[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]
EXAMINING LONG-TERM CARE IN AMERICA:
THE IMPACT OF THE CORONAVIRUS
IN NURSING HOMES
=======================================================================
HEARING
BEFORE THE
SELECT SUBCOMMITTEE ON THE CORONAVIRUS CRISIS
OF THE
COMMITTEE ON OVERSIGHT AND REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED SEVENTEENTH CONGRESS
SECOND SESSION
__________
SEPTEMBER 21, 2022
__________
Serial No. 117-105
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Printed for the use of the Committee on Oversight and Reform
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available on: govinfo.gov,
oversight.house.gov or
docs.house.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
48-802 PDF WASHINGTON : 2022
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COMMITTEE ON OVERSIGHT AND REFORM
CAROLYN B. MALONEY, New York, Chairwoman
Eleanor Holmes Norton, District of James Comer, Kentucky, Ranking
Columbia Minority Member
Stephen F. Lynch, Massachusetts Jim Jordan, Ohio
Jim Cooper, Tennessee Virginia Foxx, North Carolina
Gerald E. Connolly, Virginia Jody B. Hice, Georgia
Raja Krishnamoorthi, Illinois Glenn Grothman, Wisconsin
Jamie Raskin, Maryland Michael Cloud, Texas
Ro Khanna, California Bob Gibbs, Ohio
Kweisi Mfume, Maryland Clay Higgins, Louisiana
Alexandria Ocasio-Cortez, New York Ralph Norman, South Carolina
Rashida Tlaib, Michigan Pete Sessions, Texas
Katie Porter, California Fred Keller, Pennsylvania
Cori Bush, Missouri Andy Biggs, Arizona
Shontel M. Brown, Ohio Andrew Clyde, Georgia
Danny K. Davis, Illinois Nancy Mace, South Carolina
Debbie Wasserman Schultz, Florida Scott Franklin, Florida
Peter Welch, Vermont Jake LaTurner, Kansas
Henry C. ``Hank'' Johnson, Jr., Pat Fallon, Texas
Georgia Yvette Herrell, New Mexico
John P. Sarbanes, Maryland Byron Donalds, Florida
Jackie Speier, California Mike Flood, Nebraska
Robin L. Kelly, Illinois
Brenda L. Lawrence, Michigan
Mark DeSaulnier, California
Jimmy Gomez, California
Ayanna Pressley, Massachusetts
Jennifer Gaspar, SSCC Staff Director
Beth Mueller, Chief Counsel
Yusra Abdelmeguid, Clerk
Contact Number: 202-225-5051
Mark Marin, Minority Staff Director
Select Subcommittee On The Coronavirus Crisis
James E. Clyburn, South Carolina, Chairman
Maxine Waters, California Steve Scalise, Louisiana, Ranking
Carolyn B. Maloney, New York Minority Member
Nydia M. Velazquez, New York Jim Jordan, Ohio
Bill Foster, Illinois Mark E. Green, Tennessee
Jamie Raskin, Maryland Nicole Malliotakis, New York
Raja Krishnamoorthi, Illinois Mariannette Miller-Meeks, Iowa
C O N T E N T S
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Page
Hearing held on September 21, 2022............................... 1
Witnesses
Dr. Alice Bonner, RN, Senior Advisor for Aging, Institute for
Healthcare Improvement Chair, Moving Forward Nursing Home
Quality Coalition
Oral Statement................................................... 5
Dr. David C. Grabowski, Professor of Health Care Policy,
Department of Health Care Policy, Harvard Medical School
Oral Statement................................................... 7
Adelina V. Ramos, Certified Nursing Assistant, Greenville, Rhode
Island
Oral Statement................................................... 8
Daniel Arbeeny (Minority Witness), Son of Nursing Home Resident
Oral Statement................................................... 10
Dr. Jasmine Travers, MHS, RN, Assistant Professor of Nursing, New
York University Rory Meyers College of Nursing
Oral Statement................................................... 12
Written opening statements and the written statements of the
witnesses are available on the U.S. House of Representatives
Document Repository at: docs.house.gov.
Index of Documents
----------
Documents entered into the record during this hearing are listed
below, and are available at: docs.house.gov.
* List of other states that had significant nursing home
problems; submitted by Rep. Foster.
EXAMINING LONG-TERM CARE IN AMERICA:
THE IMPACT OF THE CORONAVIRUS
IN NURSING HOMES
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Wednesday, September 21, 2022
House of Representatives
Committee on Oversight and Reform
Select Subcommittee on the Coronavirus Crisis
Washington, D.C.
The subcommittee met, pursuant to notice, at 2:56 p.m., in
room 2154, Rayburn House Office Building, and via Zoom; Hon.
James E. Clyburn [Chairman of the subcommittee] presiding.
Present: Representatives Clyburn, Maloney, Foster, Raskin,
Krishnamoorthi, Scalise, Jordan, Green, Malliotakis, and
Miller-Meeks.
Also present: Representative Stefanik.
Mr. Clyburn. Good afternoon. The committee will come to
order.
Without objection, the chair is authorized to declare a
recess of the committee at any time. I now recognize myself for
an opening statement.
Few places have felt the devastating effects of the
Coronavirus more deeply than America's nursing homes. More than
200,000 Americans living in nursing homes and other long-term
care facilities have died from the Coronavirus representing 20
percent of all coronavirus deaths in our Nation.
The outside risks to nursing home residents and workers
became evident in the earliest days of the crisis. The first
major coronavirus outbreak in the United States occurred in the
Life Care Center of Kirkland, Washington, in February 2020,
where the virus infected more than two-thirds of the facility's
residents and dozens of staff, resulting in the loss of nearly
40 lives.
The ferocity with which the Coronavirus swept through our
Nation's nursing homes in 2020 exposed vulnerabilities that had
been building for years, for too many nursing homes had
inadequate staffing and poor infection control viruses well
before the pandemic.
These long-standing problems helped to drive outrage that
exacerbated the risks for Americans who need long-term care.
Compounding these problems, Americans at greatest risk were
left behind by our leaders when the virus hit our shores. The
Trump administration's failure to heed early warnings left
nursing homes workers and residents ill-prepared. They refused
to take steps necessary to curtail the spread of the virus
before vaccines were developed, leaving nursing homes without
testing and personal protective equipment necessary to detect
and prevent outbreaks.
New documents obtained by the select subcommittee and
released today paint a devastating picture of conditions inside
large for-profit nursing homes across the country during these
crucial early months of the pandemic. In reports to hotlines
run by nursing home chain residents, their loved ones and staff
members describe the dire conditions they were experiencing
during that terrible time.
At one facility in Texas, a caller reported that employees
were forced to make isolation gowns out of disposable bags that
were, quote, ``stapled and taped together.'' At another home in
the Midwest, a caller stated that employees had to wear the
same disposable masks for seven days in a row.
Examples of the reports we received are illustrated here. I
think we all should be able to see this. Multiple reports from
facilities around the country describe severe staff shortages,
with one family member commenting that, and this is a quote,
``criminal for there to be so few staff members present.''
These new documents also shed light on the pressure that
was placed on nursing home staff. An employee at the Maryland
facility who was experiencing coronavirus symptoms was
reportedly told that if they--that, they would be fired if they
did not come to work.
At another nursing home in Colorado, a manager pressured
employees to come to work even if they feel bad and have
concerns that they may be sick with COVID-19.
Fortunately, our Nation has come a long way since these
dark days. Life-saving vaccines and treatments have helped to
save countless lives among nursing home residents and staff.
The Biden/Harris administration has prioritized protecting the
health of Americans in long-term care facilities. In addition
to conducting an historic vaccination campaign and dramatically
increasing the supply of tests and PPE, the administration has
sought to institute important reforms, such as minimum staffing
requirements and measures to reduce crowding inside nursing
homes.
While the heightened risks that existed in 2020 have
passed, risks to nursing home residents and staff will remain.
We must take further steps to address long-standing challenges
in this industry. We must increase the uptick of boosters among
residents and staff to make sure that they stay protected
against new coronavirus variants.
We must ensure that nursing home workers receive adequate
pay and benefits, such as paid sick leave, which is crucial for
the health and safety of residents as it is for staff.
We must also improve oversight and transparency in the
nursing home industry to give residents and their loved ones
the ability to make informed decisions about their care. I
would like to thank all our witnesses for testifying today. I
look forward to hearing more about the challenges facing our
Nation's nursing homes and the changes that are needed to fix
these long-standing problems so that our Nation's nursing homes
are safe places for those who need care.
Before yielding to the ranking member, I ask unanimous
consent that Representative Stefanik be allowed to participate
in today's hearings.
Without objection, so ordered.
I now recognize the ranking member for his opening
statement.
Mr. Scalise. Thank you, Mr. Chairman. Appreciate you having
this hearing, and thank you for the unanimous consent request
to allow Ms. Stefanik to participate as well.
I really want to thank our witnesses for coming, and we
look forward to hearing your testimony as well.
I'll keep my remarks brief to allow for a short Video that
I'll be playing from Ms. Janice Dean. She and her family were
affected in the worst way by the deadly nursing home policies
that were put in place by a handful of Governors at the
beginning of this pandemic. She's been very outspoken in
talking about and trying to highlight this issue. She obviously
got some very emotional feelings about this that she'll share.
It is incredibly sad, though, that what we've seen in this
past year plus is a refusal to acknowledge the deadly mistakes
that were made and subsequently covered up by certain Governors
in nursing homes. We've highlighted this over and over again.
We've called for hearings on what happened to get more
transparency. We still, to this day, can't get some of that
information. But we've seen thousands, tens of thousands of
preventable deaths that happened because some Governors gave
orders. We've highlighted these mandates over and over again by
specifically five Governors who seemed to all, almost cookie
cutter, take the same order over and over again to go against
science, to go against the CDC and the CMS guidance for how to
properly take care of nursing home patients in a nursing home
setting.
If you go back to when the Trump administration wrote
numerous documents to protect the elderly, to protect the
vulnerable, especially in nursing homes, and I've included some
comments from CDC from CMS, where they talked about things like
limiting visitors, increasing protective equipment, and
strengthening the quarantine guidelines in nursing homes,
especially.
