Care and Distribution Systems and imposing a deadly toll on seniors, in particular. It has hit close to home for many on this committee and im sure that all of our members want to join me in expressing our condolences to senator elizabeth warren, who lost her 86yearold brother to the coronavirus. Elizabeth, were very sorry for your loss. Restrictions on visitors to Nursing Homes have affected even those families whose relatives do not have the virus. I know two brothers from maine whose father is in a nursing home and has dementia. They have not been able to see him for some time now and his health is failing. They are worried that he may not still be alive by the time that they are allowed to visit him. Something that used to happen regularly. This virus has already claimed the lives of more than 90,000 americans, the vast majority of whom were older adults. Adults aged 65 and older are more likely to suffer severe complications from covid19 and to have more difficult recoveries. They represent two out of every five hospitalizations and eight out of every ten deaths from the virus. Those in Nursing Homes and other congregate care centers are especially at risk. Nationwide nursing home residents represent onethird of all coronavirus deaths. In maine the toll on nursing home residents is even higher. Maine is the oldest state in the nation by median age and the centers for Disease Control and prevention reports 1,819 cases in our state and the virus has claimed 73 lives. More than half of those deaths have been residents of longterm care facilities. You can see that maine has an even higher death toll in Nursing Homes and other longterm care facilities than the national average. Earlier this month we wrote to the administer on the centers for medicare and medicaid, outlining a series of recommendations to better protect older adults in Nursing Homes. Among the issues that we urged be considered is how longterm care facilities and inhome care settings can access adequate testing as well as personal protective equipment and how the Higher Health risks of older adults living in Nursing Homes can be taken into account in the distribution plans for any future covid19 treatments and vaccines. New diagnostic tests, therapeutics, and vaccines are moving forward at remarkable speeds. I look forward to learning more about this Research Today as well as promising treatments and strategies that can speed recovery for the most vulnerable populations. Through this and subsequent hearings, i hope that we can gain insight into additional actions that may be needed to better protect our seniors. Congress has already taken a number of actions in response to the pandemic. We have passed four legislative packages totaling nearly 3 trillion to provide Public Health support to states and to Economic Relief to Small Businesses and families. Phase one provided appropriations to supplement the Strategic National stockpile, to develop and purchase diagnostics, therapeutics and vaccines to support Community Health centers and to help positives and Health Systems respond. Phase two provided free coronavirus testing and increase federal funds for medicaid and other critical safety net programs. Phase three, known as the c. A. R. E. S. Act, provided additional funding to purchase critical protective equipment and testing for the stockpile. New resources for medical professionals on the front lines to whom we owe a great debt of gratitude, direct aid to states, and economic support for Small Businesses and their employees through the paycheck protection program. The c. A. R. E. S. Act also included the Home Health Care planning improvement act. This is a bill that i have championed for 13 years to allow Nurse Practitioners and physician assistants to certify home Health Services. Cutting down on timeconsuming, unnecessary paperwork requirements that not only failed to improve patient care but also delays access to that care, could not have come as a better time. In addition, the c. A. R. E. S. Act makes a number of improvements in the delivery of telehealth. More progress is still needed and i plan to introduce the bill soon to create a framework to reimburse for Telehealth Services provided by Home Health Agencies. Finally, phase four provided additional funding for the paycheck protection program, 75 billion for our hospitals, and 25 billion for additional testing. Much of the funding provided through these bills has yet to be released by the department of health and human services. Therefore, i urge the department to act with urgency so that this funding can flow to areas where it is desperately needed. Today we will hear from a panel of experts who are leading the charge in supporting seniors across a variety of settings of care including in hospitals, in Nursing Homes and in the community. We will be joined by dr. Mu dr. Mulligan from New York University, a professor of Health Services research at the university of chicago Whose Research focuses on quality of care in longterm care settings, and dr. Landers, who serves as the president aof visiting nurss group. Im grateful for the work theyre doing and for taking the time to join us today. Their expertise will help us advance Public Policies to slow the spread of this devastating pandemic and to lessen its impact on our nations vulnerable seniors. Dr. Casey, i know youre joining us remotely, and i would now call on you for your opening statement. I also want to acknowledge that senator braun has joined us in person at the hearing this morning and, as i said, there are many that are online joining us and we expect others to be here physically as well. Senator casey. Chairman collins, you can hear me, i hope . Ill assume that youre hearing me. Chairman collins, thank you for convening this hearing. Our nation at this point in our history is facing the greatest Public Health crisis in a century. This terrible virus is causing death and destruction at lightning speed. For seniors, the only thing thats moving faster than the virus itself is fear. The fear of being alone. The fear of contracting the virus. And, of course, the fear comes from isolation. And that has every Single Member of the family worried, worried for our seniors, thousands of seniors in hospital icus and Nursing Homes are dying scared and alone with no family and no friends to confront them in their final moments. Millions who are millions of seniors more are at home, isolated from their loved ones and scared to death, often, to leave the house even to get a bag of groceries. This unprecedented challenge calls for equally unprecedented action. The administration has to do more. Congress has to do more to help our seniors and our families at every turn. It is now may the 21st and we still have no National Testing strategy from the administration. The lack of personal protective equipment continues to put our Health Care Providers and other front line workers at risk. This puts every Single Person that comes into contact with and puts at risk if entire community. Nursing home residents make up 0. 05 of the population. And deaths associated with Nursing Homes and other longterm care facilities account for onethird of deaths. They get onethird of the deaths are Nursing Homes and longterm care centers. Still to this day, were trying to help those residents and workers in Nursing Homes with one hand tied behind our backsebacks because the administration is not releasing data of outbreaks in these facilities. This is unconscionable and the Administration Needs to act. Weve heard promises that by the end of may they will, we need to see specific evidence that theyre changing policy to give families, residents and workers in Nursing Homes and other longterm care settings more information. Congress has taken a number of steps as chairman collins outlined. Weve added unprecedented amounts of funding to purchase personal protective equipment to keep workers from contracting and transmitting the virus. Weve funded Health Care Worker or funded efforts to help Health Care Workers and Health Providers help patients in those settings. We provided dollars to insure that seniors have access to proper nutrition at home, but not nearly enough. The policies in funding in these four bills that we have passed into law, only begin to scratch the surface. Congress has to do more. The house of representatives passed the heroes act and that legislation calls for policies that ive been calling for since the beginning of this crisis, especially as it relates to seniors. It would require, the bill would, require Nursing Homes to collect data on the impact of the virus on residents in Nursing Homes and other longterm care facilities so we need how to distribute resources. The bill would also provide those Nursing Homes the dollars they need to contain the spread of the virus. The bill would also invest in communitybased services for seniors and people with disabilities, especially the 800,000 seniors with disabilities on waiting list for care so they can receive the services and the supports that they need to keep them out of congregate settings. This bill would also pay our essential frontline workers who are leaving the safety of their home to care for our aging loved ones. For the generation who fought our wars and working in our factories and taught our children and built the middle class, built the nation we have, and gave each of us life and love, we have to do more for our seniors. We cannot stop working, we cannot stop legislationing, we cannot stop appropriating dollars to help our seniors. We owe it to them today everything we can. Theres no such thing as doing sto too much for our seniors in the grip of this pandemic. Chairman collins, thank you for convening this critically important hearing. The first hearing in congress on the impact of covid19 on seniors and i look forward to the testimony of our witnesses as well as the questions. Thank you very much, senator casey. For those of you who are watching us on cspan, i want to explain that this room is specially configured in line with the social distancing recommendations of the cdc which is why you see so many blank spaces. And, again, we have several members who have already joined us by remotely. I see senator josh hawley, senator rick scott, and others as well. Some more who will be coming physically as well. There are also many other members whose pictures i cant see, but who have joined us at the hearing. But i wanted to explain that this is one of only three hearing rooms that is configured to allow us to hold hearings. I see senator blumenthal has arrived and i want to acknowledge him as well. Were now going to move to our witnesses. Our first witness is joining us from New York University. Dr. Mulligan is the director of Infectious Disease at the nyu school of medicine and director of the universitys vaccine center. He has a professor of medicine and a professor of microbiology at nyu. As the chief Infectious Disease specialist for nyu, he oversees the treatment of covid19 patients at the universitys Health System hospitals in brooklyn, long island, manhattan, bellevue and the va. Next we will hear from a doctor of Professor Health Services Research at the department of Health Sciences at the university of chicago. Her research focuses on the relationship between economic incentives and the quality of care in longterm care facilities. Shes leading work to untangle factors associated with the disproportionate impact of covid19 on nursing home residents and staff. Finally, we will hear from dr. Steven landers, the president and ceo of the visiting Nurse Association health group. Its the second largest Home Health Care