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the america health care association is with us this morning to talk about the impact of covid-19 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. >> there's 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 didn't know so many people

who didn't have symptoms could spread it. we didn't have availability of testing. we didn't 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, we're starting to get a grasp with it. but what we're 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. it's 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 that's been a challenge. >> "the wall street journal" reporting the news that covid deaths topping 100,000 in u.s. long-term 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 community-level 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 we've 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 can't control it in the community, it's going to be hard to control it in the assisted living. people need to honor the social distancing, family get-togethers are a challenge, and we're 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. 202-748-8000, 202-748-8001, and you have a loved one in a nursing home, that line is 202-748-8002. 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 you've 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 n-95 masks that filter out the virus and the gloves. those are made overseas and as we've 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 we're not a priority. we're 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 you're

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. what's the plan in nursing homes across the country? how will the vaccine be administered? >> we're very excited with the prospect of the vaccine. i think that's going to help both the residents and the staff in these facilities. the federal government is really been working on a robust plan where they'll work with walgreens and cvs so come in and administer the clinics or with some of the other long-term 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. that's why it's more important than ever that we slow the spread now, let's 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 don't develop symptoms or test positive often for a number of days and up to 14 days. that's 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 don't have it. you're still within that 14-day window. you still can change. that's why we're 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. that's 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? it's very tough. and particularly for individuals with dementia who can't remember why this is going on and each time it's something new, it's been very tough out there. it's be tough in my own family. my parents are 88 and 89. they live about 45 minutes away. i've hardly been able to see them. they live at home. they're not in a facility. it's the same episode there. they're not able to interact and that's been tough. i'm going to show you photos there of various facilities. i'm thinking in illinois,

they've gone on strike demanding pandemic and hazard pay. is that something your organization has looked into? >> certainly we've been arguing from the very beginning that we need the right equipment for the staff to take care of the residents to they're protected and they protect the residents and fully agree with that. we've 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. he's the chief medical officer of the american health care association. and we welcome your calls, 202-748-8000, mountain and pacific, 202-748-8001, if you have a loved one in a nursing home, that line 202-748-8002.

the biden/harris campaign had put out during the campaign a proposal, the biden/harris plan to make nursing homes and long-term 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 covid-19. 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 long-term 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 long-term care facilities. they say that the -- joe biden will protect residents of nursing homes and facilities. he's committing to providing older americans and people with disabilities with a safe and dignified community to live in during the covid-19 pandemic and

beyond. a couple of those points, dr. gifford, one, is to ensure effective point-of-care 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 long-term care facilities have optimal ppe by invoking the defense production act. you pointed out that you have a short fall of the n-95 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. we've been an advocate for the infection preventionists in there. we've been an advocate for more testing and supplies. we've been an advocate for more n-95 masks and increasing local

production for that. i think all of those things would help. >> let's 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 weren't giving me my meds right, they weren't -- i'm 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, i'm home, sir. thank god i'm home. i want to be at home. these nursing homes down here in florida are terrible, sir. i can't 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 don't 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 don't have family members and can't live at home alone. it's really a last resort. we understand that. they're very sick and disabled as you can hear from jeanette's

story. i think during this pandemic, it's 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 ever-changing as we've learned more, i think, earlier on, as she described. we were moving people around based on symptoms which probably in retro spectate we've learned is not necessarily the right thing. you need to base it on test results. those are all good points that she's 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. we've been following it. but also just the pace of and need of getting information out there, there's been a lot of state guidance and local guidance and, frankly at times it's been confusing. some states say, make sure you

do "x" but don't do "y." some stays are saying, do "y" but don't do "x." i think you're starting to see a little bit of reconciliation on that. but we need consistent guidance. >> let's hear from alice in brick, new jersey. alice, you're on the air, go ahead. >> caller: okay. thank you. you know, i listen to c-span in the morning and i get so aggravated and i'm 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. >> that's 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 long-term 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. we've not seen a shortage of medications in this setting. if you're living in the community, that's a different story. it's 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 don't have family members or the family members are faraway. and so they've really been fantastic with that process out there. but many of them have been sick. many of them have died from the covid, and that's 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 that's been a challenge. >> before the pandemic hit, what was your organization's approach to a potential pandemic spread? what was the worst-case 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 we've 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, that's 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 worst-case scenario. >> let's 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. i'll take it off the air. >> james, it's 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 n-95 masks also take time to build the right equipment and you just can't turn it on and make it right away and that's 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 wouldn't work. it's 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, it's 202-748-8002.