Clearly, some of the states that I referenced ignored that
went against the science. Despite the cover-ups that we've
seen, here's what we do know: Completely ignoring the CDC and
CMS scientific recommendations that positive patients not be
admitted back into nursing homes without the availability of
proper care, multiple Governors mandated that COVID-positive
patients, in fact, be admitted or readmitted to the nursing
home setting, despite the fact, in some cases, that they knew
they were COVID positive.
In fact, if you read the Governor of New York's mandate--
and again, the state of New York, like in most states, the
state is the regulator of nursing homes. I'll just read from
the advisory. March 25, 2020, Mandate from New York to all
nursing homes, quote: No resident shall be denied readmission
or admission to the nursing home solely based on a confirmed or
suspected diagnosis of COVID-19. Nursing homes are prohibited
from requiring a hospitalized resident who is determined
medically stable to be tested for COVID-19 prior to admission
or readmission.
Again, going against the science that CMS and CDC laid out.
The regulator, not just New York, but then it was almost cookie
cutter, cut and pasted by the Governor of New Jersey, we saw
the Governor of Michigan do the same thing, the Governor of
Pennsylvania, and the Governor of California all gave mandates
very similarly saying that you had to, as a nursing home, take
patients back even if they were COVID positive and prohibited
them from testing for COVID. And should anybody be shocked of
the results we saw? Tens of thousands of patients died who
never should have died.
These orders were in direct conflict with the science. We
saw it with Governor Cuomo. He actively and multiple times
covered up the total number of COVID-19 nursing home deaths by
not reporting those nursing home residents that died in
hospitals. Governor Cuomo and his team engaged in a cover-up
that was designed to deceive the public and protect the
Governor's image and personal profits from a multi-million
dollar book deal. He had millions of reasons to cover up the
truth.
No wonder Governor Cuomo refused our request to testify. We
asked him to testify at this very hearing, and he still, to
this day, has not even responded. Surely, he's not here, he's
not participating, but he didn't even feel he owed those
victims a response to the questions we had for him.
I continue to be shocked that my colleagues on the other
side of the aisle have largely ignored this scandal. Why is
excessive and preventable death in nursing homes being made a
partisan political issue? The Democrat majority has
consistently used this pandemic as a political tool to divide
Americans, and it has caused great harm and led to more
distrust in public health.
With that, Mr. Chairman, I would like to show the Video
from Ms. Janice Dean because it does give some more insight
into what happened.
Specifically, if we could run that.
[Video shown.]
Mr. Scalise. Thank you, Mr. Chairman. Thank you, Ms. Dean,
and my thoughts and prayers continue to be with Ms. Dean, with
all the other family members who had loved ones who were lost
during that period. We will continue, Mr. Chairman, to press
for the answers.
Why were these orders by the regulators of those nursing
homes sent out, mandating that they do something that went
against the very science that was coming out from CDC and CMS
explaining in detail how to keep seniors safe when we knew the
data was there showing this is how to keep seniors safe?
They went the opposite direction and forced those nursing
homes to take COVID-positive patients, banning them from
testing the people that were coming back into the homes. Tens
of thousands of people died unnecessarily. We will continue
pressing for those answers.
With that, I yield back the balance of my time.
Mr. Clyburn. Thank you, Mr. Scalise.
I would like to welcome today's witnesses. Dr. Alice Bonner
has been a nurse practitioner caring for older adults and their
families for over 30 years. Dr. Bonner is currently the senior
adviser for aging at the Institute For Healthcare Improvement,
the chair of the Moving Forward Nursing Home Quality Coalition,
and an adjunct faculty member at the Johns Hopkins University
School of Nursing.
Dr. David Grabowski is a professor of healthcare policy at
Harvard Medical School, where he studies long-term care and
post-acute care. He's a current member of the Medicare Payment
Advisory Commission and previously served on the CMS Nursing
Home Coronavirus Commission. Dr. Grabowski has appeared before
Congress numerous times in the past, including at a briefing of
the select subcommittee in June 2020.
Ms. Adelina Ramos is a certified nursing assistant who has
worked in nursing homes for 11 years. As a staff member at the
Greenville Nursing Center in Greenville, Rhode Island, she
worked on the front lines of the pandemic, including
periodically providing care for dozens of critical ill patients
during the early months of the coronavirus pandemic.
Dr. Jasmine Travers is an assistant professor of nursing at
NYU Rory Meyers College of Nursing. Her current work focuses on
mitigating health disparities in long-term care for older
adults. Dr. Travers is a primary care nurse practitioner and
has published widely on the topics of aging, long-term care,
health disparities, and work force diversity.
Mr. Daniel Arbeeny is the principal at the executive search
firm CMF Partners. Mr. Arbeeny's father, Norman, passed away
during the early months of the pandemic while living in a
nursing home. Mr. Arbeeny, please accept our sincere
condolences for your loss.
Will the witnesses please rise and raise your right hands.
Do you swear or affirm that the testimony you are about to
give is the truth, the whole truth, and nothing but the truth
so help you, God?
You may be seated.
Let the record show that the witnesses answered in the
affirmative.
Without objection, your written statements will be made
part of the record.
Dr. Bonner, you are recognized for five minutes for your
opening statement.
STATEMENT OF DR. ALICE BONNER, SENIOR ADVISOR FOR AGING, CHAIR,
INSTITUTE FOR HEALTHCARE IMPROVEMENT, MOVING FORWARD NURSING
HOME QUALITY COALITION
Ms. Bonner. Chairman Clyburn, Ranking Member Scalise,
members of the House Select Subcommittee on the Coronavirus,
Representative Stefanik, and others, thank you for the
opportunity to speak today on behalf of the Moving Forward
Nursing Home Quality Coalition. We are a growing coalition of
more than 200 action-oriented leaders and organizations that
have come together this year to create action plans for
effective and sustainable improvements that will be delivered
in the near future. I'm here today because each and every one
of us cares deeply and is committed to improving the quality of
life for individuals living in nursing homes in the United
States.
We have submitted a letter to the subcommittee on behalf of
the coalition that outlines six ways that Congress can begin
taking meaningful steps to improve nursing home quality. It's
not an all-inclusive list, and not all the proposals can be
done right away. Some will require more time.
We urge Congress to work alongside us to take action so
that all nursing home residents receive the care and support
they deserve. Nearly 1.3 million people live in our Nation's
15,000-plus nursing homes, as you know, and another 1.5 million
work in them.
The coronavirus pandemic has brought an intensified sense
of urgency to addressing long-standing issues of inadequate
care and support. The Moving Forward Coalition is committed to
improving quality by building on strong research, clinical
expertise, tested models, and advocacy for sustainable
improvements.
The Moving Forward Coalition's approach is different from
some other groups. Our purpose is to develop, test, and promote
a set of step-by-step action plans that can be implemented
based on the recommendations in the National Academies of
Sciences, Engineering, and Medicine report that was released in
April 2022.
The coalition began this past July and has established
seven committees, each focused on key priorities. Over 200
individuals and organizations, including nursing home
residents, workers, policymakers, advocates, and others, have
joined the coalition in just a few months. And that number
continues to grow every week.
NASEM report recommendations are well-aligned with critical
needs described in the White House's February 2022 fact sheet
on protecting seniors and people with disabilities. Both
documents clearly convey a sense of urgency to address growing
gaps in care and support that were brought into sharp focus
during the pandemic, as well as they cite best practices.
Every person deserves safe, high-quality, age-friendly care
and support throughout their life, and the people who dedicate
their professional lives to that work for whom it is a calling
or the work I was meant to do, they also need the resources,
compensation, training, and support to deliver that care.
I began my professional working with older adults when I
was 19 years old and got a job as a nurse's aide in a nursing
home when I was still in college. I proudly wear the name badge
that says nurse's aide because that experience led me to a
lifelong career in nursing homes because I was inspired by what
was possible and what the nurses and nursing assistants did to
create a positive, supportive, loving home.
I've seen how hard many nursing home teams work to provide
quality care and support for older people, often under
challenges such as COVID. However, I've also been in nursing
homes in which care falls short of meeting basic human needs,
such as getting help to go to the bathroom or getting a bath or
a shower, even once a week.
Over 85 percent of nursing home residents need assistance
with one or more activities of daily living, and yet many of
them are not receiving that care consistently. That must change
and must change as soon as possible.
While we have Federal and state regulations designed to set
standards for nursing home quality, those regulations may not
be fully enforced in all cases by inspectors or state
surveyors. We need a regulatory framework that reinforces and
rewards quality. We need to ensure that what matters to
residents is part of the culture in every nursing home. All
nursing homes need to be quality homes.
The Moving Forward Coalition is off to a strong start. Our
committees are holding their first calls or meetings this
month, and we look forward to sharing action plans with this
subcommittee back in early 2023 on the work that's beginning
now.
Nursing homes are a part of the healthcare system that's
often overlooked. The Moving Forward Coalition is bringing
individuals and organizations together to raise expectations
about what is possible. We urge Congress to lead the way toward
a future of nursing homes full of the humanity and grace that
all of us want and deserve.
We offer the Moving Forward Coalition as a leader eager to
work with Congress, state and Federal agencies, and others to
improve nursing home quality now and in the future.
Thank you very much for this opportunity.
Mr. Clyburn. Thank you, Dr. Bonner.
We'll now hear from Dr. Grabowski. You are now recognized
for five minutes.
STATEMENT OF DR. DAVID GRABOWSKI, PROFESSOR OF HEALTH CARE
POLICY, DEPARTMENT OF HEALTH CARE POLICY, HARVARD MEDICAL
SCHOOL
Mr. Grabowski. Great. Thank you. Chairman Clyburn, Ranking
Member Scalise, and distinguished members of the House Select
Subcommittee on the Coronavirus Crisis thank you for the
opportunity to testify today on this important topic.
I am here today speaking in my capacity as a professor of
healthcare policy at Harvard Medical School who has studied
nursing home quality for 25 years.
Residents, their families, and their caregivers have long-
known that U.S. nursing home care is broken, yet this issue has
gone largely unnoticed in the broader population. COVID changed
this. As one family member recently stated, the pandemic has
lifted the veil on what has been an invisible social ill for
decades.