organization in the country. He focuses on home visits to low mobility older adults and has played a Critical Role in caring for seniors during this pandemic. Thank you all for being here. Good morning, chairman collins, Ranking Member casey, members of the committee and fellow witnesses, i also wanted to mention, im an nihfunded investigator working with the New York University vaccine unit, part of a new network focusing on Infectious Diseases, including work on seniors. This is a very important part of the work i do as a clinical investigator. This Novel Coronavirus emerged five months ago in china and led to the Global Pandemic that we now find ourselves combatting. The human population, unfortunately, is highly susceptible. Were nonimmune to this virus. Most of us have been exposed to four distant cousins, seasonal cold viruss that are also coronavirus, but they do not provide immunity against the current virus. For physicians, scientists, and leaders, the virus has continued to humble us. Theres so much we dont know yet about diagnosis, prevention and treatment, about medical countermeasures, but that is an important part of what i will be discussing today. Seniors are at an increased risk due to the waning of the immune system. It is not only their age, however, that renders seniors less able to have protective immunity against microbial threats, its the Chronic Health conditions that are present more frequently in seniors such as cancer, chronic heart, lung and kidney decides and diabetes. The risk is seen in the frail elderly, those who reside in Nursing Homes and longterm care facilities. The nurses, the doctors that i have worked with in the hospital since late february taking care of patients are incredibly dedicated and caring. Its very moving to see how much they put into their jobs to help their patients and yet its been a struggle. They have not had the medical Counter Measures they have needed to help seniors fight this virus. Certain work with less effective social distancing, the longterm care facilities weve talked about, factories, have had the worst outbreaks of covid19 and weve heard that while just 11 of covid19 infections in the u. S. Have been in Nursing Homes, onethird of the deaths or perhaps more, once we get good data, have occurred in Nursing Homes or nursing home residents. Our main weapons to fight the virus continue to be done, pharmaceutical intervention, all of the social distancing. We know that this work is effective and theyve provided a strong benefit to society and individuals by reducing spread of the virus. However, they come with a cost to the economy, to society, and to human existence. Therefore, a very important additional carrying or the medical countermeasures which i will now talk about. A vaccine holds out the promise of immune protection, that is producing an entity within our bodies that will protect us against the virus upon a future exposure to the virus. Vaccines have always been our most important weapons to battle Infectious Diseases with Public Health importance. Just two days ago, the first early report of a covid19 vaccine appeared, and, thank goodness, it was promising. Theres a long road ahead for development of safe, effective covid19 vaccines, but it was great to have a very positive early signal. Seniors will be included in the allimportant efficacy trials that are planned to be supported by the u. S. Government. However, the elderly did not respond as well to vaccines as younger adults do. So the approach of providing an antibody as a preformed drug, treatment or prevention in seniors is one that is attractive. One u. S. Government and industry partner said theyre moving as quickly as possible with a randomized control trial of an antibody that will be delivered to nursing home residents and nursing home workers in regard to try to get control of outbreaks. The highest quality of medical research comes from randomized control trials. They provide the answer. One antiviral drug remdesivir, preliminary information from a controlled trial of remdesivir has yellielded a modest benefit. Its a muchneeded first signal that we have an effective approach to begin to start to battle this virus. Testing must be continued and increased. It provides a benefit. It allows us to identify those with infection until they recover, they can be isolated and reduced further spread of the virus. The more we test, the more we can fight the virus. Ill close by saying that the nonpharmaceutical interventions we have deployed against the virus have been highly beneficial and this remains doubly important for protecting our very vulnerable seniors. As we await further development of medical countermeasures, vaccines and treatments and broader testing. Medical countermeasures may need to be tailored specifically for seniors given the differences in their biologies. Thank you i thank the committee for the work they are doing. Thank you, very much, doctor. Dr. Konetzka. Thank you for the opportunity to testify today. My name is tamara konetzka. Ive been researching longterm care for 25 years, often focusing on nursing home quality. The central role of Nursing Homes in the covid19 pandemic has become increasingly clear, just a month ago, Nursing Homes staff and residents were estimated to account for onefifth of all deaths. The estimate is onethird nationally and more than half in many states. In some ways, these rates are not surprising. Nursing homes provide hours of handson care daily to people with underlying Health Conditions living in close quarters. Nursing homes compete with hospitals for both testing and ppe, which are still in short supply in many areas. But is the spread of covid19 in Nursing Homes inevitable or have some Nursing Homes managed better than others to manage outbreaks . We set out to answer that question using data on Nursing Homes from 12 states. We merged state lists of reported covid19 cases and deaths with data on nursing home characteristics including data from nursing home care, fivestar rating system. We calculated the percent of Nursing Homes with at least one case or death by star ratings, profit status and several resident characteristics. Our analysis revealed three key results. We found a strong and consistent relationship between race and the probability of covid19 cases and deaths. Nursing homes with the lowest percent White Residence were more than twice as likely to have cases or deaths as those with the highest percent white residents. We found no meaningful relationship between the nursing home fivestar ratings and the probability of at least one case or death. In fact, even the direction of the relationship was inconsistent from state to state. Third, we found no difference between for profit and nonprofit facilities and only a weak relationship with the percent of residents on medicaid. We conclude from this analysis that while some Nursing Homes undoubtedly have better Infection Control practices than others, the enormity of this pandemic coupled with the inherent vulnerability of the nursing home setting left even the highest quality Nursing Homes largely unprepared. And the patterns were not random. Nursing homes are a reflection of the neighborhoods in which their located. Nursing homes with traditional underserved, nonwhite populations are baring the worst outcomes. Turning to solutions, it is increasingly clear that longterm care facilities must be a top priority in fighting the pandemic. Thats where the deaths are. I would suggest several shortterm measures. First, Nursing Homes need a direct influx of funding and Technical Assistance in order to achieve adequate numbers of staff availability and proper use of ppe and regular and Rapid Testing of all nursing home residents and staff to enable separation. Second, we need to enhance the ability of medicaid beneficiaries to receive Homebased Services. The decision between care at home or in a nursing home is difficult for families in the best of times. Now the risks and benefits have likely shifted. Resources need to be directed toward enabling them to avoid institutionalization during this highrisk time. Third, Data Collection and transparency about cases and deaths are essential. Timely reporting enables resources to be directed where theyre needed most and older adults and their families need this information to make their own best decisions, decisions that may be about life or death. These shortterm measures are urgent and necessary but they do nothing to change the underlying systemic challenges to improving the quality of nursing home care and the lives of older adults who live in them. Nursing home residents are ill equipped to monitor their own care, to advocate for themselves or to exert political influence. This makes oversight necessary. Some regulations have been relaxed during this pandemic, but it will be important to reinstate them once the crisis has passed with increased attention to Infection Control practices. But the effectiveness of regulation is limited when the structure of nursing home payment is fragmented, uneven, and leads to systematic underfunding of essential services. Those of us who study longterm care are accustomed to hoping for fundamental change and not seeing it. One positive outbreak of the severe financial fallout from the pandemic may be that it forces a fundamental reeducation reevaluation of how we pay for longterm care in the u. S. Thank you very much for your excellent testimony. Dr. Landers . Good morning, chairman collins, Ranking Member casey, members of the Senate Committee on ageing, im a family doctor. My clinical work focuses on house calls to homebound seniors and i serve as the president and chief executive officer for visiting Nurse Association health group. Were a large Nonprofit Agency headquartered in new jersey, ohio, and florida as well. Our team of 3,000 dedicated caregivers, theyve stepped up during this crisis to help medically fragile older adults come home from hospitals in nursing facilities and in some cases, never have to go into the hospital in the affaifirst plac. Weve taken care of over 650 older adults in the home care setting with known covid19 infection. Ive never seen the system so stressed and at the same time never felt more proud of the incredible people that i work with every day. One of the reasons weve been able to keep serving has been because of chairman collins and your leadership in the c. A. R. E. S. Act, the Provider Relief Fund, some of the measures that cms have taken have been important because our revenues have gone down because of the cancellation of elective medical procedures and expenses related to personal protective equipment or ppe, testing, those expenses have gone up. That Financial Support has been critical and also i want to thank you, chairman collins and colleagues, for your leadership advancing the role of Nurse Practitioners and physician assistance in homebased elder care. Homebou homebound older adults have have limited access to care. And the extension of the team with the Nurse Practitioners and physician assistants is important in preserving access and the other measures related to the workforce that were in the c. A. R. E. S. Act, very important. Ive been reminded of the difference that home health and hospice can make on quality, compassion, Patient Safety and, you know, weve seen the stress that hospitals in terms of bed capacity, emergency rooms, nursing facilities, the challenges that theyve faced and its highlighted the need for a strong home care option. An option home care, best working in concert with hospitals, physicians and nursing facilities to delivered coordinated care. In order for