Transcripts For CSPAN3 Dr. David Gifford 20240711 : vimarsan

The America Health Care Association is with us this morning to talk about the impact of covid19 and health care facilities, Nursing Homes across the country. Good morning, dr. Gifford. Good morning, bill. Since the pandemic began first of all, how many give us numbers on how many facilities, assisted living facilities, Nursing Homes, your organization represents. Theres about 15 now Nursing Homes in the country and about 35,000 assisted living and we represent about 10,000 of the 15,000 Nursing Homes. What has your organization done since the beginning of the pandemic, the changes you have made to address the issues, the spread of the virus, the deaths in those facilities . Well, i think the challenge has really been learning about the virus. Early on, no one new about the virus. It was really hard to control. We didnt know so many people who didnt have symptoms could spread it. We didnt have availability of testing. We didnt know what the right practices were. And so it was very hard to control for the first several months. Now that we have a better sense, were starting to get a grasp with it. But what were learning is, as the virus is in the community, it spreads into the facility. Workers live at home, families are visiting, new admissions coming from the hospital all bring the virus into the assisted living and Nursing Homes. You think that the have your facilities gotten better at taking those initial steps in addressing the things like quarantining, the social distancing and then separating, isolating people in those facilities who do have the virus . Those are a lot of the steps people are taking. Its partly the availability of resources has still been limited. The numbers of tests, the amount of personal protective equipment, masks and gloves and gowns are still hard to get out there. And so thats been a challenge. The wall street journal reporting the news that covid deaths topping 100,000 in u. S. Longterm care facilities and they write, despite efforts to protect senior facilities by limiting visitors, experience from the early days of the pandemic and research have shown that communitylevel outbreaks pose a significant risk. How what next steps do you think have to be taken to try to get a handle on the virus in Nursing Homes . Well, i think weve been tracking it since the beginning and the amount of covid outbreaks in the Nursing Homes directly correspond lalates wit amount of covid in the community. If we cant control it in the community, its going to be hard to control it in the assisted living. People need to honor the social distancing, family gettogethers are a challenge, and were very worried that the recent holidays are going to skricontribute to spread. Over the summer, we saw outbreaks in the nursing home were linked to the community. Our guest today, david gifford, chief medical officer for the American Health Care Association. 2027488000, 2027488001, and you have a loved one in a nursing home, that line is 2027488002. We also welcome your comments by text. Generally, dr. Gifford, have you been nine months now into the pandemic able to at your facilities, your member organizations, been able to provide the personal protective equipment, been able to staff as well as youve hoped to . The personal protective equipment has gotten a little bit better. The federal government sent us some. But the challenge still has been particularly the n95 masks that filter out the virus and the gloves. Those are made overseas and as weve opened up and as the virus spreads in surges again, everyone is competing for those and we really need to ramp up local production to help with that because were not a priority. Were out there competing with everyone else for that. The same with testing. We got test supplies and we got some test equipment, not enough. But turnaround times for testing can still take three to five days or longer and that allows the virus to spread while youre waiting for the results to come back. On the vaccine front this morning, moderna is going to ask the fda for emergency approval. Reports say this morning. Whats the plan in Nursing Homes across the country . How will the vaccine be administered . Were very excited with the prospect of the vaccine. I think thats going to help both the residents and the staff in these facilities. The federal government is really been working on a robust plan where theyll work with walgreens and cvs so come in and administer the clinics or with some of the other longterm Care Pharmacies that support the Nursing Homes. Tweet from the former head of the cdc, he tweets this morning, increasingly likely that an effective vaccine will be available in the coming months. Thats why its more important than ever that we slow the spread now, lets hang on until vaccination is widely used. Physical distance, masks, handwashing, rapid isolation of infectious people are key. How about the intake of new patients into Nursing Homes . How has that changed during the pandemic . Well, when they come in, they usually kept in a single room and treated as if they have covid from an interaction standpoint. For usually the first two weeks because i think people forget if you get exposed to the virus and contract it, you dont develop symptoms or test positive often for a number of days and up to 14 days. Thats why everyone has to quarantine for 14 days when they get exposed. We see a lot of people who will test negative and they say, well, i dont have it. Youre still within that 14day window. You still can change. Thats why were seeing outbreaks out there. People are misinterpreting a negative test. When we have a new admission from the hospital, we have to assume they were exposed on the day of discharge from the hospital. They have to be kept in isolation for 14 days. Thats hard. Very hard for them and the family. There must be a