COVID completely devastated nursing homes in the U.S. There
have been over 1.2 million COVID cases among residents leading
to roughly 172,000 COVID-related fatalities. Over 2,600 nursing
home staff members have died from COVID, making nursing home
worker the most dangerous job in America.
Not surprisingly, both resident census and staff employment
levels are still down by over 10 percent relative to their pre-
pandemic levels.
A key question in directing policy resources is determining
what factors were associated with COVID outbreaks in nursing
homes. In a systematic review of 36 peer-reviewed studies, our
research team concluded that COVID outbreaks were largely a
function of where you were located versus who you were as a
facility.
This does not suggest there was nothing that could have
been done to prevent COVID outbreaks; rather, it suggests that
policymakers needed to adopt a system-level approach to address
this problem.
It is not too late. There are several short-run and long-
run reforms that can support nursing home residents and their
caregivers. In the short-term, I would encourage policymakers
to focus on two areas: increasing vaccination levels and
improving staffing.
First, it is time to extend the initial Federal vaccine
mandate for nursing home staff to include booster doses.
Roughly half of all staff are not fully vaccinated; second, to
ensure all residents and staff have access to a vaccine clinic,
I would recommend federally supported clinics for any facility
with low booster vaccine rates for staff and residents.
Short-term steps to improve nursing home staffing include
introducing a Federal minimum staffing standard, increasing
staff pay and benefits, providing opportunities for career
advancement, and creating a better work environment.
In the longer run, the recent National Academies of
Sciences, Engineering, and Medicine Committee on which I served
concluded that the way in which the United States finances and
regulates care in nursing home setting is ineffective,
inefficient, fragmented, and unsustainable.
To create a more rational approach to financing nursing
home care that would address these significant shortcomings,
the National Academies report included a recommendation about
moving toward a Federal long-term care benefit by studying how
to design such a benefit and then implementing state
demonstration programs to test the model prior to national
implementation.
To ensure adequate investment in caring for long-stay
nursing home residents, our study committee recommended the use
of detailed and accurate financial information to ensure
payments are adequate to cover comprehensive nursing home care.
We also recommended the designation of a specific share of
Medicare and Medicaid payments go toward direct care services
as opposed to noncare costs, such as lease payments. And we
also recommended the increased use of value-based nursing home
payment models to reward facilities for providing better
quality.
In terms of regulatory reforms, the National Academies
committee provided recommendations to ensure state survey
agencies have adequate resources, and we made additional
recommendations for the oversight of state survey performance.
In terms of increasing financial and ownership
transparency, we recommended collecting, auditing and making
detailed facility-level data on the finances, operation, and
ownership of all nursing homes publicly available in real-time
in a readily useable data base that allows for the assessment
of quality by a common owner or management company.
In summary, the pandemic has indeed lifted the veil on
nursing home care in America. We have an incredible opportunity
right now to address problems that we have ignored for far too
long.
I look forward to working with the members of this
subcommittee on this effort. Thank you.
Mr. Clyburn. Thank you very much, Dr. Grabowski.
We'll now hear from Ms. Ramos. Ms. Ramos, you are now
recognized for five minutes.
STATEMENT OF ADELINA RAMOS, CERTIFIED NURSING ASSISTANT,
GREENVILLE, RHODE ISLAND
Ms. Ramos. Thank you, Chairman Clyburn, Ranking Member
Scalise, and the members of the committee for inviting me to
speak today.
My name is Adelina Ramos. I'm a certified nurse assistant
at a nursing home in Greenville, Rhode Island. I'm also a proud
member of SEIU 1199 New England.
Like so many facilities across the country, we were not
prepared for COVID. Our facility already had issues, and COVID
made everything worse. When COVID first hit, three or four
residents in my facility died each week. A CNA at my facility
was one of the first nursing home workers to die of COVID in
Rhode Island.
In May 2020, I got the news that I've been dreading for so
long. I had COVID. I did everything I could not to catch the
virus, but the conditions were so bad in my facility, it was
impossible to avoid. It didn't have to be like this.
We needed personal protective equipment. We needed more
training to keep ourselves and the residents safe. We need more
staff. We pleaded with the management, but nothing changed.
Mother's Day 2020 really broke my heart. One of my
residents was slipping away, and her children could not see
her, and she wanted me to sit with her, but I couldn't because
I was caring for 25 other residents. There was only a nurse,
another CNA, and a housekeeper on that shift that day.
Most of those residents couldn't eat, drink, get out of
bed, or go to the bathroom without help. They all required
oxygen changed every 15 minutes. We regularly have to make
impossible choices about which residents to help first. Do I go
to the resident sit in a soiled bed, or do I go to a resident
who fell and is asking for help? What if it happened--the fall
happens while I'm toileting another resident.
Rushing can only cause more harm. Our residents' families
trust us to care for their loved ones. I can't describe how
painful it feels when we are forced to make those kinds of
choices.
Today, I'm vaccinated. The vaccine and boosters have made a
huge difference. We can care for our residents better, and
they're not as scared of the virus; however, the crisis in our
nursing homes is far from over. We continue to face a severe
staffing shortage.
CNAs are burnt out mentally and physically. Our pay is so
low that some of us have to work two or three jobs. Nursing
home staff leave the work force for agencies because they pay
higher. The residents want care from people they know and
trust. They can get the right--I'm sorry.
They can't get that right now at my facility because the
turnover in agency staff is in and out. We never know who will
be there on a given day if there will be enough staff.
Residents are disappointed and frustrated. Some ask me, why
can't we have more staff? And why can't they pay more? I also
want to say that this isn't about CNAs. Every single nursing
home job is essential--housekeepers, maintenance workers,
nurses, dietary workers, aides, and activity workers,
altogether, to give residents the best care possible and the
best quality of life.
The majority of nursing home workers are women and people
of color, and we are often called unskilled and uneducated. Our
jobs are devalued. It's disgraceful. After 2-1/2 years of a
daily pandemic, we're still treated this way.
We are fed up with the lack of respect nursing home owners
and lawmakers show our work force. Change needs to happen now.
One way we can do that is through unions. Our unions have
secured additional sick leave and better health insurance.
We want guidelines to ensure that we have safe staffing
levels more often. A union contract means management has to
follow the rules; it means workers have a seat at the table,
and it means we can fight for our residents to have better
care, but not every nursing home has a union. The workers--and
the residents are suffering.
I'm here today, again, representing the thousands of
nursing home workers who are still fighting for what we
deserve. Congress has the power to set standards in all nursing
homes. You have the power to hold nursing home owners
accountable and make sure that public dollars are used to
improve care and care jobs, not increase profits.
We will need quality care--we all will need quality care at
some point of our lives, and that can only happen with a
skilled, strong work force that is respected, protected, paid,
and staffed.
On behalf of all nursing home workers and our residents,
please take action. Thank you.
Mr. Clyburn. Thank you, Ms. Ramos.
We will now hear from Mr. Arbeeny. Mr. Arbeeny, you are
recognized for five minutes.
STATEMENT OF DANIEL ARBEENY, SON OF NURSING HOME RESIDENT
Mr. Arbeeny. Thank you, Chairman Clyburn, Ranking Member
Scalise, and members of the Select Subcommittee on the
Coronavirus.
My name's Daniel Arbeeny, and I live on Amity Street in
Brooklyn, New York. In one week in April, four family members
died:--my father, my uncle, and my two close cousins of the
virus. Three of them are in nursing homes.
It was--we reluctantly, at that time, joined the 100,000
other New Yorkers in what we call the New York COVID nursing
home orphans. There were a lot of people.
Thank you for very much for hearing this, and appreciate
the opportunity to speak about our personal family experience.
The GAO testimony last year pointed out that while nursing
home residents are less than one percent of the population, at
that time, they were nearly 30 percent of the COVID deaths.
Thank you, Chairman, for pointing out its now 20 percent.
Those are the ones that we're supposed to love, honor, and
protect, and we failed. We failed miserably. No family should
go through this, and we all went through it. Many here lived it
on the other side.
In New York state, the critical component was the March 25
directive compelling nursing homes to accept COVID-positive
patients. My family has lived on the same block for five
generations in Brooklyn. It's a wonderful heritage we were
given, but more importantly, it's where my family has deep
community roots.
My father was a vivacious 88-year-old man, still working
and driving with a very sharp mind and a quick smile. He sat on
the stoop of the house, always offering a smile, a helping
hand, and a greeting to everybody regardless.
In short, my dad was in rehab to get strong right around
the corner. From his window, he saw the rehab center. And was
COVID-free up until the time of the Governor's March 25 order.
It was the nursing home who actually came to us and told us
about the order and how Cuomo and the state health commissioner
refused to listen and just ignored their pleas. They even came
up with options for the state, all ignored. Excellent options,
mind you.
Despite 24-hour care, we brought our father home, gave him
24-hour care. A week later, he passed away.
We took a COVID test 12 hours before; he died 12 hours
later. Twelve hours after that approximately, we got a COVID-
positive test. Even nonmedical personnel, we knew it was
senseless for state government to exercise the fullest of its
powers to compel people with a highly contagious disease, a
killing machine at the time, into nursing homes where the
weakest and most vulnerable were confined.
What could they possibly be thinking? My brother and I, we
talked about this my family, our friends, and those similarly
situated like us.
Then the state legislature agreed with the Governor and
gave blanket immunity to everybody. At that point, our family
decided we were going to find the truth, and that's what we're
going to focus on and meaningfully help those like us.
Thankfully, the media began to focus on the Cobble Hill
Health Center, our local nursing home. Why? Because New York
state had asked all the nursing homes what were the number of
probable deaths from COVID. One out of over 600 nursing homes
answered truthfully--five, 10, 15, and our nursing home said
55.
Well, the media, thankfully, descended on them. They were
the canary in the coal mine. They truthfully answered. They
truthfully answered, and the media were trying to skewer them.
We spent hours speaking to every outlet you can imagine, AP,
The Wall Street Journal, and CNN, to show them what was
happening. And in the end, each one of them realized that had
nothing to do with the nursing homes in New York, they were
forced into this, and they had no idea about the March 25
order, the PPE shortages in the nursing homes that the state
was ignoring.