us to provide that option, job number one is protecting our treasured frontline caregivers. Weve been able to maintain care because weve been able to maintain a supply of ppe. Now, that has been incredibly difficult to do. Were using, in my organization, 17,0 17,000 surgical masks a week, thousands of isolation gowns and goggles and pay seven to ten times the normal price from all over the world just hoping the shipments would arrive. And so Going Forward, i would encourage us to look to policies that could make sure Home Health Agencies have the needed ppe at a reasonable price. And also, you know, important to our ability to serve during this crisis has been our spirit of innovation. So weve really embraced the use of telehealth within our Home Health Agency in order to help people stay safely at home during this crisis. For the covid19 patients. They need monitoring of vital signs, oxygen, and respiratory assessment. Even though theyre not reimbursed for telehealth, we felt that was important and, you know, we also had seen even before this crisis that telehealth could play an Important Role in home health and weve been trying to advance that. I think Going Forward, to make sure we have a Strong Home Health option for our Older Americans that finding a way to reimburse Telehealth Services is really important. Also, preserving the ability for physicianing and Nurse Practitioners to do the facetoface encounter via telehealth is really important. So really, thank you for including me in the hearing this morning and very sad about all the death and suffering, but also optimistic that we can strengthen home care and elder care for Older Americans. Thank you. Thank you very much, doctor. I want to note that senator tim scott and senator Martha Mcsally have also joined us in person, physically, today. What were going to do because there were many people who logged on at the very beginning, is were just going to go in order of seniority. I cant figure out any other way to do this given the people who have showed up physically but also the people who have been on line at the very beginning of the hearing. Usually i would like to reward those who show up first, but i think since there were people online, i as i said, i cant figure out any other way to do this fairly. Let me begin with my own questions and then senator casey will question next remotely. First of all, when we hear the statistics which are so devastating with half of the deaths in maine being in longterm care facilities, a third nationally. My heart goes out not only to these patients but to their families and to the staff of Nursing Homes and other assisted living facilities, congregate care settings. Theyre all praying that covid19 does not find its way into their facility. Yesterday the Government Accountability Office Released a report that found that nearly half of the more than 13,000 nursing facilities surveyed had Infection Control deficiency citations in consecutive years which the report called an indicator of persistent problems. Yet as dr. Konetzka said in her testimony, even the highest quality Nursing Homes have been largely unprepared. And what weve usually looked at, the ratings, has not proven to be a reliable indicator of which Nursing Homes are safest because in this environment. And indeed one of the worse outbreaks in maine was at a nursing home that had five stars. I think what were learning is that Health Care Providers are rethinking some of their initial assumptions and that we need to think more about hospital discharge planning. But, dr. Konetzka, i want to have you expand a little bit more on what we can do. I believe that you recommended universal testing for every nursing home resident and staff, which i think is a good idea and have been recommending. How often, however, would you have to do that and would that allow Family Members who have been tested to finally be able to visit their loved ones . And i hope we can unmute dr. Konetzka, because i can see that she is responding. We cant hear her. Go ahead. Can you hear me . Yes, thank you. Okay, great. Yes, thank you for that question. I think that were learning a lot as we go about how best to fight this virus in Nursing Homes and so we dont have, unfortunately, great data yet on exactly what testing strategies have been used and how successful theyve been. A lot of what were going on is anecdotal evidence. What i can say is that there have been a few key Lessons Learned and one is that it is important to test all residents and not wait until residents are asymptomatic because until residents are symptomatic because by then its too late. Theres a symptomatic spread and given the close proximity and the fact that staff go from resident to resident every day, the virus, you know until people get symptomatic can spread throughout the facility. Weve learned that lesson, that all residents really should be tested and not only tested, but tested regularly. What ive heard from doctors is that generally weekly would be good. At least biweekly so that residents can then be separated and the transmission can be stopped. I would say it might be very hard, especially as we relax some of the restrictions on visitors which is essential to prevent the sense of social isolation among our seniors. As we relax those restrictions, its going to be very hard to prevent all cases in the nursing home. The key is a Rapid Response to prevent transmission to the rest of residents and staff. Thank you. Dr. Landers, i appreciate your talking to us about the importance of home care and that can help people be safer. Ive always been a strong supporter of home care. One issue that we have is that people who are older are being increasingly isolated and that too can have a very detrimental impact on their Underlying Health and thus make them more vulnerable to the coronavirus. Could you comment on how Home Health Visits can help keep a senior more connected and less isolated . Chairman collins, you know, absolutely home health is a way to, you know, show people that theyre known and worth something, that theyre valued. Its an act of humility, really, and in this crisis its been more important. Sometimes our nurses are the only people that are, you know, even checking in on a frail elder and ive heard them tell stories of, you know, having to kind of go out and make sure that the person had, you know, a food supply or undergarments or other things that are essential. The isolation is critical. I think your focus on telehealth also adds although its not perfect. Making sure that those people who are home bound also have access in between the visits to some interaction via telehealth could also improve the amount of attention that our older patients are getting. Its a real crisis and sort of loneliness and isolation. Were trying to do all we can. Thank you. Senator casey . Chairman collins, thanks very much. I wanted to start with my questions with dr. Konetzka. I have a particular question for dr. Konetzka regarding Nursing Homes. We know that Nursing Homes have become unfortunately ground zero in this pandemic and yet theres still no National Strategy and i believe and i think the testimony today indicated in part that theres still an insufficient supply of personal protective equipment for nursing home staff. These are among the heroes in our society, literally soldiers on a battlefield in a war against the virus. And theyre putting themselves at risk for the disease, contracting the virus, also putting themselves at risk for death itself, and that includes their family. The word hero definitely applies to these Health Care Workers. They need, i believe, simply more leadership out of the administration and congress, more help. They dont need pat on the back only and expressions of gratitude and acclamation. Thats nice. What they need is direct support and more than that. Ill start with the support for what they do on the job. The most important thing one of the most important things we can do is to help them implementing what the Public Health experts tell us are proven practices. Ive been asking the administration, first and foremost, for data. The centers on medicare and Medicaid Services and the cdc are the ones that would have to transmit this data to the american people. Were talking about basic information on case counts, basic information on deaths, so that we can direct and target the resources to the Nursing Homes that need it the most. Now, theyve said, as i indicated earlier, that its coming by the end of may, but weve been hearing that for a long time. So ive introduced legislation that would focus specifically on Nursing Homes and other longterm care settings. This particular bill, the nursing home covid19 protection and prevention act that i introduced with senator whitehouse and a number of our colleagues, has 20 billion in emergency funding to invest in what works. We know that in Nursing Homes, if you have cohorting, separate the residents with covid19 from those who dont have the virus, that is a good practice, but that costs money. We have to help them with that. Other uses for the dollars could be surging of medical expertise into a nursing home. But, dr. Konetzka, i would ask you two basic questions, why is it so important that we have basic data on covid19 in Nursing Homes, thats question number one, data, and question number two is, what are some of the policies that we can use to help Nursing Homes put in place information this information in the ample resources . Thank you, senator casey, for that question. As i touched on in my testimony, i think data and transparency are critically important in this crisis. I think often during a crisis were tempted to, you know, down play the need for collection of data and priorityize other actions. But its essential in this case for three main reasons. One, we do need to know where resources need to be directed if we know where there are outbreaks in Nursing Homes, we can direct resources to them and we can also identify the communities in which the virus is probably spreading. Second, as we look back on this crisis, we need data in order to do the Hard Research to figure out what worked and what didnt work so that we can make better policies in the future. And, third, consumers and their families really need to have this information. Anybody looking for a nursing home placement right now or worried about their loved one in a nursing home right now really needs to be able to know whats going on in a very timely way so that they can make their best decisions. In terms of the exact resources, i think a lot of it is about staffing. And weve had a problem with chronic understaffing in Nursing Homes and the kinds of resources that could help most on an emergency basis for a facility that has an outbreak is to strategyize to ensure enough staff. This means providing paid sick leave, this means providing adequate ppe, basically putting nursing home staff on a par with what we naturally want to provide for hospital staff. Its the same situation. Thanks very much and i want to i know im almost out of time and chairman collins has been generous with our time. Ill ask dr. Landers a quick question about our frontline heroes. A number of us in the senate and i know this is true in the house as well, have madesenate, and i know in the house as well, have made it a focus to create a heroes fund. Some manifestation of our gratitude for those who have put themselves at risk in the front lines. I know in the case of dr. Landers, im told that you have, in fact youve in fact kind of stood up and taken a lead on this. That you have that apart from the 50 of your employees that have volunteered