real emotional toll both orientation t residents of the nursing home and their families for not being able to see each other only only seeing each other from a physical or safe distance. Do you have any sense of that . Its very tough. And particularly for individuals with dementia who cant remember why this is going on and each time its something new, its been very tough out there. Its be tough in my own family. My parents are 88 and 89. They live about 45 minutes away. Ive hardly been able to see them. They live at home. Theyre not in a facility. Its the same episode there. Theyre not able to interact and thats been tough. Im going to show you photos there of various facilities. Im thinking in illinois, theyve gone on strike demanding pandemic and hazard pay. Is that something your organization has looked into . Certainly weve been arguing from the very beginning that we need the right equipment for the staff to take care of the residents to theyre protected and they protect the residents and fully agree with that. Weve also been, you know, advocating to congress to provide as much resources because not only is the cost of all of this equipment gone up significantly, so is the cost of hazard pay and salaries to the staff. Those costs are unsustainable. We would need Additional Resources from congress. Dr. David gifford is our guest. Hes the chief medical officer of the American Health Care Association. And we welcome your calls, 2027488000, mountain and pacific, 2027488001, if you have a loved one in a nursing home, that line 2027488002. The Biden Harris Campaign had put out during the campaign a proposal, the biden harris plan to make Nursing Homes and longterm care facilities safe. Some of what they say in their the proposal that is that they say that more than 200,000 americans have lost their lives because of covid19. The pandemic has had devastating impact on Older Americans and people with disabilities and the workers who care for them, particularly those living in Nursing Homes and other longterm care facilities. Part of what the biden harris plan says is this, the Biden Harris Administration will protect residents and workers in Nursing Homes and longterm care facilities. They say that the joe biden will protect residents of Nursing Homes and facilities. Hes committing to providing Older Americans and people with disabilities with a safe and dignified community to live in during the covid19 pandemic and beyond. A couple of those points, dr. Gifford, one, is to ensure effective pointofcare testing and Contact Tracing is available, requiring Infectious Disease specialists in every regulated setting and among the points, again, ensure that all workers and residents in longterm care facilities have optimal ppe by invoking the defense production act. You pointed out that you have a short fall of the n95 masks and other ppe. It sounds like you would support some of this plan, at least. It sounds like a sound plan. We would support it. Weve been an advocate for the infection preventionists in there. Weve been an advocate for more testing and supplies. Weve been an advocate for more n95 masks and increasing local production for that. I think all of those things would help. Lets hear from jeanette in largo, florida. Caller good morning, sir. Good morning to your guest speaker. I was in a nursing home, advanced nursing home, and a black girl brought it in there and gave me gave it to the wing, okay, they put me in a covid wing. And they said that i had a fever. They threw me in the covid section. Then they took me out of that nursing home and threw me in another nursing home. And i was they werent giving me my meds right, they werent im on morphine and percocet for pain. I have extremely bad pain and i also have os osteo myelitis. Are you currently in a nursing home now . Caller no, im home, sir. Thank god im home. I want to be at home. These Nursing Homes down here in florida are terrible, sir. I cant go on like this. I never want to be put back in another nursing home. I g i g i got scabbies in the other nursing home. Any response . Most people dont want to go to a nursing home and understandably want to be at home. Certain people are need to be there after they come out of the hospital for some rehab and care and others sometimes dont have family members and cant live at home alone. Its really a last resort. We understand that. Theyre very sick and disabled as you can hear from jeanettes story. I think during this pandemic, its been a little bit chaotic with having to move residents around and trying to shuffle them into covid wings in different buildings and that guidance has been everchanging as weve learned more, i think, earlier on, as she described. We were moving people around based on symptoms which probably in retro spectate weve learned is not necessarily the right thing. You need to base it on test results. Those are all good points that shes raised. In general, where is most of the guidance coming from, the cdc or do most Nursing Homes follow the state and local guidance on their operation . Well, most of the guidance has been coming from the cdc. Weve been following it. But also just the pace of and need of getting information out there, theres been a lot of state guidance and local guidance and, frankly at times its been confusing. Some states say, make sure you do x but dont do y. Some stays are saying, do y but dont do x. I think youre starting to see a little bit of reconciliation on that. But we need consistent guidance. Lets hear from alice in brick, new jersey. Alice, youre on the air, go ahead. Caller okay. Thank you. You know, i listen to cspan in the morning and i get so aggravated and im so glad i finally got through to you this morning. What i want to know is, how is joe biden going to do all these things that you say, especially today, when he has dementia . Everyone knows he has dementia. How