On October 18, we held a mock funeral for our Governor's
leadership and integrity, which focused on two simple things:
An apology and the true death toll. That came about because he
was writing a book on his leadership, and he had just published
it. October, six months later?
Despite the fact that COVID being a virus, knows no
political party; he blamed it on politics. Based on what we
know today, every statistic New York state used was misleading.
Rather than using facts to point us to the truth, the guardians
of the public interest used their offices to point us away from
the truth.
Finally, and thankfully, on January 2021, the state
attorney general announced a bombshell report that the deaths
were undercounted, and so were the readmissions. Speaking for
myself and almost every other family member in this situation,
we still have not accomplished our goal of learning the truth.
And I'm here before you to hope that you can help us accomplish
that.
No one in public or private sectors admitting the
culpability for the death, distress, pain, and suffering that
was caused and concealed; for this reason, we welcome the
attention of this committee on the nursing home aspect of this
American tragedy and urge further oversight and help.
Thank you.
Mr. Clyburn. Thank you.
The chair now recognizes Dr. Travers for five minutes.
STATEMENT OF JASMINE TRAVERS, RN, ASSISTANT PROFESSOR OF
NURSING, NEW YORK UNIVERSITY RORY MEYERS COLLEGE OF NURSING
Ms. Travers. Chairman Clyburn, Ranking Member Scalise, and
members of the Select Subcommittee on the Coronavirus Crisis
thank you for this invitation to speak today on the work force
issues, equity, and disparities.
Several issues are inherent to the nursing home work force
of many rooted and structural inequities. These inequities
present as staffing shortages, inadequate pay and benefits,
lack of advancement opportunities, and poor working conditions.
Certified nursing assistants, and CNAs, bear the brunt.
When asked about the biggest challenge affecting nursing
homes' day-to-day operations, administrators often mention
insufficient staffing. Proposed minimum staffing hours had been
defined, yet these levels are rarely met. Nursing homes, not
meeting hours, have higher Medicaid census portions of Black
residents, for-profit ownership, and located in severely
deprived neighborhoods and rural settings.
Staff shortages have severe consequences for resident
safety, quality of care, and job satisfaction. CNAs have
reported being responsible for more than 20 to 30 residents
simultaneously, creating heavy workloads and unhealthy working
conditions.
Insufficient staffing can result from the inability for
homes to recruit and retain staff and not scheduling enough
staff. Such challenges center around stigma toward nursing
homework, including the type of work, pay, and workload. Often
staff receives less pay than peers working in other settings,
such as hospitals or even other industries where the work is
less demanding.
Last, funding the care of older adults has often been
deprioritized in deference to childcare, critical care, and
other specialties. Staffing interventions must address these
issues.
Centers for Medicare and Medicaid services, hereafter
referred to as CMS, intends to propose a minimum staffing
standard next year. CMS is collecting information and opinions
from staff residents and families. Vital for the success of the
minimum staffing standard is supplying more funding.
As it stands, CMS is pushing states to use their Medicaid
funding to improve nursing home funding and tie increases to
accountability efforts, such as quality measures and higher
staff wages; however, CMS must do more than encourage state
action.
A strong commitment is needed to improve the working
conditions and environment related to education and training,
compensation and benefits, opportunities, empowerment, and
treatment through mandates, incentives, and accountability
efforts, along with temporary support, such as strike teams.
It is important to highlight this systemic inequities that
have perpetuated disparities among nursing home residents.
Homes with any Black residents experience significantly more
COVID infections and deaths than homes with no Black residents.
Beyond the pandemic, when compared to the White
counterparts, Black and Latino's residents are likelier to
experience pressure ulcers and falls, and under treatment for
pain, ordered antipsychotics and restraints, and less likely to
receive preventive care.
Residents who identify as LGBTQ+ or living with dementia
often do not receive the required care because of limited staff
knowledge and training on how to care for these groups, along
with biases.
Failure to hire staff that is culturally congruent to
residents results in inequitable care experiences when
residents' cultural and linguistic preferences are unmet. To
that end, all older adults deserve equitable care. Several
recommendations in the National Academies reports speak to
this.
First, identify care preferences and implement and monitor
corresponding care plans. Second, ensure nursing homes are
accountable for the total cost of care and poor care delivered
through alternative payment models. Third, require staff
participation in ongoing diversity, equity, and inclusion
training. Fourth, prioritize models that reduce disparities and
strengthen connections to communities and broader healthcare
systems. Last, develop a health equity strategy for nursing
homes. This is important to know what additional work is needed
and where.
Finally, I want to emphasize the importance of combining
policies, data, and experience to truly appreciate the
consequences of decreased oversight, support, and
accountability.
During the pandemic, CMS waived inspection requirements
outside of infection control. Thus citations for deficiencies
such as odor and care planning were ignored. Visiting homes, my
nose would sting from the pungent smells of urine and feces.
Sheets were heavily soiled, and residents were severely
unkempt. Pleas among residents for simple requests such as
going outside just to feel the sun on their faces were constant
yet unaddressed.
While such citations may seem unimportant, it leads to poor
quality of care, such as falls, pressure ulcers, infections,
depression, and avoidable hospitalizations and deaths. We must
consider the lives that were lost for these reasons and
approach such waivers more meaningfully in the future.
In conclusion, I urge the subcommittee to recognize that
older adults do not want to stop living, although they might
need help living. Only then we'll be able to start to make a
meaningful change necessary to improve nursing home care for
our staff, residents, and families.
And I just want to recognize Congresswoman Carolyn Maloney,
who represents NYU. Thank you.
Mr. Clyburn. Well, thank you very much, Dr. Travers. Each
member will now have five minutes for questions.
The chair now recognizes himself for five minutes.
Thanks to the Biden/Harris administration's historic
vaccination campaign, 87 percent of nursing home residents and
89 percent of staff have been vaccinated against the
Coronavirus. These tremendous vaccination rates helped to
curtail the devastation that we saw in nursing homes in 2020.
Ms. Ramos, you worked on the front lines of the coronavirus
pandemic as a certified nursing assistant at a nursing home in
Rhode Island. You've testified today that you had personal
experiences that I would like for you to tell us what you think
has been the impact of this Coronavirus on your life and the
lives of the residents you cared for.
Ms. Ramos. Thank you, Senator, for the question.
So on, 2020 was the worst day I've ever experienced in my
whole life when we first got our residents that was sick with
the virus. At that time, I was working on the dementia unit,
which means that those residents couldn't tell us, like, their
symptoms, how they were feeling.
We--our residents were falling, and then that's when we
find out they were very weak and sick. And at that time that's
when we kind of figured, like, they were getting sick and then
they were trying to test them and to make sure they had the
virus.
But for us, the staff, they weren't testing us at that
time. So we had to go out on our own and, if we had the
symptoms, to test ourselves. The facility wasn't doing that.
And also, we didn't have enough PPE at the facility. We were
told we had to use the same mask for several days and we have
to reuse the gowns. And we were also told that what we were
trained in infection or if you had any virus, we're supposed to
change our PPE. And we were told that they didn't have enough.
So since the facility that I work at, we have a union. We
had to call our union organizer and complain the situation that
was going on at the facility, that some staff are having the
symptoms and they were not testing them. And they would go out
on their own and get tested, and that we didn't have enough
PPE.
So our union had to bring us extra PPE, and also they had
to call the state to come in and test us. That's how they send
in the National Guard, and that's when I find out I was
asymptomatic, and I find out that I was positive when the state
came in.
Mr. Clyburn. Can you tell me, did the vaccine, once the
vaccine came, was there--what was the extent of the change?
Ms. Ramos. So when we finally got the vaccine, I was
actually one of the first ones in the group with my other
colleagues that decided to go first because a lot of our
colleagues weren't sure about the vaccine. They were kind of
afraid of the symptoms, and they were afraid that they have to
lose time from work.
And so our--, again, our unit had to make sure and, like,
work with the management and told them that we're doing that
for the best care of our residents and that we shouldn't be
losing our pay if we get the symptoms.
So after we got the vaccine, our coworkers saw that, you
know, we were doing better with the--symptoms weren't that bad.
So--and also, our residents, some of our residents were very
excited that we had the vaccine, and they were excited to get
the vaccine.
So they went, and I got the vaccine. So after we got the
vaccine, our residents and our staff members were very excited,
and also our residents didn't die on the rate they were dying
previously. So we probably had three--, like one to two
residents that died from COVID for the past year.
Before the vaccine, we lost like 20-plus residents at my
facility.
Mr. Clyburn. Well, thank you very much. I'm almost out of
time.
I'll now yield to the ranking member.
Mr. Scalise. I thank the Chairman again, and I appreciated
all of the witnesses' testimoneys. As we covered in the
beginning, we saw pretty early often in the pandemic as the CDC
and CMS were putting out guidance and specifically for nursing
homes, they were making it very clear that a nursing home
shouldn't be taking patients if they didn't have a plan to keep
COVID-positive patients separated. Yet, in fact, you saw New
York, through Governor Cuomo, start issuing that order that,
ultimately, then other states followed.
We saw New Jersey come right behind it, almost verbatim.
And I'll read the New York guidance because it was then used by
New Jersey, Michigan, California, and Pennsylvania went for it
as well, and this is, quote, from the mandate from Governor
Cuomo's health department: No resident shall be denied
readmission or admission to the nursing home solely based on a
confirmed or suspected diagnosis of COVID-19.
Nursing homes are prohibited from requiring a hospitalized
resident who is determined medically stable to be tested for
COVID-19 prior to admission or readmission.
So there you have the Governor of New York saying, if
you're a nursing home and there is a patient coming from a
hospital, possibly COVID-positive, back into your nursing home,
and you're not prepared to take care of that patient, you still
have to take them going against guidance from CDC, and even
further more egregious, you are banned from testing them for
COVID.
And, of course, New York is the regulator of the nursing
homes. And so Mr. Arbeeny, in your testimony, you pointed out
that the nursing home saw this. They saw what was going on with
COVID, the deaths that were happening, especially in the most
vulnerable populations, and they knew this could be a huge
problem, but their regulator's telling them, you got to do
something that actually could undermine the health of your own
residents, and they pleaded with the Governor not to do this.