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 there's a lot of problems with this nursing home. although it's 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 you're trying to search for a decent place with decent food and a good staff. i'll hang up. thank you. >> okay, diane. >> diane, i'm 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, it's a very common question i get given my role and what i've 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, there's 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 wouldn't just look at the overall rating, whether it's 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 they're going there for a short stay and care, i want to focus on that aspect. if they're going there for dementia care, i want to focus on that longer term aspect of

the measures. i find that is the best source to looking for information and sorting it through and certainly you need to visit the facility and see what's going on. are the staff interacting with the residents or are the residents not being interacted with the staff. it's a little bit harder to do the visiting now because of the covid that is out there. that was something independent often do before. i think people often try to pick the facility that's closest to them so they can visit more frequently. and then that's an important aspect. but proximity to you may not be -- guarantee the best facility and you may need to go further to get a better facility. and that's a balancing act. it's a hard decision. >> let's hear next from john in philadelphia. good morning. >> caller: good morning. i have four questions for you. one is, why are nursing homes so

negligent? another is, why not a mask mandate throughout america? why these superspreader events are allowed to take place? and that's pretty much what i would like you to answer for me. >> john, i think the recommendation for wearing masks is really key and distancing is out there is really needed. you know, i think somehow people are perceiving these masks just about protecting them and their freedom. well, the challenge that we know is about half the people who develop covid, never develop symptoms. you could develop it and unknowingly pass it to other people. even if you do develop symptoms, for two to three days before you develop symptoms, you can spread the virus to other people. this is why wearing a mask is really showing a respect to the elders grandparents, your parents, whoever it may be, that you're respecting the spread to

other people. it's not just about protecting you and somehow we lost that message that's out. there i think that's an important message that you're zeroing in on out there. >> sheldon is next in new york. good morning, you're on with dr. david gifford. >> caller: good morning, dr. gifford. thank you for taking my call. i'm -- i assume by your title that your task is to ensure that medical practices and diseases are fought across the board. your first caller, jeanette, was openly racist. why didn't you say something about that? what was the relevance of her having to inject that woman that brought the covid into the nursing home wing where she was was black? don't you think that you should have said something about that?

thank you. >> well, i do think that this covid is disproportionately affected african-americans, latinos and asians and that's been a significant problem in the country. and many of the workforce in the long-term care and assisted living are minorities and they need better access to care and rou resources that is out there. it has nothing to do with their ethnicity as to what the problems are that are out there. i think that is a point that we need to address. some of the facilities that take care of more african-american and latino, asians need more resources because they tend to be in poorer neighbors and they have less access to the resources that are needed that are out there. and i think those are all good points that we need to tackle as a country. and i think we've learned that some of these things are just sort of built into the system and we need to address them better. >> some of the reporting after the holiday weekend and a number

of news reports indicating there's maybe a further surge in covid cases. a report here in "the washington post" about hospital beds inside a hospital as the coronavirus surges, where will all of the patients go. dr. deborah birx, member of the coronavirus task force at the white house, was on face the nation yesterday talking about her concern in the rise in post thanksgiving covid numbers. >> if you look at the second wave going into the memorial day weekend, we had less than 25,000 cases a day. we had only 30,000 inpatients in the hospital. and we had way less mortality, way under 1,000. we're entering this post-thanksgiving surge with three, four, and ten times as much disease across the country and so that's what worries us the most. we saw what happened post memorial day. we're deeply worried about what could happen post-thanksgiving

