nomination of senior associate counsel brian miller to be the first special inspector general for a pandemic recovery. a new position created by the cares act to oversee spending of government funds in response to the pandemic. senators may also learn about legislation providing flexibility to small businesses. it is possible that further work on the reauthorization bill could take place. watch the senate live on c-span2. host: we are joined by john dickens here to talk about the gao report on infections and infection control in nursing homes across the states. what prompted the report? was it driven by the covid response? guest: the covid issues have highlighted infection prevention and control.

the gao oversight of the federal response as well as a request from the ranking minority member of the finance committee gao conducted a review of looking at what the issues were in nursing homes in terms of finding deficiencies, prevention, and control prior to the pandemic. what the history has been in terms of what has been reported to hhs. host: here are some of the top line data out of that report. tor 13,000 homes from 2013 2017 were cited with citations. deficient. nearly all of the deficiencies are by state surveyors as "not

severe." enforcement actions were only taken for 1% of these deficiency. deficiencies. who is responsible for monitoring infection issues and other health issues in nursing homes? guest: this is a joint issue. homes are meeting the standards and if there are there is a vote for

them to correct those deficiencies, and if they are more severe or repeated or not corrected, there could be enforcement action such as training. those are put in by federal enforcement action. host: you mentioned some of the responses in terms of actions that nursing homes could or should take according to your report. what are the top responses nursing homes need to take? particularly in light of the covid-19 pandemic. guest: many of the things we reported on that were identified prior to the covid-19 pandemic were fairly basic techniques that permit the spread, or limit the spread, of infection like the basic handwashing,

isolating, not having staff that are showing symptoms of being sick, working directly with residents. a range of basic steps. if nursing homes were not meeting those standards and the inspectors found deficiencies, there would be a requirement of the nursing home to correct those deficiencies and that they not occur further. pandemic bothd-19 of targeted inspections more and provided a series of guidelines to nursing homes on steps they need to take to bolster their infection prevention control. hopefully they can limit what has been a devastating experience. host: we are talking about infection prevention and control with john dicken who is with the gao. the new report on the issue.

if you live in the eastern or central time zones, that line is (202-748-8000). mountain and pacific, (202-748-8001). ave had experiences with the nursing home, that line is (202-748-8002). the role of infection control and prevention is a pivotal role in american hospitals. what is the difference between how it is handled in a hasbro situation, or is there a difference, and how it should be handled in the nursing home? themes,here are common but differences in a nursing home setting. residents need assistance with daily living whether it is being moved, fed, bathed. they are concrete settings often

spirit some of that has been reduced. eating in ae not common area, but they should be eating separately because of the risk of infection. these are 24 hours, seven days a carethey will have direct by a range of nurses, nursing aides, and so the risk of infection is spreading in a vulnerable population that may have underlying conditions. that is why it is critical to take these basic steps of handwashing, not sharing medical equipment upon residents, and isolating residents so they are not spreading infectious diseases. host: first of all, how does the gla defined a deficiency in nursing home infection control?

secondly, give us a range of the issues you found in terms of deficiencies. establishes what the standards are and inspectors will go in and cite a deficiency. this could range in severity. they could become at the most serious, those that are causing actual harm or jeopardy. or they could be something that is less severe of having a potential for harming residents. that is where we saw most of the deficiencies in terms of infection control. about 99% were at the potential to cause harm. they could be for individuals or widespread across a group. deficiencies -- most of them inspectors were

seeing things at the lower end of severity. they were things that had the potential for harming residents, but the inspector did not determine their had actually been harmed. we did see in some of the more severe cases there were situations where residents of the nursing homes were not being wiped down and respiratory infection spread. they did not demonstrate that they isolated them and there was common sharing of, for example, waste bins. host: go ahead and finish her thought. guest: there is a real range from those that are basic techniques to very serious. host: you mentioned senator ron wyden had asked for the survey? the senator had asked us

to a broad evaluation of infection control. this was the first part of that and based on that request as well as gao's overall responsibility. andress asked to evaluate so we will be evaluating both the response. host: let's go to our first call. ricky is in north carolina. caller: my first question is my mother-in-law works in a nursing home. i am calling on behalf of her. i believe there are more than 200 cases now. federal officials will not give the names of these nursing homes. let's hear from joyce in brian, ohio. caller: i used to work in a

nursing home years ago and i have had friends who put patients in after i left. the cleaning is not what it should be in these homes. patients are given a shower once a week and just spited up, i call it a , but the beds were washed once a week. a lot of the nursing homes do not take the time to change the heads that they clean the rooms with. if they even clean it once a day. there is a problem with cleaning supplies, i think, it is a low part of the job and morris put

toward the -- more is put toward the patient. when you pay over $8,000 a month you should get a little more than what you're getting in these nursing homes. as far as transferring patients they put them from the hospital because they cannot treat them anymore. they go to the nursing home or they go to hospice and then the nursing home. this should maybe be looked into. i don't know what else could be done, but there is a bottom line that is not being looked at. it is the fact of the way the patients are treated. i appreciate your time. host: thank you, joyce. guest: i appreciate the caller sharing their experience and important points of some of the issues are basic things.