to help care for patients that have tested positive for covid19, and i understand in recognition of their work, youre providing these individuals with additional compensation. So we commend you for that. I guess the basic question is simple. Its a question or no answer. But if the federal government provided you with the option to receive funding to provide what we call pandemic premium pay for essential workers and the work theyve done in this pandemic, would you apply for the funding . Senator casey, thank you. And yeah, we were trying to do all we can to support our front line heroes and if theres something we were eligible for in the criteria were appropriate, we would certainly do so. Thank you. Thank you. Senator tim scott. Thank you, chairman collins, chairwoman collins. I will say this, your leadership, chairwoman has been spectacular. From the ageing community to the paycheck protection program, and to this hearing, you consistently show up for the seniors in maine, for the seniors in america. The Small Businesses. How you accomplish all that you do, im not sure, but youre one of the hardest working, most dedicated Public Servants ive met. Thank you for this hearing and this opportunity to discuss this incredibly vital issue of protecting our ageing communities which i am closer and closer being a part of. Thank you so much for your kind words. To the panel, ill just say this, without any question if you are in South Carolina or most of our states what youll realize very quickly is that those diagnosed with covid19 on average is just over 50 years old. Who are hospitalized. And those who die from the disease in South Carolina is just over 50 over 75 years old. In fact, nearly 90 of fatalities in my state, South Carolina, have been from those over the age of 60. Its one of the reasons why i highlighted senator collins dedication to this issue, because onethird of all covid19 deaths, in South Carolina, happen in a nursing home or another senior care facility. So, this is an incredibly important issue and an incredibly timely hearing. In other states, the numbers are even worse than in South Carolina. That said, there have been some encouraging numbers recently. And our governor of South Carolina, and frankly, governors around the nation, i would like to highlight, the governor in florida as well. Desantis who decided to focus on the attention on the Nursing Homes. Thats exactly where we should start this challenge. How we should face this challenge is by focusing on the most vulnerable populations. Id often ive often thought about how important it is for us to recognize that Nursing Homes are the epicenter of activity also the folks who take care of the patients are disproportionately minorities, africanamericans, who have perhaps the second most vulnerable population in our nation. You think about states like louisiana where 70 of the deaths are africanamericans, only 33 of the population. And in my home state, 53 of the deaths, africanamericans, only 27 of the population. So you have one Vulnerable Community being served by another Vulnerable Community. And that only highlights the importance of testing, testing, testing. In our nursing home facilities. I am thankful that in South Carolina that the 40,000 nursing home residents will be tested between now and the end of june. Im thankful that in South Carolina well have over 220,000 tests completed in pay and in june, of residents in South Carolina. 60,000 already tested so far this month. These are encouraging numbers. And its one of the reasons why i have introduced legislation to make this the model for the nation. That our nation should take serious testing first in our Nursing Homes and providing more resources for the vulnerable populations in this country. Along those lines, ive encouraged hhs to set aside a robust share of the Provider Relief Fund appropriated through the c. A. R. E. S. Act, along with 25 billion that we dedicated to testing specifically for Nursing Homes and Community Residential care facilities. They need the resources, the supplies and tests as soon as possible. My question to the full panel, beyond funding, what steps should we be taking at every level of government to help these providers and communities develop the tools and strategies necessary to detect, isolate and address cases where they occur without straining existing resources by increasing administrative burdens. If i may ask if i may answer, one part of that, i think in addition to funding, Technical Assistance to Nursing Homes is essential. Because i think sometimes just providing the funding for it doesnt mean that Nursing Homes will necessarily know what were learning about the best practices in terms of actually stemming an outbreak. And so, i think to the extent that, you know, local Public Health departments, state organizations can provide Technical Assistance as well as the funding and the resources like surge teams to stem an outbreak that would be helpful. Thank you. And senator scott, i was just going to add that the importance of Clinical Research in seniors in Nursing Homes, educating families because theyre often legally authorized representatives about Clinical Research. Everything in our medicine accountant cabinet is there because we conducted medical research. We absolutely need to include seniors in our vaccines in july. And antibodies into Nursing Homes to provide this option to participate in research. Thank you very much. Thank you, senator. Senator gillibrand is joining us remotely. And she is next. Madam chairwoman, could you skip me, im having a technical problem. I just need five more minutes. Do the next person. Absolutely. Let me just check on your side of the aisle. And its senator blumenthal who is right here. Thank you, madam chair. Thank you senator collins and senator casey for bringing us together on this supremely important topic. And as i was listening to my colleagues, i couldnt help but remember last monday when i accompanied Senior Pastor Patrick Collins in a ritual that he has done, literally, every morning. He places white flags on the lawn in front of the First Congregational Church in greenwi greenwich, connecticut, and i accompanied last lay eied him l we together placed 69 new flags in the state of connecticut. On tuesday, pastor collins placed 41 more flags, yesterday, 23. Right now, literally, as we hold this hearing, exactly to the moment, pastor collins is almost certainly placing another 57 new white flags, adding to this sea of markers infer froin front ofe first Congrational Church in greenwich. Every one of those flags represents a life and thousands of lives lost around the country. 70 of them are seniors. 7 in 10. And many are in Nursing Homes. So, the obligation that we have to these vulnerable individuals brought home very dramatically and graphically by that picture worth a thousand words, literally. And thats why i have supported the hazardous duty pay, the heroes funds for our nursing home workers who all too often are risking their lives and making financial sacrifices. And its more than just rewarding to recognize them. But its also to retain them and to recruit new nursing home workers. And so let me ask, first of all, dr. Konetzka a question. Isnt it a fact that all too often, the employees of these Nursing Homes are underpaid for the risky and backbreaking work that they do . Thats exactly right. Nursing home workers, especially nurse aides are generally paid minimum wage. Often have no paid sick leave. And often have no health insurance. And, so, its natural that in normal circumstances, Nursing Homes have a hard Time Staffing adequately. But under these circumstances where staff are also afraid to get sick, afraid to bring the virus home to their families, or on the other hand, may show up to work because they dont have paid sick leave, even though theyre feeling ill, i think that all contributes to the issues were seeing in Nursing Homes and the understaffing problem in particular. Thank you. One of our Nursing Homes run by a friend of mine, tyler tyson balinger, provides nursing facilities, so they are protected, they have to live away from their families, but they are sealed away from possible infection. The result has been to greatly reduce the incidence of infection. Is that kind of innovation, dr. Konetzka, a possible promising route that others should follow . Yes, certainly. I think that nursing home workers should have the option of having a different place to stay, whether thats provided by the nursing home. Or like many cities have done for hospital workers, perhaps providing them with unused hotel rooms so that they have the choice of not risking infecting their families. Tyson balinger, by the way, happens to be a veteran, having served multiple tours in the afghanistan and iraq wars. Ive introduced legislation with senator booker. Its called the quality care for nursing home workers and residents during the covid19 act. It would immediately address some of these same problems, not just more testing. In fact, it would require weekly testing of a resident, and testing before every shift of Health Care Workers. Its mandated that all Health Care Workers have sufficient ppe and comprehensive Safety Training for dealing with covid19. And that each facility have a fulltime Infection Control preventionist on staff to keep residents and workers safe. It would guarantee that sufficient staff is available to facilitate weekly virtual visits between residents and their families. Those are just examples of the kinds of measures that i hope that may reduce the number of flags, white markers, that pastor collins places every morning in front of the first congregational surge of greenwich that we do better in our nursing home, thank you, madam chair. Senator. Thank you, senator collins. I want to echo senator scotts comments for your leadership and the unprecedented challenge. Thank you. Thank you for this important hearing. And to our witnesses for their testimony. In arizona as of last night of, there have been 747 deaths related to the coronavirus. And 593 are over the age of 65. So thats about 79 . And as i think about this, this is a cruel virus, as we all know. And its the cruelist to our most vulnerable. And this is the greatest generation were talking about. This is our opportunity, as we learn more about the virus, we didnt know a lot about it, but as were learning more about it, for us to do everything we can to protect the greatest generation. This is our generations opportunity to give back to them. And theres been an important focus on Nursing Homes for the vulnerable who are in these c conco congregate setting. But also those in independent living. My moms 85. Shes in good health for her age. Shes in independent living but shes also now been isolated for now two months, because shes just as vulnerable as others from this cruel disease. And i have neighbors and constituents who are sharing their stories of their loved ones who are in these settings. And we need to make sure that we protect them. As i think about Going Forward and its not a choice of are we going to continue to protect lives or allow people to safely return to work, as we move forward, we can do both. But for seniors in congregate settings, we need to put a mote aroun moat around them. Anyone who goes there, supports or visits there, we know theyre nod inadvertently bringing the virus in with them. We now know, unlike several months ago that people can be asymptomatic carrying the virus. So checking temperatures is not enough. Thank you for the testimony yesterday. I want to look broadly and one of the challenges we have is where theres oversight