot, but in some States, they just do not
use wait lists. We may be underestimating the people who
actually need services there.
In other States, they do not assess people for eligibility
before putting on the wait lists, so the wait lists are huge in
those States.
That aside, I think we can certainly agree that there are
probably many more people who could benefit from these services
that are getting them, and during this crisis, I think it is
absolutely essential that we do what we can to try to enable
more people to get those home-based services because the risks
of entering a nursing home right now have just grown
astronomically, so enabling more home-and community-based care
right now may really save lives.
Senator Casey. Thank you very much, Doctor.
The last question I have is for Dr. Landers. I just want to
go back because I was jotting down numbers before, and I think
I missed one of the numbers in your testimony. It is regarding
the personal protective equipment, PPE.
You had indicated, I thought, that you needed for just a
week, 17,000, and I was not sure what that was. If you could
repeat those numbers, because one of the real failures--and
this is a colossal failure--of the PPE is not simply that we
have all kinds of instances where there is not enough in care
settings, not to mention first responders and other
circumstances, but what is going to happen in the months ahead?
It is not just a question of what we need for this month or
next month, and I think we do not have a sense yet of the
numbers, the scale of the problem.
I guess I just wanted to give and provide an emphasis on
one provider or one care setting and what you need.
Dr. Landers. Senator Casey, thank you.
Yes. Our current kind of ``burn rate'' is kind of the term
that is being used in terms of how fast we are going through
PPEs as a company is that just over 17,000 of the surgical
masks and then over 3,500 of the N95 masks every week. When I
look to our chief operating officer and chief financial officer
who are responsible for procuring this stuff, that is kind of
what they are trying to find on the market with various
vendors. It still remains a challenge for them to track down
enough vendors.
I am thankful that you are considering that going forward
because it is an ongoing issue, and that is who we are able to
continue to serve is by having that protective equipment.
I actually did a home visit. It was a little bit warm last
week. I was in an apartment building that was not very well
ventilated, and I was sweating, and I was realizing, oh, I need
to change my mask because the mask is getting soaked, so we do
have to remember that sometimes these get soiled. There is a
lot of need there, and so thank you for looking out for that
issue.
Senator Casey. Thank you.
Thank you, Chairman Collins.
The Chairman. Thank you very much, Senator Casey, and I
would second your concern about the availability of PPE for our
home health agencies. That has been a problem in the State of
Maine as well that I have been working on personally to deliver
some PPE to our home health agencies. It is something that is
very difficult for them to do their jobs without it.
I want to thank our terrific witnesses for being with us
today and for their work and their research. It really makes a
difference. I want to thank the staff for figuring out how we
can safely hold this hearing and observe social distancing,
which we did throughout.
I would note that virtually every member of the Committee
joined the hearing either in person here in the hearing room or
remotely, and I am very pleased with that. I think it shows how
much people care about this issue.
I also want to give a special shout-out to the technical
experts who made this possible. When you have that many
Senators who are joining us remotely, Senators who are joining
us here, and witnesses in three different places in the
country, it is amazing to me that our technical experts were
able to make everything go so smoothly, and I thank them.
This week, the overall death toll in the United States from
the COVID-19 virus surpassed 90,000 people, 80 percent of whom
were older adults. This means that we have lost more than
72,000 older adults to this pandemic.
At the beginning of this hearing, I remarked on the
enormous challenges and tragedy that COVID-19 has brought to
our country. It has also brought countless examples of great
courage and selflessness from those on the front lines of this
pandemic, including our medical personnel and our direct-care
workforce, but they are not the only ones. We see it at the
grocery stores. We see it with those who are stocking the
shelves and running our gas stations and other essential
businesses. We see it as those as I have seen in the State of
Maine who are making the swabs in rural Maine that are
essential for our testing. We see it all over our country as
people step forward and businesses step up to convert their
lines and do their part. I appreciate all of that sacrifice,
that compassion, that effort.
I also want to pay special tribute to our witnesses today.
I thought they were absolutely excellent and really increased
our understanding.
Dr. Mulligan's leadership on vaccine development helps
advance tangible medical countermeasures for those most in
need, and I appreciated his giving us a great education today.
Dr. Konetzka's research helps us better inform our efforts
to protect the residents not only of nursing homes but of
assisted housing that our seniors have and other congregate
care facilities.