because the number of cases, 25,000 versus 180,000 a day, that's where -- that's why we're deeply concerned. as you described, it looked like things were starting to improve in our northern plain and now with thanksgiving, we're worried that all of that will be reversed. >> dr. david gifford with the american health care association, given the potential for a rise after thanksgiving and during the holidays, what new or further actions are you proposing for your facilities that are represented by the association? >> well, you know, i think we have the same concerns. you asked me earlier, what was our -- in worrying about a pandemic, what have our worst case scenario? in many situations, nursing homes are sort of the relief valve for hospitals to clear out individuals who need care so they can make room for all the sick people coming in. well, in this scenario, with

this virus being so serious with the elderly, you don't want to move everyone out of the hospital into a facility, and when the outbreaks are occurring in our facility, we're sending more people to the hospital and the icu, which is increasing the occupancy. this is why we've been calling for us to be a priority with the ppe, the 95 masks and the testing. right now you can still go to a clinic and get your test results back within 24 hours, but many nursing homes send test results off and get them back in five days. we need to be in the front lines, because the residents are affecting the care in the hospitals. >> could you see a return to potentially some of these mobile hospitals set up in april and may if the cases got that bad? >> i hope not. but yeah, that is a possibility that could happen, yes.

>> let's go to new jersey. this is ethyl. hi there. >> caller: hi. i just wanted to know my daughter is in a nursing home in jacksonville, florida, and i live in new jersey, and i would like to get her here, but she keeps going from the nursing home to the hospital. in three weeks, she's been into the hospital twice for the same thing. and she had open heart surgery, that's why she's in jacksonville, florida. she really lives in brunswick, georgia, but they sent her to jacksonville to get the open heart surgery, and she's been there for a year. now she's in a nursing home. >> and ethyl, is she positive for covid?

ethyl, does she have covid? >> caller: no. she had open heart surgery. >> but you -- >> caller: she's been in the hospital for a whole year, and she's not being well taken care of in that nursing home. and i don't know how i can get her back here to her home. >> okay. dr. gifford, any observations? >> no, you know, ethyl, it's -- i'm sorry. i'm sorry your daughter is going through that. but i think it is a good example of the people that need nursing home care are very sick. and they often go back and forth to the hospital because they're very sick, even when they get all the right care. and so that's been a challenge. you know, one potential silver lining out of this covid is that people are beginning to learn

how to explore the use of zoom and videoconferencing with that, and i would encourage you to figure out how to, you know, make sure you videoconference with your daughter and with the staff in the facility and ask them those questions. i think those are all very good questions you should be asking them for. and i think hopefully we'll have better communication, because as ethyl is describing, this is a very common scenario, where family members live many states awe waway and they can't go vist them. >> let's hear from lisa from punta gorda, florida. >> caller: thank you for taking my call. dr. gifford, i have a mother in a care facility in punta gorda. i struggle with the fact that i'm unable to verify her level of care. we are allowed outside visits,

we have to sit outside in the heat. and i'm not even close enough to hand her a banana without being shouted down by the staff. i understand trying to prevent the spread of the virus. however, my concern as the only person in her life who is -- providing her sheets are clean, that her physical well-being is clean. i found sores on her arm, et cetera. i am inquired via phone and i can't seem to get satisfactory answers a lot of the time as to what is going on, how they are caring for her. she doesn't have any co-morbidity type of aspects. but obviously she cannot advocate for herself. and i really struggle to advocate for her.

what do you recommend for that, and who holds nursing homes accountable when they are shut down to the degree that those who care most about the people inside cannot verify the level of kacare? >> lisa, appreciate that. thank you. >> so a couple of things. the new guidance allows for compassionate visits. not just outdoor visits. if someone really needs you to check up on them and it's affecting their mental health, that is now qualifying as a compassionate visit, so you should be able to use that. if you go the cms website, they do have the guidance on compassionate visits. certainly lly get tested befor go in. the other point is one that the staff there are terrified of getting the virus that could

affect your mom and everyone else. so they are taking extreme measures, but that's having an effect as you said. another option would be to do some videoconferencing with your mom and you talk to her, hopefully if she's able to express that. the other is, we've seen in some places family members have volunteered to help work. someone has gotten training as nurse's aids, and not just care for their family members but others as well. because we do have a shortage out there. so i think those are all potential options. there's also a state ombudsman, so if you wanted to google your state ombudsman, you could talk to them if you have concerns about what's going on. >> this is bill in virginia beach. hello. >> caller: yes. are you talking to me? >> yes, we are. go ahead.