in our nursing home, oversight from hhs and the independent and county level, independent assisted living, theyre usually private entities. Theyre trying to get ppe. Theyre trying to get testing. Its not an easy topdown thing to do with the supply chains. Weve had many innovations in arizona, amsafe used to make air bags for airplanes. They just started making masks and gowns. Its an incredible story. We need to have more of that happening. I want to ask dr. Konetzka, can you share broadly, with all of the seniors in those congregate settings, what does it look like to keep the moat around them, with individuals going in there, and highlevel situational awareness, plus the controls that weve learned to isolate and treat quickly, but what does that look like not just for Nursing Homes, but everyone in this vulnerable category in a congregate setting . First, thank you very much for that question, because i think theres a tendency to focus only on Nursing Homes. And in many states, assisted living facilities look very much like Nursing Homes in terms of the level of care needed and provided. And the vulnerability of the resident. And yet, becausal sifted living facilities are licensed by state and dont receive generally, a lot of medicaid or medicare funding, we sort of tend to ignore them in these situations. And yet, theyre completely just as vulnerable. So, i think, you know, your question about the social isolation in these settings, not just assisted living but also independent living is a huge challenge. So, i think, you know, the riskiest time where we have to prohibit visitors, some things can be done in the meantime, like making sure that these facilities have appropriate technology so that residents can at least communicate through, you know, facetime or other video chats with their families on a regular basis. In the longer run, i think, you know, its essential for all of the reasons that you and others have mentioned that we do worry about the social isolation and start allowing visitors. Thats one of those things that i think well learn as we go, in terms of how much is too much. But that balance has to be struck. We have to limit that social isolation even as we try to stem the virus. And thank you, i know im over my time, but i also want to say this, isolation, ive heard cruel story, after cruel story. The virus is cruel of people fighting for their lives alone. And the amazing nurses that are with them, but not with their loved ones and Family Members. People taking their last breath alone without their loved ones and Family Members. Not being able to be there for their funeral. Weve got to be able to focus on allowing people when we can, as quickly as possible to be with their loved ones safely during these times so that they can be there. Its impactful not just for the senior, but also for the other Family Members who feel helpless. Working together, weve got to address this issue to allow people to safely be able to visit at the right time. Thank you, madam chair. Thank you, senator. Senator gillibrand has fixed her technical problem. She is next. Thank you, madam chairwoman, i appreciate this hearing very much. In my state of new york, the most terrible Horror Stories are coming out of our Nursing Homes. And a lot of people who have lost their lives have lost them in Nursing Homes. One of the concern, i have are for the workers who work there. If we had had National Paid leave in place at the beginning of this, then any worker who had to take care of a Family Member or was sick themselves or a child at home, would have been able to keep their job, keep their health care and take up to three months leave for the length of the health or sickness of their family. Without that, we have no safety net that would structurally be there for our workers when they have this kind of emergency. And this pandemic is the perfect example of how it could have been used more effectively. So, i want to ask, dr. Konetzka, do you agree that workers especially nursing home and Home Health Workers were allowed to consider their health or the health of their families by having access to a comprehensive paid leave program, that could better protect their patients in compliance to slowing the virus . I think a National Paid leave program could help in a number of ways. I think, you know in a broader sense, providing paid leave for Health Care Workers and longterm care workers would allow them that flexibility, as you just mentioned. It would also allow, perhaps, other people, the choice of taking care of their parents or another Family Member, instead of putting them in a nursing home. So, i think it would affect all kinds of decisions at the margin. Under this particular crisis, i think we would still have a staffing shortage, right . Because people leaving and having the paid leave to take care of Family Members, as they need, doesnt help with staffing in Nursing Homes. So i think theres two sides to that. The other concern i have is that our Nursing Homes are still struggling to get access to testing and ppe. And we know that nursing home workers and people they serve are among the most vulnerable around the country. Both dr. Landers and dr. Konetzkas testimony, we enforce the need for an essential workers bill of rights to protect our essential workers, including nursing home and direct care professionals during this direct health care emergency. Every direct worker in our country should have access to safety precautions. They should have access to frequent testing and ppe. They should have more robust compensation. They should have paid sick leave and they should have the support they need, because they really are the front line workers in this pandemic. So, dr. Landers, do you believe that the Health Outcomes for patients improve when we have well paid, well protected directed workforces . And do agree that we need federal investment in the workforce . Senator, thank you. Patient care, home care, nursing home care is all about people caring for people. Thats really what matters. This is people. People need the tender loving care. And to the extent we have a strong, welltrained, wellsupported workforce, the outcomes are going to be better for patients and families. I do believe that. And i am concerned about the shortages, you know, shortages of nurses in particular because, you know, i hearing the Nursing Schools are turning away half of the qualified applicants. Even though we have over 80 million ageing older adults. Im thankful you that and your colleagues are thinking about the workers. And then i have one idea that id like anyone to comment on. So, for the shortage of Health Care Workers and Home Health Workers and workers in Nursing Homes, one of the things i think we should be doing is having a health force where we train a million workers in the next two months to do the exact tracin c tracing, to do the testing and eventually the vaccinations. For anyone on the panel, do you think training up this health force in the next two months would be able to help us have Health Care Workers in the future so you wouldnt have shortages for people who want to work in health care for our older adults, whether its in direct care or in an assisted living facility. Anyone can give an opinion on that. Thank you, senator gillibrand. I do think that having resources in place in advance of future crises is absolutely what we need. What we find is if were not ready ahead of time then we chase our tails. We do have invest in advance in order to be ready when a crises comes in the future. Having a group of young people who might then become very inspired by the work theyre doing, and go on to become fulltime Lifelong Health care professionals, i think thats a very inspiring thought and something we should aspire to. Senator, i think, you know, absolutely, getting, you know, new people in the workforce, in these caring fields is really important, particularly, you know, Home Health Aides and personal care work, of course, theres definitely a need for more people to enter that field. Things like nursing. I mean, the nurses really are the keys to a lot of these teams. And we need really smart bachelorprepared nurses and thats something thats going to require more longterm policy making. Going forward, that cant be created overnight. Same with geriatric positions. As far as personal care, funding can help with that. Dr. Konetzka. Ill just add, i think its a really good idea. For both the short term and the long term, right . It seems like something where it could help with the urgency of this situation, to increase staffing in Nursing Homes and in home health. And to hem with the pipeline problem in that we just dont have enough people coming out of training programs, wanting to work in longterm care and getting people interested early on. Even as we try to improve the working conditions so they want to stay in it is a good idea. Thank you, madam chairwoman. Thank you. Senator braun. Thank you, madam chair, i want to echo what senator scott said. Im on several committees here in the senate, and i think the best hearings have been in this committee because you generally pick a topic that needs to be talked about at that moment in time. So, thank you. Thank you. So, ive got several questions teed up. As a business guy and entrepreneur, when i look at trying to apply the skills that work there, generally, you need to be agile. You need to think out of the box. You need to do things differently if theyre going to be successful in a market. And im interested because weve made the case that disproportionately Nursing Homes have been impacted. What has been the rate of improvement in these few months that weve been grappling with it. Have we seen the rate of infections and deaths come down . Or are we still at a leel that i know is bad, but have we seen any improvement . And then the corollary with that would be, what best practices, what things have we seen in the successful Nursing Homes that would be, maybe, of key importance . One, two and three. So, has the great improved, and then what best practices have surpassed in this time weve been tackling it. And anyone on the panel, feel free to jump in. Ill be happy to start with that. I think the answer to your first question is we dont quite know, because we dont have great data yet. So even for our study, you know, we had to sort of pull state lists off the internet. And do a lot of data cleaning to make sure that we were analyzing something valid. And without the data to really know exactly where the infections and cases and deaths are, we wont be able to really answer that question. I suspect were still learning as were going. And that many areas will still see outbreaks in Nursing Homes. For your second question, in terms of best practices, i do think there are, you know, a few things weve learned. As i mentioned earlier, testing everybody in a nursing home, on a regular basis to prevent asymptomatic spread. And separating residents as much as possible into covid and noncovid parts of the facility i think has been successful in many places. Senator braun go ahead. I just wanted to say to the senator that were seeing in the home health setting, over time, it seems like the rates of infection of our treasured workforce, it does seem to be becoming less common week by week. And so these are people working in the hardest hit areas of northern new jersey, where weve seen some of the highest levels of infection in the country. So, i do think week by week, the social distancing measures. The ppe, the expanded testing which still needs to expand further, but were certainly in a better spot than we were in, you know, in