Dr. Landers focused on home health care, which has always
been a special passion of mine, and technologies such as
telehealth which helps us to improve care of older adults in
their own homes, and after all, that is where most older adults
want to be. They want to be in the privacy, security, comfort
of their own homes if they can be.
This Committee will continue to explore potential solutions
to the challenges discussed in this hearing as well as other
impediments to the health and safety of our Nation's senior.
This week, members of the Aging Committee introduced a
resolution to designate this month as Older Americans Month. As
we work to improve care for older adults amid this pandemic, we
also should take the time to recognize our seniors as valued
members of our society, our culture, and our lives. The health
and well-being of seniors strengthen our Nation as a whole and
is the very mission of this Committee.
Senator Casey, I would like to call upon you for any
closing comments.
Senator Casey. Chairman Collins, thank you for convening
this hearing on such an important topic, and I am grateful for
the opportunity that we have had. I am certainly grateful for
the testimony of our witnesses who bring to bear a degree of
expertise and experience with these issues that are so
important to families when it comes to caring for our seniors
in all settings, and we are grateful that the witnesses are
with us today, and I know there will be even more followup.
I do want to thank and reiterate what Chairman Collins said
about the staff. This is a technical challenge, and they helped
all of us through this. We are grateful for their good work, as
we always should commend the staff in the Senate who do such
good work and especially under these circumstances.
We also want to thank, of course, as we all have in one way
or another, all of the health care and home health workers
throughout the country, service providers as well, caregivers
for caring for our aging loved ones all the time but especially
during this terrible virus, which has caused such devastating
across the country.
We owe all of those workers a debt of gratitude. I think we
should do more than just say thanks. We talked about pandemic
premium pay and other ways to reward their work because they
are not just frontline workers. In many cases, they are at the
front of the front line, exposing themselves and putting
themselves at risk, and our Nation should reward them as we did
returning soldiers from other battlefields in our history.
Congress has done a number of things to help seniors in the
four pieces if legislation that have been passed, but I would
argue not nearly enough, not nearly what we must do for our
seniors. That is why we have to keep acting legislatively.
I am frustrated, as I know a number of Senators are, that
we spent virtually the whole month of May on nominations and
not voting on COVID-19 policy or appropriations, and
unfortunately, we are going into June with that same setting or
that same circumstance in the Senate. I think we should be
voting--if we are going to be here and voting every week, we
should be voting on COVID-19. That should be the top priority
and, of course, the economic consequences that flow in the wake
of this terrible virus, so we have more to do. We certainly
need to do more on testing nationally. I think the
administration should outline a strategy at long last.
We mentioned personal protective equipment for our
frontline workers. We cannot talk about or work on this issue
enough. There is just no way to comprehend that in a Nation as
powerful as ours, a Nation that was able to produce the
armaments and other production capacity to win World War I and
all the wars in between, including World War II, the idea that
that same Nation cannot produce enough masks--masks or gloves
or personal protective equipment for everyone that needs it is
really an appalling--it is an appalling failure and we have to
worry about the next couple of months. I know that as of eight
o'clock this morning in the State of Pennsylvania, 64,412
cases, the death number in Pennsylvania is now 4,767. That is
only for March, April, and May. I do not want to be sitting
here in December because we did not do enough on testing and
personal protective equipment and find out that another 4,700
or 5,000 Pennsylvanians have died.
We need the productive capacity, and we are not doing
enough as a Nation. The Federal Government has to demand that
we set forth the production capacity on PPE. If we could do it
in the past to win wars, we can do it now to win this war, and
the administration has to do a lot more to make sure we can
produce what we need, so we have a long way to go, lots more
work to do, lots more legislating and appropriating, but we are
grateful, Chairman Collins, for this hearing and thank you for
giving us this opportunity.
The Chairman. Thank you.
Committee members will have until Friday May 29th to submit
additional questions for the record. If we do receive some, we
will pass them on to our witnesses.
Again, I want to thank everyone for participating, and this
hearing is now adjourned.
[Whereupon, at 11:35 a.m., the Committee was adjourned.]
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APPENDIX
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Prepared Witness Statements
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Questions for the Record
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Additional Statements for the Record
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