>> caller: great, thank you. my name is bill, and i'm going to be 71 in january. i'm a heart patient, had bypass surgery back in '99, and i take about a half dozen pills a day. a couple for cholesterol, one for blood pressure and one for heart. i'm in good shape overall. i am a little overweight, but i feel pretty good. most of the time i hibernate at home watching tv and people like yourself. my main question is this -- i noticed on the television that the -- i believe they call them therapeutics. there were a couple of them, the names slip my mind a little bit. you're particularly familiar with them, that were given to president trump when he went to the hospital. what is it -- oyx something and the other starts with an "r" like retinol or something of

that nature. he had great success with those. they made him feel good, took care of his symptoms any way and he was in and out of the hospital rather quickry. i was wondering if these types of drugs are currently able to be used in some situations with people in nursing homes? >> so billy, a good point. there are a couple of medications that can be used. remdesivir is one, i think that's the one you were mentioning. it took me several months to get the name of that one down right. another one is hydosteroids. those are the two that the president received. then the two new medications that have come are monoclono antibo antibodies, and those are antibodies that fight the virus and block it from infecting

other cells in the body and spreading in the body. so you need to use it early on in the process. the two other medications i mentioned at the beginning, the remdesivir and the steroids, need to be administered in the hospital. the antibodies are meant to be administered in the nursing homes or other settings. you want to treat someone early on. once the virus has spread throughout the body, using those antibodies may make things worse. so we do have a couple of new promising treatments out there. again, i think we're advocating they make those available for the nursing home setting. right now they have made all those medications available to the hospitals and we have to figure out how to get them into the nursing homes. >> patty in cambridge, massachusetts. good morning. >> caller: hello, hi, thanks for taking my call. i have three separate questions. first of all, have you noticed

an uptick in family trying to discharge their loved ones from nursing homes and take care of them at home with more people being unemployed just to prevent their contracting the covid? secondly, i read where minnesota's governor sent emails to state employees asking if they would volunteer in long-term care settings for up to two weeks, no experience necessary, if this is a good idea and if they've been successful. i think it kind of exemplifies the crisis and staffing that we're experiencing. and lastly, do you anticipate they will be mandating nurses for the vaccine and do you worry this could be a concern with more staffing problems if nurses are not comfortable getting this new rollout on the vooaccine? thank you for your answer. >> good questions, patty. the -- certainly we do need more

staff to come in. i would say that, you know, any volunteer coming in, there are volunteer work that can be done that doesn't require training that frees up some of the other staff to care for the residents. so that can be very valuable. there are some short cases to be a nurses aide. we have not seen many family members trying to take people out of the facility. usually people are there because they can't be cared for at home. you're right, some people are at home now, but many people are still trying to work from home remotely. so that's been a hard aspect of it. so we haven't really seen that much of that change. what we have seen is just fewer people going to the hospital for elective surgeries, or elective treatments that would need care. so they've not been going to the facility. so we've seen a big drop in the

census of the facilities across the country out there. and then the last one on mandating of the vaccine, i don't hear anyone planning to mandate the vaccine out there. i think it's a good idea. i'll be first in rhine in line e vaccine myself. i'm encouraged by the data out there. >> dr. david gifford our guest, chief medical officer with the american health care association. we appreciate you joining us. >> my pleasure, bill. >> weeknights this month, we're featuring american history tv programs as a preview of what's available every weekend on c-span3. tonight, we hear the experiences of three women who reflect on their time working on the apollo space program. they share how they overcame challenges and their roles with nasa. watch beginning at 8:00 eastern and enjoy american history tv every weekend on c-span3. >> a discussion on the nato alliance and