If you can expand on that, what did you hear from the guy?
Have you gotten a response from the Governor, because we surely
haven't, and we've asked time and time again for the same
numbers you're talking about. Still, if you could share--
because that had to be a really frightening experience to be
told by your regulator, you have to do something that you know
could lead to the deaths of the very people you're there to
protect?
Mr. Arbeeny. Thank you. It was--we knew at the time what
was happening at the hospitals, which were struggling, too,
with staffing, and we knew what was happening on our nursing
home. And when they came to us and said, you can take better
care of your father at home because you're engaged, you need to
take him home, it was--it was like a hurricane.
I have no other way to describe how my family and I all got
together and came up with a plan. The hospital had left some
medical needs alone. They weren't doing anything unless it was
life-threatening, so we had to get those taken care of.
It was--we were in a race for our lives, and we knew it,
and we did everything in our power to get him home. And at the
same time, we were going out, and--we made a donation. My
family led a group donating to our local police station and
twice to our local nursing home, thousands of pieces of PPE
because we saw with our own eyes what was happening to our
loved ones. We saw what was happening to our police. They had
nothing.
So our city knew, our state knew what was happening, and
they ignored it. Their focus was the hospital----
Mr. Scalise. And did you get any reaction from Governor
Cuomo or his office that they were,--I mean. Obviously, they're
being told this could be deadly. Did they even care? Did they
do anything differently?
Mr. Arbeeny. No, they did nothing differently. Our local
elected officials sent emails, called. We had a fully
functional ICU hospital one block from our house, one and a
half blocks from the nursing home. They were, Please, use that
building. It's the perfect building. Negative. Pressure rooms
built specifically for this. Governor Cuomo would not use it.
Mr. Scalise. Let me come back to that. I wanted to ask Dr.
Grabowski because it seems like you've done some research.
There's some pretty riveting numbers that you talked about, not
only nursing home deaths, but especially 2,600 people who
worked in nursing homes--it wasn't just the nursing home
families, like you said, 100,000 families who were part of this
orphan class now you're talking about, but those workers, were
you aware of these mandates from the regulators, the states
like New York who said you have to take them back and you can't
test them for COVID?
Mr. Grabowski. So we didn't study those directly in our
research. We took a much more national focus, but certainly,
I've since then heard a lot about the----
Mr. Scalise. Does it sound like that followed CDC guidance
to force them to do something that CDC was telling them not to
do?
Mr. Grabowski. Yes. So I didn't sort of get into that in my
research at the time. We didn't focus a lot on kind of the New
York and the timing of when CDC was releasing that guidance, so
I wouldn't be the right person to comment on that.
Mr. Scalise. Mr. Chairman, I'll yield back, but Mr. Arbeeny
and every other family out there, we are not going to stop
fighting to get those answers even if Governor Cuomo and others
want to keep hiding the facts. We are going to dig until we get
the answers to those questions.
I yield back.
Mr. Clyburn. Thank you, Mr. Scalise.
The chair now recognizes Mrs. Maloney for five minutes.
Mrs. Maloney. Thank you so much, Mr. Chairman, for calling
this important hearing. Paid sick leave for nursing home
workers allow staff to take care of themselves and their
families and to keep residents safe, but shockingly, many
nursing homes do not offer paid sick leave to workers at all.
This puts many staff in an impossible situation,
particularly during outbreaks of infectious diseases like the
Coronavirus.
Dr. Bonner, what impact does the lack of paid sick leave
have on the health and well-being of both nursing home staff
and the residents they care for? Ms. Bonner?
Ms. Bonner. Thank you for the question.
So I think it's significant that in nursing homes, not only
things like lack of paid sick leave but other benefits may
drive people to, you know, come to work even when they are not
feeling well, even when they, you know, have sick children or
sick older adults at home.
And so, you know, this has been identified in some of the
studies that our colleagues have talked about today as, you
know, one of the factors that may have led to spread of the
coronavirus crisis more rapidly in, you know, organizations
like nursing homes.
So there are over 500,000 CNAs who work in nursing homes
and many other professionals, and, again, they felt a sense of
duty to be there to take care of residents. And so the lack of
paid sick leave--also, many of the people who are nursing-home
workers are single parents. They've got children at home, and
they've got bills to pay. And so, you know, without any paid
sick leave, this was thought to be one of the challenges during
the pandemic.
Mrs. Maloney. Well, thank you.
Ms. Ramos, I understand that you have been caring for
nursing-home residents throughout the pandemic and that the
facility where you work does provide paid sick leave to you and
your colleagues.
How has paid leave helped you and your coworkers do your
jobs effectively during the pandemic? Ms. Ramos.
Ms. Ramos. Thank you for your question.
So our facility does have sick leave. That's because it
says in our union contract that we accumulate sick leave
through the bargain that we did. And, also, we have a state
sick leave that's, like, separate from our contract.
But at the beginning of the pandemic, we were also told
that we had to use our sick time when we got COVID from work.
So our union had to work with the management and negotiate with
the management, saying to them they got sick from work, and
they shouldn't be using their sick time to pay for them to be
out because they got COVID from work.
So what ended up happening is that our union finally talked
to the management, and they come up with, if we got COVID from
work, we will go through workman's comp. And so that's how we
got paid. And we were homesick, and then, whenever we got
better, that's when we went back to work.
But for a lot of workers that are not--that have non-union
facilities, I've heard from some of my friends that they had to
go to work sick or else they would lose their jobs, they were
told.
And some of them were actually sick at work until they
couldn't be sick anymore, you know, they couldn't take it
anymore, and they had to be out, but they were not getting
paid. And I felt bad for one of my friends when she told me
that, what was happening.
Thank you.
Mrs. Maloney. Thank you.
Nursing-home workers, many of whom are women and people of
color, also struggle with low pay and have high poverty rates.
According to a 2022 report by PHI, a leading authority on the
direct care work force, 12 percent of nursing assistants
working in nursing homes live in a household below the Federal
poverty line, and 34 percent rely on some form of public
assistance.
This is not just an economic issue; it's a real-life
consequence for nursing-home residents.
Dr. Grabowski, how does low pay for nursing-home workers
create risk for nursing-home residents in addition to the
staff?
Mr. Grabowski. Thanks for that question.
Our nurse staff are heroes. We didn't treat them or pay
them like heroes before the pandemic, and we certainly didn't
treat them and pay them like heroes during the pandemic.
When we underpay staff, they leave these positions, there's
huge staff turnover at these facilities, leading to gaps in
care, discontinuities in care that leads to bad outcomes for
our residents.
The best thing that we can do for our residents is support
our staff. And that means paying them well, giving them strong
benefits, like Ms. Ramos just described with paid sick leave,
and really making it a job worth having.
Thanks.
Mrs. Maloney. Thank you.
My time has expired, and I yield back.
Mr. Clyburn. Thank you very much.
The chair now recognizes Mr. Jordan for five minutes.
Mr. Jordan. Thank you, Mr. Chairman.
Dr. Grabowski, was it a bat, to a penguin, to a
hippopotamus, to Joe Rogan, and Aaron Rodgers, or did COVID
start in a lab? Dr. Fauci and Dr. Collins say it's the former;
they said it was animal to human.
Some of the virologists who they've given our tax dollars
to over the years have said the same--, although, initially, I
think it's interesting to point out, before they had their
conference call with Dr. Fauci and Dr. Collins on February 2,
on January 31, 2020, Dr. Kristian Andersen, who's received a
number of our tax dollars over the years, said ``virus looks
engineered,'' ``virus not consistent with evolutionary
theory.'' Dr. Garry said, ``It's easy to do this in a lab.''
They, of course, changed their position after they had this
famous conference call with Dr. Collins and Dr. Fauci.
I was just wondering what you think. Did it start in a lab,
or was it from a bat, to a penguin, to a person?
Mr. Grabowski. So, I'm a health economist. My research has
been focused on nursing-home supporting staff, supporting
residents----
Mr. Jordan. You've got a degree--I saw your background.
You've got a degree from Duke degree from Chicago. You're a
professor of healthcare policy at Harvard.
Is it a good idea for the guys in charge of our government
policy on this to mislead the American people?
Mr. Grabowski. So, I don't have an opinion on where the
virus started or----
Mr. Jordan. Just last week, Dr. Redfield was interviewed,
and Dr. Redfield said this: ``Fauci knew he was misleading the
Congress and the country.''
Do you agree with Dr. Redfield, or do you think Dr. Fauci
was telling us the truth?
Mr. Grabowski. Once again, I don't have an opinion on this.
This is sort of outside the scope of my----
Mr. Jordan. When the government said the vaccinated
couldn't get the virus, were they guessing or lying?
Mr. Grabowski. Once again, this is sort of outside the
scope of what I focus on. I'm really focused on the care of our
nursing-home residents, in particular----
Mr. Jordan. Yes, but you're a smart guy. You're a professor
at the Harvard University School of Medicine.
Mr. Grabowski. And I'm a smart guy that chooses to focus on
nursing homes and really supporting those----
Mr. Jordan. Well, how about this question? How about this--
--
Mr. Grabowski [continuing]. And putting better nursing-home
policies in place to really----
Mr. Jordan. Well, can the vaccinated----
Mr. Grabowski [continuing]. Provide better care for our
residents and our staff.
Mr. Jordan. Can the vaccinated get the virus?
Mr. Grabowski. Sorry. Ask that again.
Mr. Jordan. Can the vaccinated get the virus?
Mr. Grabowski. Did individuals who were vaccinated get
COVID?
Mr. Jordan. Can they get it, yes.
Mr. Grabowski. Sure.
Mr. Jordan. Sure, they can. So when the government told us
that they couldn't, were they guessing or lying?
Mr. Grabowski. Once again, that's sort of outside the scope
of what I----
Mr. Jordan. How about this one? Is the pandemic over?
Mr. Grabowski. Once again, that's not for someone in my
position. I'm a health economist whose research focuses on
nursing homes.