early march, where it was just, you know there was nothing. So, we were going a long ways to go. But the screening and education, the workforce, making sure they know when and how, you know, ask for help and when to get them out of the workforce. And then, also, the Testing Programs for the workers is, you know, increasingly important. I think, senator, the only thing id like to add, and this gets at the innovation piece is the research. The Clinical Trials. I agree with what my final panelists said about what we should be doing immediately in terms of implementing what appear to be best practices. In addition, we have to invest in research as a nation, supporting the nih and doing the Clinical Trials that will help us get out of this thing as a whole. But in doing that, we will support the seniors. For example, one of the senators talked about senator mcsally making a moat around her seniors. It made me think about herd immunity. If we can vaccinate the population properly, even if seniors dont respond to the vaccine, get the workers immune. They would have been protected and not become infected. So investment in Clinical Research. Thank you. This one will be for dr. Landers because i think as we debrief this over time, finding out what works is best practices. But weve noticed that in florida, where arguably, you might have the most vulnerable populations, is there something there that we can glean . Because i think the laboratory of states gives us a much better way to learn than maybe that one size fits all, cite the cdc, when we first looked at testing cost us 30, 40, 50 days because of that focus on just one wave. Is there something there in florida that anybody could weigh in on . And dr. Landers do you think that this will speed the move from Nursing Homes to home care over time . Because it seems like youre probably more safe in your home than you would be in a place thats got a lot of folks in the same building. Senator, theres no question that theres increasing interest in Home Health Care. And ive been in several living rooms, you know, quite frankly, in the last couple of weeks, with families who have brought Family Members home from facilities to continue their recovery at home. And you know, theyve been relieved and, you know, happy they get the home health and visiting nurse support which is really critical for them being able to come home. In terms of, you know, the differences in different locations. Absolutely, there are, you know, weve seen geographic variations. And we should try and learn from those. Living in new jersey, a lot of the people we serve actually are, you know, travel between florida and new jersey. Its a fairly common, you know, consideration for snowbirds and such. A lot of the questions weve gotten has been around, you know, can people come back for their, you know, those people that are fortunate to be able to travel as such and is it safe then . Were all interconnected but at the same time, there are differences and well have to learn from this, you know, Going Forward. Thank you. Thank you. Senator warren, i dont know whether you heard my opening remarks, but i do want you to know that i know i speak for every member of this committee in expressing our condolences to you. Youve been touched very personally by this virus. So welcome. Thank you so much. I appreciate it, madam chair. You reached out to me personally, right after my brother died. And he died in a comforted setting facility in a rehab. So, thank you, i appreciate it. And i very much appreciate that youre holding this hearing today. In fact, what i want to talk about, i want to talk more about how seniors are bearing the brunt of covid19. And Nursing Homes have become the epicenter of the crisis. And it is important that we do everything we can, if theres testing and that theres Contact Tracing and we get a vaccine and we develop treatments. Well, one of the things we need to do is collect more data. So, i want to start by asking dr. Konetzka, why is it so important that Nursing Homes collect and report in a timely manner and transparently data about covid19 infections . I think its critical for several reasons. One, its just that we need to know where to direct resources, right . Nursing homes need help when theyre having a mental break. And so, we need to know that right away. It also gives us a signal about whats happening in communities in which Nursing Homes are located. And second, it will enable us to do research that will help us later figure out what works and what didnt work. And so that we can, perhaps, do better the next time. And then, finally, its really critical to consumers, right . Weve been encouraging consumers since 2009 to get our nursing home prepared. Look at the nation for their Nursing Homes, but right now, they cant easily find which ones have covid outbreaks. Wed like to give them that information so they can make good decisions. Thank you. I think thats really important. You know, its such a serious issue, in massachusetts, for example, more than half of the covid19 deaths are directly linked to longterm care facilities. Now, the center for day care dedicates services, the federal entity that regulates Nursing Homes, is taking important steps to ensure better data. Just last month, as you may know, dms started requiring nursing home to report new covid outbreaks, infections, hospitalizations and dentaths a they have to report it to the cdc. Nursing homes also must notify residents and families of these infections. But Nursing Homes arent the only facilities, longterm care facilities that have been hit hard by this pandemic. Luckily, 800,000 americans live in assisted living facilities. In massachusetts, about twothirds of assisting living facilities have reported covid19 infections. Now, residents in assisted living facilities that serve Older Americans require less frequent medical care than those in Nursing Homes. And less help with activities for daily living. But populations in both places are similar. Older people who need some help from caregivers in order to conduct daily tasks. So, dr. Mulligan, youve been serving on the front lines of the coronavirus pandemic. When it comes to the patients that youve seen, does coronavirus affect nursing home residents any differently than how it affects assisted living residents . Or are both living in both settings vulnerable to the crisis . Yes, theres no question that theyre both very vulnerable. I think the assisted living and the community dweller residents are at equal risk. 80 of deaths with seniors, that means theres an equal number to the hursting home deaths, outside of the Nursing Homes. Senator, you are correct. Okay. That is really important. The reality is this virus doesnt care whether seniors are living in assisted living facilities, or living in Nursing Homes. It can affect them regardless. So, let me go back to you, dr. Konetzka, are assisted living care facilities required to report the same coronavirus information as Nursing Homes like report on infections or hospitalizations or deaths or outbreaks to the federal government and to the families and to the people who live there . No, they are not. Just like Data Collection in longterm care, generally, we dont collect much data from assisted living because theyre not as dependent on federal funding. And under the cms guidance, as i understand it, were also not collecting information from assisted living facilities which for all of the reasons you mentioned is unfortunate. Yeah. So assisted living facilities have similar populations as Nursing Homes. They have similar infection risks, but they arent subject to the same regulations when it comes to the coronavirus. And that is why i launched an investigation with senator markey and with congresswoman maloney into how assisted living facilities are tracking Coronavirus Infections and preventive measures at these facilities. And whether they have enough preventive measures in place. Assisted living facility residents and their families deserve to know whether or not their facilities are experiencing a coronavirus outbreak, just like nursing home residents are entitled to know that. So, i believe we owe to our seniors to get this done. Thank you all for being here today. And thank you again, madam chair. Thank you. Senator rick scott had to leave and go preside he had joined us remotely. So, now, well turn to senator doug jones. Thank you, madam chairman. Thank you very much for holding this hearing. Appreciate it. Thanks to our panelists for this very, very important hearing. I kind of want to follow up a little bit about not just at sifted living, but the Nursing Homes in particular. You know, my mom is in assisted living so its been a challenge for all of us, especially her, over the last few weeks, we lost dad in december, so the isolation has been a struggle. We lost dad to alzheimers. And i think its been particularly tough on the alzheimers patients and caregivers. Those forms of dementia create special problems, regardless, you know, its been sad to listen that my mom has been talking every week. She will mention that she, as much as she misses my dad who she was married to for 70 years, shes also somewhat thankful that he passed before all of this pandemic hit. And in part, i think that is because of the problems that she would have faced. She used to go down and visit him every day. And especially troubling. My friend John Archibald who writes for a. L. Com writes that coronavirus creates a special hell. He tries to write what it is like for caregivers. Imagine what its like to share social distancing to a person who does not share reality. Pam winter, a Program Director at the cfas karre schls c. A. R. E. She said its like being on an airplane, you got to take care of yourself. You have to put on your oxygen mask before helping Anyone Around you. On the panel, given the knew week challenges that were seeing, what can we do to support individuals with dementia, both in these facilities and out and their families and caregivers . And are their special trainings that might be needed for the longterm care and dementia facilities in a situation that were in now, that weve not seen before, but we could see again . Ill open it to anybody. Senator jones, i really think that youve touched on something so important. I think as a society, we will always be judged by how we take care of the most vulnerable. And certainly, our demented seniors at this point are among the most vulnerable. Theyre not able to express, for example, if they are becoming ill, they wouldnt necessarily be able to express that they dont feel well. That they feel hot. That theyre short of breath, et cetera. So, they have medical, as well as sort of the psychological, emotional vulnerabilities at this time of pandemic, that are unique to them, i think. And i dont know that i have any specific answer for you but i would encourage any effort to bring together a think tank to brainstorm about this. I think its absolutely needed and thank you for raising it. Senator jones, thank you for raising this critical issue. And i share your deep concern for the well beading of People Living with dementia. And actually, one of the sad parts about all of this has just been hearing my staff explain whats going on when theyre doing nursing visits with older adults. With severe dementia. And in cases where theyve had to do a test, those nasal pharyngeal swab tests in some cases are upsetting even to dot test because the person just doesnt understand. One thing in assisted living, independent living, because thats a big topic in this hearing. We should point out Home Health Agencies are able to come into