[Congressional Record Volume 166, Number 133 (Tuesday, July 28, 2020)]
[Senate]
[Pages S4531-S4533]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              CORONAVIRUS

  Mr. CASEY. Mr. President, I rise this afternoon to talk about long-
term care and a number of related challenges that confront our country, 
especially at this time.
  One of the most horrific numbers in all of the horror that we have 
seen in the aftermath of the onset of the virus and COVID-19 disease 
and the jobs and economic crisis that have followed it is the number of 
deaths in long-term care settings.
  When you combine the deaths of residents in nursing homes and other 
similar settings--sometimes called long-term care or even congregate 
settings--with the deaths of workers, we know that the number now 
exceeds 59,000 Americans. About 40 percent of all the deaths are either 
a resident of a long-term care facility or a worker in those 
facilities.
  So we are talking about those Americans today--those families--when 
we consider what we do next because no one here, I don't think--I don't 
care what side of the aisle, what point of view, who you are, what 
State you are from, no one in this body or in the House would want to 
accept the idea that, say, 4 months from today, or 5 months or 6 
months, another 59,000 or 60,000 people will have died in those 
settings.
  We know a lot about how to get those numbers down. It is not one of 
those things where we can throw up our hands and say there is little 
that we can do. There is a lot we can do because Americans are smart, 
innovative, and caring, and a lot of smart people have figured out how 
to get those numbers down.
  So 59,000--more than 59,000--Americans is unacceptable. Also, 40 
percent of all the deaths going forward is also unacceptable. About a 
month ago, I came to the floor with some of my colleagues, and we 
pressed for a vote on the solutions we need to save lives in nursing 
homes and also protect the workforce. The majority blocked the vote. 
Since then, the Senate has done nothing when it comes to this issue 
that has impacted so many families and so many communities. We have a 
chance now.
  I realize sometimes when a bill gets blocked that that isn't the end 
of the story and that the individual or the party blocking might have a 
different idea, a better idea, a different solution, a better approach. 
If that is the case with the majority, we need to hear it. I would hope 
that a solution, a remedy, a strategy to get the 59,000-death number 
down would include the resources to do it because this isn't a 
circumstance where you can just wish it away. This isn't a circumstance 
where you can just move a little bit of policy around. We need 
resources, and I will talk more about them.
  We know that yesterday Senate Republicans released their plan for the 
next piece of legislation relating to COVID-19 and the economy. This 
proposal is 2 months--a full 2 months--after the House passed the 
Heroes Act to bring relief to the millions of Americans who are 
suffering, families who are suffering, not only in the context of long-
term care--having lost a loved one, a resident, or a worker in their 
family--but they are suffering for other reasons as well.
  We know the unemployment rate is intolerably too high. In my home 
State of Pennsylvania--just imagine this--the number was 1-plus million 
people out of work in April. Thankfully, that number went down in the 
month of May, but it only went down to 849,000 people out of work.
  I was hoping, as I know everyone was in the State, that the June 
number would fall precipitously and maybe by the same percentage, so 
849,000 people would go well into the 700s and maybe even into the 
600,000s and would keep going down from there. Unfortunately, in the 
month of June, it went from 849,000 to about 821,000 people out of 
work. I don't think I have seen unemployment numbers like that in my 
home State in my lifetime.

  The 13.4 percent unemployment in May dropped but only went down to 13 
percent. Just by way of comparison, in the great recession of just 
roughly a decade ago, Pennsylvania's unemployment rate went way up, as 
it did in a lot of other States. It stopped at 10 percent. Some 
counties were above 10 percent, 11 percent, 12 percent or higher. 
Statewide, it never really went above 10 percent.
  We are now in our third month of unemployment rates well above 10 
percent. It was 16 percent in April, almost 13.5 percent in May, and 
now 13 percent exactly now. We have a lot of work to do.
  For purposes of today's discussion, I wanted to talk about what we 
can do in the long-term care context. The Republican proposal of 
yesterday makes no