Mr. Jordan. Yes, but you're in front of the--you're in
front of the Select Committee on Coronavirus. I mean, we talked
about the number today. I think you cited--Representative
Scalise cited this as well. I think it was 172,000 individuals
in nursing homes lost their lives. We're talking about
healthcare policy.
One of the things it seems we should be getting to the
bottom of is how did this thing start. You're a witness in
front of the committee with this background--educated guy,
professor of healthcare and policy at Harvard. I'm just asking
you something--the President of the United States seems to
think the pandemic is over. I'm asking, do you think the
pandemic's over?
Mr. Grabowski. Once again, this is a hearing about nursing
homes. I'm really focused on, how do we support our staff and
how do we support our residents? And that's what my research--
--
Mr. Jordan. Well, we might not have had the terrible things
happen in nursing homes if the government would've been square
with us from the get-go. That's one of the things I think is
important for the country to understand. Maybe some of these
terrible things don't happen.
In fact, we've had testimony in front of this committee
that said if they would've focused on the idea that this came
from a lab--, and I asked Dr. Jarrar. I said, ``Would that have
changed how we dealt with the virus, and could that have saved
lives,'' and he said, ``Yes, it would've.''
So that's why we're asking the question. That's why it's
important to the American people. And, frankly, just on a
fundamental level, it's important that the government not
mislead its citizens, which it obviously seems they're doing.
So maybe I'll ask it this way now. If the pandemic's over--
because the President said it just a couple days ago--and the
government misled us on the origin of the virus--it seems
pretty obvious they did. They definitely misled us on the
statement that the vaccinated couldn't get it or transmit it--
should people who lost their job be able to get it back?
Mr. Grabowski. Once again, that's kind of outside the scope
of kind of what I--what I research.
Mr. Jordan. Recruitment levels for our military are off 40
percent. I just talked to colleagues on the House floor who say
for the first time in their time as a Member of Congress where
they didn't have as many apply to go into our academies,
because of the vaccine--because of the vaccine mandate that's
on.
I'm just asking the basic question, should people--
healthcare policy. This seems to have a bearing on overall
policy. Should people who lost their job be able to get it
back, particularly in the United States military?
Mr. Grabowski. So my research hasn't focused on, kind of,
job loss in the military. That's really kind of outside the
area that I study. I'm very focused on nursing homes, which is
the focus of this hearing.
Mr. Jordan. How about this one? Should Pfizer, J&J, Moderna
have to pay the back-salary of people who lost their job,
seeing how they've been misled on the effectiveness of this
vaccine?
Mr. Grabowski. Once again, that's not an issue that I've
focused on in my research.
Mr. Jordan. Mr. Chairman, I yield back.
Mr. Clyburn. I thank the gentleman for yielding back.
The chair now recognizes Mr. Foster for five minutes.
Mr. Foster. Yes, thank you, Mr. Chair.
And I guess I'd like to start by apologizing on behalf of
the U.S. Congress, you know, and to express my admiration for
your not getting lured into trying to talk about things where
you don't have the training or the knowledge about. As you can
see, the U.S. Congress is not constrained in that way, for
talking about things we know nothing about.
Mr. Jordan. Do you think knowing where this thing started
is important?
Mr. Foster. Reclaiming my time, I would like to actually at
this point ask you----
Mr. Jordan. Well, I mean, this is a fundamental question.
This is the Select Committee on the Coronavirus.
Mr. Clyburn. Mr. Jordan----
Mr. Jordan. The origin of the virus is an important----
Mr. Foster. Reclaiming my time----
Mr. Jordan [continuing]. Question, Mr. Chairman.
Mr. Clyburn. Mr. Jordan, I think you know that I'm not
going to tolerate that.
Mr. Jordan. Well----
Mr. Clyburn. No one has disrupted you.
Mr. Jordan. No, but he commented----
Mr. Clyburn. No----
Mr. Jordan [continuing]. About my questioning, and I'm
asking a fundamental question.
Mr. Foster. I commented on my time. And I will continue to
use my time----
Mr. Jordan. About my questions.
Mr. Foster. Correct. And that's----
Mr. Jordan. You can ask whatever questions----
Mr. Clyburn. No----
Mr. Jordan [continuing]. You want. You don't have to
comment about mine. And if you comment about mine, I want to
raise the fundamental question, why won't this committee look
into how this thing started?
Mr. Clyburn. I answered your question, and you aren't going
to ask a question again now. I'm going to ask you very politely
to----
Mr. Jordan. Obviously----
Mr. Clyburn [continuing]. Recognize and respect----
Mr. Jordan. Mr. Chairman----
Mr. Clyburn [continuing]. The gentleman's time.
Mr. Jordan [continuing]. Obviously, the Democrats don't
care about finding out how this virus that disrupted so many
lives, including Mr. Arbeeny's family--they don't care about
finding how this thing started.
Mr. Clyburn. My family has been----
Mr. Jordan. I do, and the folks I represent do.
Mr. Clyburn. Your family has been impacted by this, and so
has mine. So let's stay away from that.
Mr. Jordan. So I'd think you would like to know how--I
think it makes sense for you----
Mr. Clyburn. And I've got----
Mr. Jordan [continuing]. To question how this thing
started.
Mr. Clyburn [continuing]. Enough sense to know that we are
going to do this in regular order. And the order here today is
to talk about nursing homes. We are not going to get into that.
Mr. Jordan. You've yet to get into it in two years that
we've had----
Mr. Clyburn. Mr. Foster?
Mr. Foster. Yes. Thank you, Mr. Chair.
And I also--I, too, lost my favorite aunt and my favorite
uncle in a nursing home in the situation. And I just want to
say that the vast majority of people working in the nursing-
home industry were trying to do the right thing with imperfect
information.
You know, it was months before we knew that this was
primarily aerosol and that all of the business of sterilizing
your food and super-washing your hands was largely irrelevant,
and what was important is not to exhale in the presence of
people who are vulnerable. OK? And it took us a while to
understand just how simple that was.
Also, I'm a little bit concerned that we're trying to focus
too much on what happened in certain--there were problems all
over the country. And I'd like to at this point ask unanimous
consent to put into the record a list prepared by staff of
other states that had very significant problems--you know,
Georgia, you name it--large--Connecticut, Maryland--just all
over the country.
Mr. Clyburn. Without objection.
Mr. Foster. And my aunt and uncle passed away in
Pennsylvania, and I thought that staff there were doing the
best they could under terrible circumstances.
And the way patients passed away, you know, being unable to
talk to their loved ones, was tragic and, unfortunately,
necessary, given what we knew about the virus then and what we
know now, actually.
And there's a large number of lessons to be learned. One of
them, too, is, as has been mentioned, the fact that we have
been underinvesting in the end-of-life care in this country for
a long time. There is enough money in our country to solve this
problem. It is not like we're asking for something that's
unachievable.
You know, since the start of the Obama recovery, the net
worth of Americans has increased from $60 trillion to nearly
$150 trillion. All right? That's a lot of money. But
unfortunately, not much of that increase in wealth has ended up
in those in the middle class who fall out of the middle class
at the end of life. Because that is who ends up in nursing
homes.
This is not something just--you know, nursing homes are not
just for minorities. And there's a sort of narrative about
``this is what nursing homes are about,'' and it's not. It is
ordinary, middle-class people who simply run out of resources
at the end of their life.
And we have enough money to fix this in this country, and
it is to our shame that we don't.
It was one of the first things I did when I was elected,
geez, about 12 years ago, I guess. I asked: What, in Illinois,
does your life look like when you run out of assets at the end
of your life?
And there's a certain amount of money that we have. It's
made much worse in Illinois, in fact, because Illinois, like
New York, like California, and a number of other states, writes
an enormous check to the Sunbelt and to the low-population
western states. If we simply had--because we pay a lot more in
Federal taxes than we get back in Federal spending.
That alone, fixing that, would provide a much better level
of healthcare generally and particularly end-of-life care in
states like New York and Illinois, and California, the large-
population states who are routinely rooked by formula-driven
spending from the U.S. Senate.
That's not the subject of this hearing, but it's really
important when you talk about what's going on in individual
states is the balance of payments between the states.
So I'd like to just talk a little bit about the labor force
shortage here. You know, there's an obvious solution to this.
It is called immigration reform. And there are hordes of very
competent, well-trained nurses around the world. And they
traditionally have entered the U.S. work force. They enter the
U.S. and then start qualifying to get nursing credentials. They
work as ordinary nursing assistants in eldercare homes. I
visited one just a few weeks ago here.
And this is an obvious solution. And is there any reason
that you've come to understand about why we can't fix this?
Because it's all Americans who suffer from the lack of
assistance.
Yes, Dr. Grabowski, any----
Mr. Grabowski. Yes, sure.
So a large share of our labor force in nursing homes are
currently immigrants. And I think as you're suggesting,
Congressman, we could expand that, and we need to expand that
going forward, especially with the aging baby-boom generation.
We're doing a study right now, and it fits exactly with
what you're asking. It turns out areas with greater immigration
see an increase in the work force in nursing homes, and guess
what: It leads to better quality.
And so that link is absolutely there. We need to encourage
strong pathways to get more immigrants in because that's going
to be a big part of the puzzle. It's not the only piece, but
it's going to be a big part of it going forward. We cannot do
this on just using domestic workers alone. We're going to need
strong immigration going forward.
Mr. Foster. OK. Thank you.
My time is up, and I yield back.
Mr. Clyburn. If you have another question, I'm going to
allow it because I think we took a minute and a half of your
time listening to some foolishness. So I will allow you----
Mr. Foster. Yes, OK.
I guess, what we talked about,--you know, I'm a scientist,
so I look for technological solutions that will make things
better. And one of the things that strikes me is that there are
a,--you know, diabetes is one-third of our healthcare costs.
And there are treatments that are now looking like they're home
runs in treating obesity and diabetes. You see them on TV,
which--I won't quote the trade names, but you see them all the
time.
And so the question that I have is, we've learned in COVID
there are huge advantages in giving away certain things, like
vaccines and testing, for free and that they net out as a huge
savings in quality of life as well as taxpayer savings.
And I was wondering if there are ongoing ways--what is the
framework for studying that and understanding if we can save
the taxpayer money by distributing these diabetes cures, you
know, for free to everyone?