those settings, and to buttress the care in those facilities. So the extent that we can continue to have a Strong Health options and focusing around the things that senator is focused on. And goals of care and family caregiving plans also can help the really tough issues were facing. Thank you very much. Both of you for that. Dr. Konetzka, real quick, as my time runs out, your research has indicated racial and ethnic minorities and lowincome individuals have been disproportionately affected with Nursing Homes that have larger populations more likely are to have more coronavirus cases and deaths. I think theres an article to that in the new york times. Can you share what it may contribute to those disparities . Yes, thank you for that question. So, disparities in nursing home outcomes from covid early not unlike disparities we see across the health care system. And its the result of many years of differences by race in health infrastructure, in resources, in risk factors of population. What we found in our research was not necessarily that nonwhite residents were more were having worse outcomes. It was about the percent white in a facility. So, to me, its really about the neighborhoods in which Nursing Homes are located and staff going back and forth between those facilities and the neighborhood. So, i think its a lot about where the virus is circulating. And who is in those facilities and who is going back and forth. Well, thank you. And thank you, madam chairwoman, for holding this hearing. Its very, very important. Thank you. Thank you, senator. Senator rosen. Thank you, senator collins, for holding this very important hearing. It is incredibly sad to see whats happening in our Nursing Homes and our assisted living, going on with our caregivers across the country. I was a caregiver for my parents and inlaws. I understand this perspective. And it is overwhelming, frightening and frustrating, particularly at this time. But one thing that i think we really need to focus on is research. Research to fully understand how this virus works and how to best treat and prevent it. Its so critical. I recently introduced legislation with senator rubio, the ensuring understanding of covid19 for the Public Health act thats going to require a longitudinal study of covid19, including individuals of all races, race, ethnicity, gender, geography. We need to understand why it kt combas seniors differently. And with others who get sick, an immune response or not. You know, thats the theory that they give in response. But reports of groups of patients becoming ill a second time is really concerning. And theres been recent reports for that group of sailors that have been getting reeneffeinfec. Dr. Mulligan, do you know what the latest research is . The latest research that is following people, diagnosed a second time with coronavirus, including seniors, because this could have a firmer impact on the Senior Living centers. Or, no, if its a brandnew infection, some with the original infection making them sick again. What do you think what in fact it might have. Thank you, senator rosen, for this question. I do think that the jury is out in terms of formal proof that having recovered successfully one is immune. Certainly, most people recover make antibodies. Weve seen that in our own studies and many others have reported that. With most viral infections its true, once youve had it, you are protected for at least a period of time. I expect that will be true here as well. The formal proof electrical done will be in a study you that described. I think thats a fantastic study. I think that the jurys out on the reports of possible infections that may well represent an intermittent negative test and a positive test, as a result of their original infection. We know that can occur. The test isnt perfect so that wouldnt surprise me if that wasnt the cause of some of them. But the jurys out and for Vaccine Development its the same. Im a scientist, i want to know what the evidence says. If we do our studies correctly, if were well supported, we will get the truth. We will get the answer. And thats what science will do for us. I want you to also you know, in your testimony, you said that medical countermeasures may need to be tailored to seniors in order to optimally protect them. Can you expand on that in the minute or so i have left, please. Give us some examples, please. Sure, im very happy to do that. Maybe the most prominent example is we have a couple of vaccines for flus. We have a highdose vaccine. We know being here, the immune systems are weaker. Having a stronger vaccine, one with an adjavent. We need to be sure to include seniors in our treatments, as well as our vaccine studies. And another great example is the monochromal antibody approach. If a senior cant make a nice antibody themselves. Perhaps we can infuse the antibody drug. And that is something that is going to be explored in the nursing home setting which i think is very important. Well, i thank you and all of the other people commissioned, we thank you. Stay well and safe. Thank you. Thank you, senator. Dr. Mulligan, i want to follow up on the questions you were just asked by senator rosen about your work on vaccines. And youve made the very important point that older adults sometimes do not respond as well as younger adults to vaccines. But that vaccines can confer this herd immunity that can help protect seniors. Youve also distinguished about different kinds of vaccines. Could you describe to us the two vaccine trials that i understand youre currently involved with . And whether or not you have seniors enrolled in those trials. Sure. Thank you, senator collins, for the question. Were currently conducting a phase one trial in healthy younger adults, age 18 to 55, with. One candidate vaccine. As soon as we see in this trial that the vaccine is tolerated and safe. In these younger assaulted, we will go to a second group including seniors. Its not all in unusual to make sure that the new treatment of vaccine is tolerated in healthier, younger adults before but go to a more vulnerable population which might be seniors or pregnant woman. We will quickly move to seniors in the trial that were conducting at our university. The second trial is the very large efficacy trial that will be launched in july supported by the u. S. Government, nih in collaboration with the vaccine that had the very promising early report. Earlier this week with that company. That child will be for adults age 18 and older. From the very beginning, that every piefficacy trial will include seniors. Thats very encouraging to hear. Could you also talk a little bit more and explain to us the fact that you could have a monochr e monochromial antibody approach. My understanding is when you get a vaccine, its usually with the live virus. And then the antibodies allow you to fight off the exposure later on. Are you suggesting that an alternative approach is rather than injecting the virus, you would inject antibodies . Is that correct . Did i understand that correctly . Yes, senator, you did. The Standard Approach is known as active immunization. We deliver a vaccine which might be a weakened virus. It might just be a protein, a piece of the vienchr and n. We ask for the immune response, make the aantibody. An alternate is what we call passive rather than active immunization. In that case, you include the antibody body. Theres ways to approach it. Its an interim approach, perhaps, to get us through the worst of this where we could protect our very vulnerable seniors and it has to be tested in a randomized trial. Thats fascinating. Where are those antibodies produced. Are they taken from individuals who already had the coronavirus . Or are they manufactured, if you will, in a lab . How are they how are they produced . Yeah, thank you. It really is fascinating. So, ill give you one example, actually the first human in the United States to come down with coronavirus. His antibodies were cloned by a company. And created converted in a lab to a drug. You can pass producer the antibody molecules and then have that availability for infusion in the future. I should have said, you pick the antibody that is very potent at neutralizing the various. You pick basically the champion antibody and then that becomes your monochromal antibody drug for testing. Very interesting, thank you. Senator casey. Madam chair, thank you very much for the hearing. And also for the brief secondround of questions. I just have two. I want to start with drdr. Connet ne netse i have mentioned the weight list. The 80,000 people on the waitlist. I get that number from kaiser family. Thats a big number. That number did not alive since the crisis began. Thats the number that predated the crisis. I want to emphasize, these are people on waiting lists that qualify for services, but theres unstuff funding to provide those services. We have some states, i know, that are increasing pay for direct Service Providers. And thats one of the steps we should consider. I have a bill that would encourage every state to do what some states are doing. Which has served as a foundation for the enhanced matching dollars that the federal government provided for medicaid in their recent legislation. But dr. Konetzka, can you explain the importance of addressing these waitlists in the context of the current pandemic. Thank you. Id be happy to talk to you about that. I should note that interpreting these waitlists are a little more difficult. These are home waitlists for the weeber program. So 800 thousand sounds like a lot. But in some states they dont use waitlists so maybe underestimating the people who need services there. In other states they dont address people for eligibility before putting them on the waitlist. The waitlist is huge in those state. That aside, i think we can certainly agree that there are probably more who could benefit from these services who are getting them. During this crisis, i think its absolutely essential that we do what we can to try to enable more people to get those Homebased Services because the risks of entering a nursing home right now have grown astro no, maamically. It may save lives. Thank you very much, doctor. And the last question i have is for dr. Landers. I want to go back,s i was jotting down numbers, i think i missed the numbers in your testimony. Its regarding the personal protective equipment, ppe. And you had indicated, i thought, that you needed just for just a week, 17,000 and i wasnt sure what that was. If you could repeat those numbers. One of the real failures this is a huge failure ppe, its not simply that we have all kinds of instances where theres not enough in care settings and not to mention First Responders and other circumstances, but what is going to happen in the months ahead, its not just a question of what we need for this month or next month, and i think we dont have a sense yet of the numbers, the scale of the problem. So i guess i just wanted to give provide an emphasis on just one provider or one care setting and what you need. Senator casey, thank you. Yes, our current burn rate is kind of the term thats being used in terms of how fast were going through ppe as a company. Just over 17,000 of those surgical masks and then over 3,500 of the n95 masks every week. So when i look to our chief operating officer and chief Financial Officer who are responsible for procuring this stuff, thats what theyre trying to find on the market, various vendors. It remains a challenge for them to track down enough vendors. Im thankful that youre considering that Going Forward. Its an ongoing issue. Thats how were able to continue to serve is by having