[[Page S4532]]

meaningful investment to save lives in nursing homes. The policies that 
address long-term care in this proposal are insufficient. I think that 
is an understatement, but I will let that go for now.
  There is no investment in home and community-based services, and 
there is no funding to reward the heroes on the frontlines. Some people 
might say: What do you mean by home and community-based services? I 
don't understand that. I am not sure what you mean.
  We know that in the United States we have a number of settings where 
care is delivered--care for older citizens, older Americans, and care 
for people with disabilities. In the nursing home context, of course, 
that is skilled care in a facility, in a so-called congregate setting. 
Depending on which number you believe, in the United States we have 
between 1.3 and 1.5 million Americans there. We also have a lot of 
Americans who are getting their care--very important care for a senior 
or for someone with a disability--in a home setting or in a community-
based setting, but the funding doesn't flow in that direction very 
often. So we are trying to change that because, obviously, if you are 
an older American, you might have certain conditions that make you even 
more susceptible, more vulnerable in the context of COVID-19. In many 
cases, it will be preferable to have you in a home setting or 
community-based setting.
  But if you are in those settings, we have to invest in the workers 
who do that heroic work in both nursing homes, in homes, and in 
community-based settings, because the care is not going to be what it 
needs to be if we are not helping the workforce. I think most people 
agree with that.
  Just as we cannot allow another 3 or 4 months to go by with 59,000 
people dying, we also cannot allow the conflict here in the Senate to 
stop us from making progress in long-term care. We have to help nursing 
homes at the same time as we demand more of them. We need to invest in 
what we know works.
  I have a bill, S. 3768, introduced with Senator Whitehouse. The name 
of the bill is the Nursing Home COVID-19 Protection and Prevention Act. 
It would dedicate $20 billion in emergency funding for proven 
practices. We would spend $20 billion to get that death number down and 
also to get the case number down.
  We are concerned, as well, about the high number of cases. We need to 
invest in best practices that some long-term care settings were 
investing in way back in early March, and some long-term care 
facilities got much better results. They had fewer cases and lower 
numbers of deaths because they were investing in these best practices. 
But to invest $20 billion in emergency funding for these proven best 
practices, I think, is a bargain to get the death number down and get 
the case number down.
  This bill will help nursing homes become a lot better and become more 
proficient at a practice called cohorting. It is real simple. That just 
means separating people in the nursing home. You separate the residents 
with COVID-19 from the residents who don't have it. When that basic 
practice is in place and when it is operative, it is something that a 
lot of places need help with. There are, obviously, costs involved in 
that. There may be costs because you have to do retrofitting. There may 
be costs in terms of needing additional staff.
  But that is only part of it. The bill also allows nursing homes to 
provide for their workers, these heroes who are on the frontlines every 
day. Obviously, if you are on the frontlines every day, you are an 
essential worker. There are all these phrases and descriptions of these 
workers. Those who are at the front of the frontline are those in 
healthcare, because they are not only going out every day and providing 
an essential service, but they are closest to the risk. That includes 
folks who work in hospitals and other settings, of course. That is for 
certain. But it also includes people who work in nursing homes and at 
home and in community-based service settings.
  Those are folks whom we call heroes, and it is nice to call them 
heroes. It is nice to say they are doing great work. It is nice to pat 
them on the back, but what we should be doing is paying them more for 
the sacrifice they make for the country.
  The analogy, of course, is the GI bill. I have a bill that would add 
similar education benefits to those frontline workers, those heroes.
  But at a minimum, they should get premium pay and overtime pay. They 
should also have essential benefits, and we should help them with 
childcare. You can't say: You have got to be on the frontlines; you 
have got to be on the front of the front lines, and you have to go to 
work every day because we need your essential skilled work to care for 
the most vulnerable, but you are on your own with childcare. Good luck.
  We haven't done much to help them with that.
  My bill also includes strong resident protections--``resident'' 
meaning residents of nursing homes--to prevent evictions to homeless 
shelters and to provide an extra check on nursing home quality.
  All these things I just recited in the bill, the Republican proposal 
doesn't have. I think the time is long overdue for Congress to take 
action to deal with what can only be described as an American tragedy--
a preventable American tragedy. No one would argue--I certainly would 
not argue--that the 59,000-plus number could be zero. It is not what we 
are saying. What we are saying is you can bring the number down. If we 
bring the number down, even a little bit, it is worth it to save lives 
and to reduce the number of cases, but I think we can do a lot better 
than that.
  Last week, a coalition made up of representatives from the nursing 
home industry, direct service professionals, AARP, the Alzheimer's 
Association, Catholic Charities, The Arc, and the Service Employees 
International Union came together to write to Senate leadership to 
demand this action and more. Think about that group. That is not a 
group that is always on the same page. They have often direct conflicts 
on a lot of issues, but they have all come together to support the 
residents in nursing homes and those in other settings and the workers 
because that is how dire it is. Groups that are often in conflict on 
legislation are together on this. Here is part of what they wrote to 
the Senate leadership: ``The urgent need to save lives, prevent the 
spread of the virus, and address the services and support older adults 
and people with disabilities need cannot be overstated.''

