[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

                               __________

      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                     
          
-----------------------------------------------------------------------------------                               
                            
                   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

                              ----------                              
                                                                   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

                              ----------                              


                     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.

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