that protective equipment. I think it was a little warm last week. I was in an Apartment Building that was wasnt very well ventilated and i was sweating and i realized that i need to change my mask. The mask is getting soaked. We have to remember that, you know, times these get soiled and theres a lot of need there and so thank you for looking out for that issue. Thank you. Thank you, chairman collins. Thank you very much, senator casey. And i would second your concern about the availability of ppe for our Home Health Agencies. Thats been a problem in the state of maine as well that ive been working on personally to deliver some ppe to our Home Health Agencies. Its something thats very difficult for them to do their jobs without it. I want to thank our terrific witnesses for being with us today and for their work and their research. It really makes a difference. I want to thank the staff for figuring out how we can safely hold this hearing and observe social distancing which we did throughout. I would note that virtually every member of the committee joined the hearing either in person here in the hearing room or remotely. And so im very pleased with that and i think it shows how much people care about this issue. I also want to give a special shoutout to the technical experts who made this possible. When you have that many senators who are joining us remotely, senators who are joining us here, and witnesses in three different places in the country, it is amazing to me that our technical experts were able to make everything go so smoothly and i thank them. This week the overall death toll in the United States from the covid19 virus surpassed 90 thou thousand people, 80 of whom were older adults. This means we have lost more than 72,000 older adults to this pandemic. At the beginning of this hearing, i remarked on the enormous challenges and tragedy that covid19 has brought to our country. It has also brought countless examples of great courage and selflessness from those on the front lines of this pandemic including our medical personnel and our direct care workforce. But theyre not the only ones. We see it at the grocery stores. We see it at those who are stocking the shelves and running our gas stations and other essential businesses. We see it at those such as ive seen in the state of maine who are making the swabs in rural maine that are essential for our testing. We see it all over our country as people step forward and businesses step up to convert their lines and do their part. I appreciate all of that sacrifice, that compassion, that effort. I also want to pay special tribute to our witnesses today. I thought they were absolutely excellent and really increased our understanding. Dr. Mulligans leadership on Vaccine Development helps advance tangible medical countermeasures for those most in need and i appreciated him giving us expertise today. It helps to better inform our efforts to protect the residents not only of Nursing Homes but of assisted housing that our seniors have and other congregate care facilities. Dr. Landers focused on Home Health Care which is always been a special passion of mine. And technologies such as telehealth helps us to improve care of older adults in their own own homes. And after all, thats where most older adults want to be. They want to be in the privacy, security, comfort of their own homes if they can be. This committee will continue to explore potential solutions to the challenges discussed in this hearing as well as other impediments to the health and safety of your nations seniors. This week, members of the aging committee introduced a resolution to designate this month as Older Americans month. As we work to improve care for older adults amid this pandemic, we also should take the time to recognize our seniors as valued members of our society, our culture, and our lives. The health and wellbeing of seniors strengthen our nation as a whole and is the very mission of this committee. Senator casey, i would like to call upon you for any closing comments. Chairman collins, thank you for convening this hearing on such an important topic and im grateful for the opportunity that weve had. Certainly grateful for the testimony of our witnesses who bring to bare a degree of expertise and experience with these issues that are so important to families when it comes to caring for our seniors in all settings. And were grateful that the witnesses are with us today. And i know there will be even more follow up. I want to thank and reiterate what chairman collins said about the staff. This is a technical challenge and they helped all of us through this and were grateful for their good work as we always should commend the staff and the senate who do such good work and especially under these circumstances. We also want to thank, of course, as we all have in one way or another, all of the health care and Home Health Workers throughout the country, Service Providers as well as, caregivers for caring for our aging loved ones all the time, but especially during this terrible virus which has caused such devastation across the country. We owe all of those workers a debt of gratitude. I think we should do more than just say thanks. We talked about pandemic premium pay and other ways to reward their work because they are not just frontline workers, in many cases, theyre at the front of the front line, exposing themselves and putting themselves at risk and our nation should reward them as we did, returning soldiers from other battlefields in our history. Congress has done a number of things to help seniors and the four pieces of legislation that have been passed. I would argue not nearly enough. Not nearly what we must do for our seniors. Thats why we have to keep acting legislatively. Im frustrated as i know a number of senators are that we spend the whole month of may on nominations and not voting on covid19 policy or appropriations. And unfortunately, were going into june with that same setting or that same circumstance in the senate and i think we should be voting, if were going to be here, and voting, we should be voting on covid19. That should be the top priority and of course the economic consequences that flow in the wake of this terrible virus. So we have more to do. Certainly, need to do more on testing nationally. The administration should outline a strategy. We mentioned personal protective equipment for our frontline workers, we cant talk about or work on this issue enough. Theres no way to comprehend that in a nation thats as powerful as ours, a nation that was able to produce the armaments and other Production Capacity to win world war i and all the wars in between including world war ii, the idea that that same nation cant produce enough masks or gloves or personal protective equipment for everyone that needs it is really an appalling its an appalling failure. And we have to worry about the next couple of months. I know as of 8 00 this morning in the state of pennsylvania, 64,412 cases, the death number in pennsylvania is now 4,767. Thats only for march, april and may. I dont want to be sitting here in december because we didnt do enough on testing, personal protective equipment, and find out that another 4,700 or 5,000 pennsylvanians have died. We need the productive capacity and were not doing enough as a nation and the federal government has to demand that we set forth a Production Capacity on ppe. If we could do it in the past to win wars, we can do it now to win this war. And the administration has to do a lot more to make sure we can produce what we need. We have a long way to do. Lots more work to do and lots more legislating and appropriating, but were grateful for this hearing and thank you for giving us this opportunity. Thank you. Committee members will have until friday, may 29th to submit additional questions for the record. If we do receive some, we will pass them onto our witnesses. Again, i want to thank everyone for participating in this hearing and it is now adjourned. First ladies influence and image on American History tv examines the roles of the nations first ladies through interviews with top historians. Tonight, we look at grace coolidge. She was the first first lady to speak in movie newsreels and lou hoover was the first first lady to speak on the radio. Watch first ladies influence and image, tonight at 8 00 p. M. Eastern on American History tv on cspan3. It is with Great Sadness that i come here because we had such optimism and such hope. The u. S. Congress has always spoken in a bipartisan house and senate, democrats and republicans, with one voice in defense of those who are oppressed by beijing and in support of freedom, justice and real autonomy for the people of hong kong. We continue to urge President Trump to hold chinese officials accountable for abuses including taking steps, we must consider all tools available, including visa limitations and economic penalties. But here today im very honored to join the general secretary Hong Kong Federation of trade unions, carol peterson, brian long, a ph. D. University candidate university of washington, and virtually, electronically, nathan wall, Legislative Council of hong kong and former chairman. Again, for years, the world has watched in horror as beijing has accelerated its campaign to dismantle the rights and freedoms of the people of hong kong, from its brutal response to peaceful protests, to the horrific extradition law that we condemned. So many times this committee, the senator marco rubio, mr. Cardin and others, have put now chris van hollen, mr. Toomey, democrats and republicans have put the bright spotlight on what is happening. The executive commission on china, chaired by mr. Mcgovern and cochaired by chris smith, vice chair chris smith have worked hard with hearings, et cetera, as has this committee, to call attention to all of this. The commission on human rights, a former chair of this committee in a bipartisan way has called attention to all of this over the years, since Tiananmen Square and in terms of hong kong more specifically, leading up to 1987 and including that. Whats so sad about it is that the chinese just think the chinese regime just thinking they can act with impunity and repress the spirit of democracy. 2 Million People turned out against the extradition law. 2 Million People. Thats a big crowd in the United States. But when you understand it was 25 of the population of hong kong, its just almost anybody who could go out, showed up against what the chinese reggim was going to do. Nancy pelosi made a rare appearance this morning at a House Foreign Affairs committee hearing. Members discussed the implications of chinas National Security law in hong kong. You can watch that hearing tonight at 9 00 eastern on cspan. The House Foreign Affairs committee holds a hearing thursday on the firing of state Department Inspector general steve linick. Watch live coverage at 9 00 a. M. Eastern on cspan3, online at cspan. Org or listen live on the free cspan radio app. Thursday at 10 00 a. M. Eastern, nih director dr. Cull ens and Department Assistant secretary testify before a senator appropriations subcommittee for review of operation warp speed, the researching, manufacturing, distributing of a safe and effective coronavirus vaccine. Watch live coverage beginning at 10 00 a. M. Eastern on cspan, on demand on cspan. Org or listen on the free cspan radio app. Cspan viewers know tom se ridge asrv the former governor pennsylvania, former secretary of homeland security. One of his projects has been to serve as cochair of the group vote safe. Secretary ridge, what is
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