Sure, yes. That sounds like healthcare economics.
Mr. Grabowski. All right. I'll take that one.
Absolutely, there's a whole area of economics called value-
based insurance design, where you lower the cost-sharing, maybe
even make it zero, as you suggested, for high-value drugs and
interventions. This might be an example of one such drug.
In order to study the savings with nursing homes, you'd
really want to think about, what are the changes in functioning
that this kind of drug might have for nursing-home residents?
Remember, for most nursing-home residents, Medicare is
going to be paying for their healthcare, so a lot of the
savings would be on the Medicare side, presumably, in terms of
their healthcare spending. But are there savings on the
nursing-home side, in terms of, you know, their functioning
gets better, as you mention, maybe obesity is lower?
There are all sorts of ways that they may potentially end
up costing Medicaid and Medicare less in the nursing home, and
that's where we'd want to focus on and see if there's any
potential offset there.
Mr. Foster. Thank you. And we'll be following up with you
on that.
Mr. Grabowski. All right. Thank you.
Mr. Clyburn. Thank you very much.
The chair now recognizes Dr. Green for five minutes.
Mr. Green. Thank you, Mr. Chairman.
Mr. Grabowski, I'm going to be submitting a question in
writing to you.
Mr. Green. But, Mr. Chairman, I'm yielding my time to the
gentlelady from New York, Ms. Stefanik.
Ms. Stefanik. Thank you, Dr. Green.
Mr. Arbeeny, thank you so much for being here today as an
advocate on behalf of so many New York families, the 100,000
New York COVID orphans, essentially, for the over 10,000 lost
loved ones in nursing homes.
I want to start off on March 25, when Governor Cuomo issued
that fatal directive, forcing nursing homes to accept COVID-
positive patients. Did you consider that a death sentence for
the most vulnerable in New York's nursing homes?
Mr. Arbeeny. We absolutely did. And not just myself, not
just my siblings, everybody we spoke to, whether they were in
nursing homes, whether they were in hospitals, we all did. And
we were all dumbfounded because we all knew the USS Comfort was
sailing in. I went with my son and my wife to see it sail in.
Unfortunately, five days later, New York City had 3,000-
plus beds that were never used----
Ms. Stefanik. That's correct.
Mr. Arbeeny [continuing]. In the Javits Center and the USS
Comfort. And the reason they weren't used was our state layered
on top of the Federal admission policies their own admission
policies, which I have access to, and so it was never used.
Ms. Stefanik. It was a disaster. And I've spoken with
constituents in my district, in New York 21, who lost their
loved ones in nursing homes in the north country and upstate
New York.
But I want to point out everyone knew Governor Cuomo and
Lieutenant Governor Hochul's directive was not according to CMS
guidance.
Look at this. Secretary of HHS: ``There is no CDC guideline
saying you should be taking positive COVID patients and putting
them back in the community in nursing homes.''
Former CMS Administrator Seema Verma: ``Under no
circumstances should a hospital discharge a patient to a
nursing home that is not prepared to take care of those patient
needs.'' And then, when asked directly, would New York state's
guidance have violated CMS guidance, the answer was yes.
This was a death sentence.
And isn't it true that, only four days after issuing that
directive, during Andrew Cuomo's press conference, he himself
said that, quote, ``Coronavirus and a nursing home is a toxic
mix'' and can be like, quote, ``fire through dry grass''? Isn't
it true that he said that?
Mr. Arbeeny. He said that multiple times. And I can
actually get out the dates he said that. It was horrific for
anybody that was living through that. Yes.
Ms. Stefanik. So Governor Cuomo knew, and they worked
overtime to cover this up. As families came forward,--they
certainly came and tried to reach the Governor, tried to share
their views, as well as the nursing-home workers--what was the
Governor focused on? He was focused on winning his Emmy, which
has since been taken away from him, and he was focused on
cooking the books, withholding the numbers, so he could get his
$5.2 million book contract, which was unethical.
I will always fight for transparency and answers.
My question is: Since Governor Cuomo has been forced to
resign, Kathy Hochul, who was the sitting Lieutenant Governor,
she promised to fight for transparency. She lied when she said
that.
Can you talk about your family's experience, working with
other advocates, your reaching out to Kathy Hochul, and what
she has failed to do?
Mr. Arbeeny. My brother printed this out. This is my
father's death certificate. And we've shown this to our
attorney general, our comptroller, and we gave a copy to our
current Governor. And she said she was mortified that she
couldn't--, and nobody could tell us if my father's death
counted, and that she wanted to get a true death count, that we
shouldn't 50 years from now be trying to figure out what
happened.
Unfortunately, nothing has happened. And as best we've been
told through somebody else, they won't be looking back; they
only want to look forward.
Ms. Stefanik. She lied. And she continues to delay any
investigation. She has refused to respond to congressional
outreach from myself, Ranking Member Scalise, and Ranking
Member Jamie Comer.
Isn't it true that the state senate, which is held by
Democrats, they've refused to do a fulsome investigation into
this?
Mr. Arbeeny. Yes. They have not done an investigation with
subpoena power, and they've whitewashed it.
And we know this very clearly because of the attorney
general, in January 2021, and our state comptroller came out
with--sorry, 2022--and our state comptroller came out with
their findings. And I could read to you those findings. I have
the quotes. But at the very highest levels in our state
government, we were lied to for their narrative.
Ms. Stefanik. Help is on the way. The subpoenas are coming.
House Republicans are committed to standing up and demanding
answers and justice for those families that our colleagues
across the aisle in New York state and here have failed to do.
The subpoenas are coming. Help is on the way.
I yield back.
Mr. Clyburn. I thank the gentlelady for yielding back.
The chair now recognizes Mr. Raskin for five minutes.
Mr. Raskin. Mr. Chairman, thank you very much.
This morning, this subcommittee released reports exposing
the truly horrifying conditions in nursing homes across the
country in the early months of the pandemic.
And I can remember like it was yesterday how the Trump
administration abandoned nursing-home workers and other
essential workers as they pleaded for the Federal Government to
help them get critical supplies necessary to protect themselves
on the job and curb the spread of the virus.
But, instead of mobilizing a serious Federal response,
President Trump contemptuously stated that his administration
was, quote, ``not a shipping clerk,'' and he told the states to
go and find their own supplies.
Today, I'm actually reading about a new book that's been
published quoting Melania Trump in a phone call with former New
Jersey Governor Christie, in which she discussed seeking help
convincing her husband to take the pandemic more seriously.
"'You're blowing this,' she recalled telling her husband,''
the authors write. ``'This is serious. It's going to be really
bad. And you need to take it more seriously than you're taking
it.' He just dismissed her. 'You worry too much,' she
remembered him saying. 'Forget it.'"
The new documents demonstrate just how severely nursing-
home facilities were affected by PPE shortages under the
dereliction of duty of the administration.
So, long before Donald Trump did nothing to rescue his own
Vice President, Mike Pence, as he was being hounded and chased
out of the Capitol by Trump's mob, he was doing nothing to
rescue tens of millions of Americans from the nightmare of
COVID-19.
Some employees were reportedly told to, quote, ``share
PPE'' with other employees. Some were only given one protective
face mask to wear for an entire week and were instructed to use
makeshift isolation gowns out of plastic or paper bags that
were, quote, ``stapled and taped together.''
Ms. Ramos, as someone who worked in a nursing home during
those early months of the pandemic, how did these systemic PPE
shortages affect you and the lives and work of your colleagues?
Ms. Ramos. Thank you for your question, Senator.
So, during that time, we didn't have enough PPE, like I
said. We were struggling to get PPE. Like, we didn't have--they
told us to use the same mask over and over again, and they told
us to reuse the gowns.
So we also had--when our staff members were getting sick,
we didn't have enough staff to work either. So we were short-
staffed at that time also.
And during that time, we called our organizer and let them
know what was going on in our facilities. And our organizer had
to come for our rescue and bring us the PPE and also tell them
that they need to do something about the staffing or the
management has to come in and help out because we didn't have
enough staffing.
Like, on Mother's Day, I remember clear that day, we had 26
residents that were very sick. And one of my residents, she
asked me if I could stay by her bedside and hold her hand
because her children were outside the window, visiting her. And
it broke my heart because we didn't have enough staff on. So
there were only 2 CNAs working that day and a nurse working
that day, for 26 residents. And so it broke my heart, because I
told her I couldn't sit with her because I have other 25
residents that I had to care for.
But we called the management, and the answer was we had
enough staff on. And the PPE, our organizer, had to drop off
some PPE.
But, also, the short-staffing, it didn't start with the
pandemic. It also start before the pandemic. We had a big
shortage of staff. So the pandemic made things worse for us in
the nursing homes.
Mr. Raskin. Well, thank you very much for your service and
also for your testimony.
The previous administration's refusal or complete inability
to do their job allowed one of the worst pandemics in history
to run practically unchecked here in the United States.
Dr. Grabowski, how did the Trump administration's failure
to provide nursing homes with PPE and other essential health
supplies affect their ability to care for residents in the
first months of the pandemic?
Mr. Grabowski. Yes. Thanks for that question.
As Chairman Clyburn mentioned during my introduction, I
served on the Trump administration's CMS Coronavirus Commission
back in 2020. And we were asked to take stock of what had
happened up until that point and offer a series of
recommendations to really provide nursing homes with a roadmap
out of the kind of crisis that they were in at the time.
And our recommendations included personal protective
equipment, testing, support for staff like Ms. Ramos, better
ventilation, and on and on and on--better data. All these
issues have come up. Mr. Arbeeny talked about PPE and more
transparency of data. You know, we had a really strong list of
recommendations.
Those recommendations were not incorporated. The
administration said, ``Thank you,'' but didn't put them into
practice. And I think that cost us a lot of lives at the time.
Congressman, if we had went ahead and really provided PPE
to facilities, rapid testing, support for our staff, and on and
on and on down the list, I think that death total I cited
earlier would be a lot lower today.
Mr. Raskin. Thank you for your testimony.
I yield back, Mr. Chairman.
Mr. Clyburn. I thank the gentleman for yielding back.
The chair now recognizes Ms. Malliotakis for five minutes.