  In addition to nursing home supports, this coalition called for 
dedicated funds for home and community-based services under Medicaid 
that I described earlier. I have a bill to do that. The House-passed 
Heroes Act, in fact, does that. The Heroes Act passed 2 months ago, and 
here we are without a bill ready to vote on in the Senate.
  I sent a letter with 28 of my colleagues yesterday to urge Leader 
McConnell to move these policies forward. We know that over 2.5 million 
older adults and people with disabilities depend on these services to 
be able to continue living in their own homes. These 2.5 million 
seniors and people with disabilities are folks who are not in a nursing 
home or other congregate setting. They are, by definition, in their 
homes or in a community-based setting. They are receiving their 
supports and services in their homes, where they are less likely to be 
exposed to the virus and often are able to see their families.
  Just to give you one example, there is Michelle Mitchell of 
Allentown, PA--on the eastern side of our State, almost at the New 
Jersey border. Michelle is a person who benefits from the services. She 
has a lifelong disability--cerebral palsy--which affects the use of her 
arms and legs. She holds multiple degrees and is a full-time faculty 
member at a local college.
  Every single day, Michelle Mitchell has the benefit of a personal 
care attendant who helps Michelle get out of bed, helps her to bathe, 
helps her to dress, and helps her to eat. Without Medicaid home and 
community-based services, thousands of people with similar needs to 
Michelle would not be able to live at home and work and interact with 
neighbors and friends. Home and community-based services keep Michelle 
safe, they keep her healthy, and they keep her engaged.
  But the agencies that provide these vital services are facing 
barriers. A survey of home and community-based

[[Page S4533]]

services providers conducted by the group ANCOR found that 68 percent 
of providers have had to close some of their services to people with 
intellectual or developmental disabilities. This same survey found that 
over half of the agencies had faced significant additional expenses 
because of pandemic expense.
  We know that life has changed for so many Americans and so many 
institutions. This is one of these agencies that do such good work. 
Some of the expenses they face include increased levels of overtime, 
purchases of personal protective equipment, and additional training for 
workers. Perhaps most unsettling is that the agencies that provide 
essential services to older adults and people with disabilities don't 
have sufficient funding to keep offering services for more than 1 month 
if payments stop. This lack of cash on hand illustrates how fragile the 
home and community-based services system is.
  Yesterday morning, administrators in Pennsylvania said that if home 
and community-based services were not available, thousands of 
additional people would need to enter nursing homes, which again, is a 
congregate setting, where the likelihood of contracting the virus is 
higher than a lot of other settings. That, of course, would put them at 
greater risk of contracting the virus and much greater risk of dying 
because of this horrible pandemic.
  When we talk about investing in home and community-based services, 
that is tied to the goal of getting not just the case number down but 
the death number down.
  The proposal by Republicans yesterday makes clear that they are not 
focused on this crisis. There is no investment in home and community-
based services at all. The response to nursing homes is wholly 
insufficient. The level of funding provided in the proposal, in my 
judgment, is an insult to older Americans. It is an insult to people 
with disabilities and their families, and it is an insult to the 
workers who support them. Claiming that people with disabilities and 
seniors are supported in this legislation is just not true.
  On top of the lack of funding, the bill blows a hole in the 
protections provided by the ADA, or the Americans with Disabilities 
Act, for people with disabilities. To ensure that seniors and people 
with disabilities are kept safe and healthy during this public health 
crisis, we need to ensure that strong policies are in place to keep 
nursing homes safe, and we need to ensure that there is dedicated 
funding for home and community-based services.
  I am calling for an investment in both settings--home and community-
based services--for seniors and people with disabilities, as well as 
investments in proven strategies that we know will help nursing homes 
and also get the death numbers down. To meet our responsibilities to 
those who are most at risk--the most vulnerable among us--the Senate 
should include these provisions that I have described in the next 
COVID-19 legislation.

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