long is he going to last as a president. Thats alice in new jersey. An early caller mentioned she was not able to get her medications. How has the pandemic made that a challenge for your residents pretty much nationwide, in addition, not being able to get out and see specialists and things like that . Well, in the nursing home and assisted living setting, they usually work with a longterm Care Pharmacy that will ship the medications directly there. Some go out and get the medications from a local retail pharmacy. But you should be able to get the medications. Weve not seen a shortage of medications in this setting. If youre living in the community, thats a different story. Its harder to get in and out and travel around. How hard has it been to maintain staff in terms of the nurses, the other aides, and the doctors who come to check up on their patients, your residents . Staffing was a problem before the covid and we were asking for help in trying to recruit and get more staff and work in this in Nursing Homes, assisted living. The staff have been tremendous. They care for the residents often like their family members. Many times, residents dont have family members or the family members are faraway. And so theyve really been fantastic with that process out there. But many of them have been sick. Many of them have died from the covid, and thats been an added stress. Many of the changes that have had to go on with the testing and the monitoring and all of equipment and keeping people in their rooms has increased the need for more staff and thats been a challenge. Before the pandemic hit, what was your organizations approach to a potential pandemic spread . What was the worstCase Scenario that you may have envisioned before all of this started . This is pretty close to it. A virus that disproportionately effects the elderly. This is a very serious virus which often lands the elderly in the hospital and certainly weve seen most of the deaths in the country being in those who are old and we take care of people mainly over the age of 80 with many chronic diseases. As jeanette mentioned earlier on, thats been a challenge. And so to have a virus that really effects this population and not everyone else in creating shortages like this really has been sort of a worstCase Scenario. Lets go to james in connecticut. Good morning. Caller thank you very much. Hello, dr. Gifford. What i would like to ask you about is as somebody who is at a high Level Medical position in the country, can you discuss the supply chain issue in terms of getting access to masks that are made in the usa. My understanding is that 3 m has two main plants here but the Biggest Issue that we hear about in terms of the defense production act is that still the precursor chemicals and the fabric that must be used has come from china. So in other words, all roads lead to china even before we want to produce more masks. As someone who is in the know, can you explain to the american population, if we need to lower our epa standards to allow chemical plants to reopen so they can make chemicals for the masks. No one explains how these masks are really produced in a supply chain and i would appreciate your higher level overview. Thank you. Ill take it off the air. James, its an excellent point that even if you were to open up and make plants in the united states, the Raw Materials for many of these things come from all places around the world. Not just china. I know that mexico has been making a lot of the personal protective equipment and many of the suppliers have turned down to mexico on this. But certainly, the Raw Materials have been a problem. Early on, the materials that make masks are the same materials used for gowns. When we had a worldwide shortages of masks, everyone took the material and started making masks and it created a shortage of gowns. The n95 masks also take time to build the right equipment and you just cant turn it on and make it right away and thats been a challenge in the supply chain as well. I think it really speaks to why we need to look at where we fit in the world and how we relate to all of the Different Countries because working it along and trying to do it along, even if we made lots of factories wouldnt work. Its going to take the world working together to battle this pandemic. For those of you who have a loved one, close friend in a nursing home, its 2027488002. On that line diane from akron, ohio. Good morning. Caller hi. My mom is in a nursing home. She did get covid. Luckily she recovered from that. But theres a lot of problems with this nursing home. Although its highly rated. We are considering moving her to a different facility and i would like to know what the doctor thinks are the most important things to look for when youre trying to search for a decent place with decent food and a good staff. Ill hang up. Thank you. Okay, diane. Diane, im glad your mom recovered. The majority of people who have gotten covid have recovered. As far as how to select a nursing home, you know, its a very common question i get given my role and what ive been doing throughout my career. The first question i usually ask is why does someone need their nursing home . Are they going there for rehab care right after being in the hospital . Are they going there to live . Do they have dementia . How mobile are they . Because you want to match up the needs of the individual with the facility. The other issues, theres a very good source nursing home compare or medicare compare where the federal government collects a lot of different medication on the survey inspections, on the Staffing Levels and the critical outcomes. I would look at that and i wouldnt just look at the overall rating, whether its a five star or a three, two, whatever star it is. I also want to make sure that the areas of need are doing well. So if theyre going there for a short stay and care,