Ms. Malliotakis. Thank you, Mr. Chairman.
And thank you to our witnesses for being here today. As a
New Yorker, I'm especially happy to welcome Mr. Arbeeny here to
tell his story.
I think we could learn a lot from you and expose the
decisions that were made by the Cuomo-Hochul administration
that ultimately led to over 17,000 of our seniors dying and,
unfortunately, your father. And my condolences for that.
I just want to talk about the timeline. Because on March
13, 2020, CDC and CMS released guidance stressing that a COVID-
19-positive nursing-home resident must be quarantined and
properly treated. The guidance directly forbids nursing homes
from accepting patients they were unable to properly treat.
Then, on March 15, in a phone call between Jared Kushner
and Governor Cuomo, Cuomo allegedly said, ``For nursing homes,
this could be like fire through dry grass.'' He admitted that.
And March 19, the Society for Post-Acute and Long-Term Care
Medicine warned, ``Admitting patients with suspected or
documented COVID-19 infection represents a clear and present
danger to all the residents of a nursing home.''
So it was very clear, very well known to everyone, that the
elderly were the most vulnerable to COVID and that putting
positive patients in the nursing home just lacked common sense.
On March 24, it was during his daily press briefing--, and
it was very famous this video clip, where he said, ``My mother
is not expendable, and your mother is not expendable.'' And yet
the very next day is when he put out that directive, that
lethal directive, that mandated nursing homes, regardless of
their ability to provide care, to accept the COVID-19-positive
patients discharged from hospitals. And that directive
prohibited the nursing homes from even testing the patients
prior to admittance.
And, to boot, the state didn't even provide the PPE to help
the nursing homes. And, like you said, you were delivering PPE.
So was I, going to the nursing homes to try to help them,
because they were forced to do this without any help from the
Cuomo administration.
And it was directly against the CDC and CMS guidance and
common sense.
Now, this is an interesting thing. Even after the Governor
set up and the President sent in the USS Comfort ship, the DOD
set up the Javits Center, on Staten Island, we had the South
Beach Psych Center, even after there were alternatives that
were not full, right, hardly used really, the Governor kept
this mandate and kept requiring that nursing homes take that.
Why do you think that is?
Yes, Mr.--I would love--why do you think, even after----
Mr. Arbeeny. Yes.
Ms. Malliotakis [continuing]. There were alternatives, that
he continued to put those positive patients in nursing homes?
Mr. Arbeeny. It's dumbfounding to me. And the way I'd like
to answer it is: I could guess, but what I'd like to do is
point out some facts.
On March 19, he started working with book publishers on his
book our former Governor. And four months later, he all of a
sudden has a book and a book deal, and he's lying about all the
numbers.
He called the President at the time, President Trump, and
asked for help. President Trump set up, in less than 10 days,
3,000--almost 3,000 beds--no, 2,000 beds at the Javits Center.
They mobilized. And five days after March 25th-ish, they all
are open.
We did a FOIA request and found out, on April 7, the vice
admiral in charge of those facilities was emailing the
executive chamber and saying, ``We have nobody here. Please
send us,''--and you see the chain of emails. They're getting
the runaround.
I can only guess that our Governor--, who then purposely
made sure no one could use the Javits Center or the USS
Comfort, because he layered admission policies on top of
that,--didn't want to do it because it might make the President
look good or it might help New Yorkers.
I can't understand how you could not do it.
Ms. Malliotakis. No.
I think we should also look into whether nursing homes got
higher reimbursements than if he had put--would the state have
gotten more money putting people in nursing homes or hospitals
versus the alternative sites. That's something that should be
looked at.
But one question. You mentioned your father was in the
nursing home from--when? When did he start being in the nursing
home?
Mr. Arbeeny. I don't remember the exact date for----
Ms. Malliotakis. Uh-huh.
Mr. Arbeeny [continuing]. The last one, but I think it was
around March 25, plus or minus a couple----
Ms. Malliotakis. March 25. So it was before the directive.
Mr. Arbeeny. Yes, it was--I think it was--, sorry. It was a
week before.
Ms. Malliotakis. So he was in that nursing home a week
prior to the directive. The directive happens. And you're
saying in April is when your father was positive and passed
away. And, at that time, there were these alternatives set up.
Mr. Arbeeny. Correct.
Ms. Malliotakis. So you believe if Cuomo decided to put
these individuals in the alternatives instead of the nursing
home, your father could still be alive today?
Mr. Arbeeny. So the answer is, absolutely. I'm sure the
staff brought the virus in. No one could say no to that. But
putting 9,000 COVID-positive patients into the nursing homes is
nothing short of a death sentence for my dad and the other tens
of thousands of--15,000 people.
Ms. Malliotakis. Yes.
Well, again, my condolences. And I've run out of time, but
thank you for being here.
Mr. Arbeeny. Thank you. Sorry for going over.
Mr. Clyburn. I thank the gentlelady for yielding back.
The chair now recognizes Dr. Miller-Meeks for five minutes.
Mrs. Miller-Meeks. Thank you, Mr. Chair.
And I want to thank all of our witnesses for being here
today.
And let me also say to all of those who lost loved ones
during the COVID-19 pandemic, as a physician and a former
public health director, we know that infectious diseases are
something that we have largely tried to help, to assist with,
and COVID-19 is one of those where we still don't even know the
origins of COVID-19 and are still uncertain about transmission
status with vaccination, but we know people with vaccines and
boosters can still transmit the virus. So we still have some to
learn.
But one of the things I can say that we do know from the
infectious disease and medical standpoint is that when you mix
sick people with an infectious disease with well people that,
you're likely to get transmission.
And as we've heard from my colleagues today, it's clear
that the Governors in New York, New Jersey, and Michigan
violated clear guidance and infectious-disease protocols by
issuing must-admit orders, which sadly led to thousands of
unnecessary elder deaths.
We already knew from the evidence we had from China that
there was transmission in elderly people, that children rarely
got ill. There was a question whether children would transmit
the virus because they have a much better immune system. We
knew that this group was the most susceptible group. And we
already knew that there was guidance from CMS and from CDC in
regards to admission status.
Let me also say that the actions of these Governors went
against CMS and CDC guidance when they forced COVID-19-positive
residents back into nursing homes, forced them to be accepted,
and declined--and sometimes actually tried to get them not to
test the COVID-19 status.
While the Trump administration was issuing guidance to
attempt to protect this already-vulnerable population, these
Governors showed carelessness and acted directly against the
science.
This is not political. It's scientific. For those of you
who have children and have gone into a pediatrician's office,
most pediatricians' offices will segregate out the well
children from the sick children. And, in fact, we did that with
pathways into hospitals throughout the COVID-19 pandemic.
Long-term-care facilities have always been more vulnerable
to infection, and infectious-disease outbreaks, for a plethora
of reasons, but especially because they're primarily occupied
by elder people who have an already-suppressed immune system.
And this has remained true with COVID-19. However, carelessness
and a lack of following the science led to worse outcomes than
what was necessary.
And I would say any public health director, state public
health director--, and I was one in Iowa,--would have known
that putting COVID-19-positive patients or patients who had not
fully recovered from a COVID-19 diagnosis and admission to a
hospital would put others at risk.
When the population of caregivers is primarily younger, who
may not get ill, it's possible they could bring in COVID-19
coming into a facility, but more likely introduced from ill
patients who had poor immune systems and were more likely to
transmit.
So I believe that, as we look back and conduct oversight of
the COVID-19 pandemic, we should look at the importance of
ensuring long-term-care facilities remain a priority when it
comes to allocation of resources such as PPE and vaccines for
situations such as when the pandemic arises in the future.
And, Mr. Arbeeny, I think you've spoken to this, but could
you speak to the risk this presents to residents of nursing
homes.
And can anyone provide a good explanation for the
inconsistencies in how we did in hospitals, acute-care
hospitals, in segregating patients, and then what was allowed
to be admitted and mandated in New York, New Jersey, and in
Michigan?
Mr. Arbeeny. It felt to me, in my experience being in the
hospital system and in the nursing-home system, that--or, not
``it felt to me,''--all the focus in the media and everything
our former Governor was saying was on the hospitals, not on the
nursing homes. It felt like nursing homes were the orphaned
stepchild. I can't put it any other way. And yet the nursing
homes are where our most loved people are--our parents, our
grandparents.
It was just--nobody with common sense would've ever done
anything like that. And, what, 50 states--, 45 states didn't do
that. The five that did, from what I remember--and I don't
remember the numbers--, the outcomes were just so much higher.
Mrs. Miller-Meeks. And at a time when we prevented family
members from being with those individuals.
Thank you so much for your testimony.
Mr. Chair, I yield back.
Mr. Clyburn. I thank the gentlelady for yielding back.
Before we close, I ask unanimous consent to enter into the
record 27 letters the committee has received from individuals
and organizations about this crucial issue.
Without objection, so ordered.
Mr. Clyburn. In closing, I want to thank all of today's
witnesses for their testimony. We appreciate your insight and
expertise as we seek to understand the challenges that
America's nursing homes faced during the coronavirus crisis so
we can learn from the past and prepare for the future.
I also wish to apologize for the outburst we heard here
today. When I was leaving home, going away to college, back in
1957, my dad shared with me a little anecdote, and he concluded
with this thought: ``Now, son,'' he said to me, ``the first
sign of a good education is good manners.''
I've held to that. And it seems to me that a lot of people
who went off to college did not get a good education. And so I
apologize for what you were subjected to here today.
And I'm grateful that the Biden administration is focused
on improving nursing homes in America so the Coronavirus and
other infectious diseases no longer pose a dangerous threat to
residents and staff.
Vaccinations, including being up to date on boosters,
remain our most important tool in preventing severe outcomes
from the Coronavirus. Nowhere has the life-saving impact of
coronavirus vaccines been more apparent than in our Nation's
nursing homes.
And I am very pleased to hear your testimony here today,
Ms. Ramos, on that subject.
I urge all Americans to get vaccinated and to go out and
get the updated bivalent booster as soon as they are eligible.
With that--and, without objection, all members will have
five legislative days within which to submit additional written
questions for the witnesses to the chair, which will be
forwarded to the witnesses for their response.
[all]