cleaningthings like also highlights the important role of the staff. also facedave infection. host: some of it seemed so solvable. the problems she pointed out were fundamental cleanliness and hygiene issues. guest: i don't want to underestimate the challenge of the covid-19 pandemic. we realize this has been devastating in many nursing homes, but it is a number of fairly basic steps all of us have been doing. washing hands, wearing protective masks, certainly in a nursing home for stuff beyond that given the vulnerability of contact,ation and the

social distancing is not an option in a nursing home. and need to take these basic minimize the spread of disease is highlighted, but it has been a persistent issue in nursing homes. infection prevention control is challenge. deborah hear from calling from north carolina. caller: i worked in a nursing home 25 years and what i have to say is the nursing homes are not what they should be. they run around like chickens with their heads cut off trying to get everything ready for the one or two days for inspection. it is not ok.

infection control in nursing homes is dirty. i agree with the caller about the mop heads. they do not have the supplies they need to clean with. you are running from here to there to try and get a bargain. agree getting none and i with what the lady says. the nursing homes are filthy and they need inspecting more than once a year. they need a consistency of inspections to make sure everything is straight. i appreciate you taking my call and have a blessed day. host: thank you. a tweet from one of our viewers says, "the residence and nursing homes are not out of the town. the spread among residents begins with persons from the outside." does the report gao published address that?

i think you highlight a key issue. pandemicthe covid-19 certainly. nursing homes are not having visitors from outside of themselvesut staff meansl as other employees there are interactions where .ovid is in that community the caller raised important things about infection. oftentors can go in more when there are complaints or there is a need to revisit a

home, but outside of this pandemic environment a key part of the nursing homes is having family visit and serving the situation. that is not able to occur right now in person. that will be through calls and electronic efforts because the priority is on reducing spread and having people coming in other than staff. next is abby in anderson, south carolina. we lost abby. we go to rick in iowa. caller: how old do you have to be to be in one of those nursing homes? i just saw a video of a 20-year-old and they are just pummeling an old gentleman.

was his symptoms to get into that nursing home? host: the age to get into a nursing home? changes inentioned hhs rules. let me ask you about a proposed rule on infection that is being proposed. medicare medicaid would moun undefined term that lets the facility decide how much time should be spent. regulation has not been finalized, but cms defended the proposal saying it aims to reduce regulatory burden and strengthen infection control. specialist who is a prevention nest ist.

these are not typical? that has not always been a full-time position. that, as wething ,ontinue to look at issues evaluating the role and need for infection control, there are requirements that nursing homes have to try and identify and prevent them. [indiscernible] at what point is medicare and medicaid penalize a nursing home for bad practice? tier ofhere are a actions that can occur for severe deficiencies or there is

a pattern of deficiencies. especially one where the nursing home is not corrected them. the goal is not to punish a home , but bring about the change the nursing home needs to make. found in prevention control was only in a small percentage of cases, for problems that were less and then not implemented because they have no track before them. the actual entities which could be requiring training or monetary penalties tends to be reserved for those nursing homes that have severe or have not corrected the deficiencies. the goal is to bring nursing not tonto compliance require punitive actions.

host: if they fail to remediate, are there potential fines against the nursing homes? fines and theye can be per day or per resident. they can vary and other actions could require training, a train and process. infection prevention control, but certainly in other types of problems at the very extreme you can deny payment for medicare or medicaid or even terminate a nursing home's license. states themselves also may have separate enforcement actions they can take, but the federal, the most common federal enforcement actions beyond training would be fines. host: a couple more calls here. we'll go to maur na wisconsin. caller: no, madison, virginia. host: i'm sorry. it says wisconsin.

sorry, go ahead. caller: yeah, yeah, i was transferred to a nursing home after being in the hospital for a gastro g.i. bleed, where i had five replacements of blood. so i was brought in on a stretcher, stayed there for three weeks for physical therapy, and the nursing home was incredible in charlottesville. but the only recommendation i would have for low staffing and low pay. they hospital gets -- they t from bhutan, and provide the visas and housing and training. and even in the hospital, i hardly saw an american. they were from all over the world, the people that drew blood. so in the nursing home, and thew blood. in the nursing home, the staff was overwhelmed and they had very little pay.

in the meantime, the nursing homes are making a lot of money, but they have to pay more to get better or more staff. that was my only recommendation, because i did get a letter from a law firm in florida. and i am in virginia in a nursing home, saying that they want -- how are you being treated? we were looking for lawsuits against nursing homes. my it is a big business, but heart goes out to the workers. host: ok, john? guest: right. as far as the turnover that the the point about, that can add challenges. having adequate levels of staffing and write staff that right staff care --

that provides the care has been a long-term challenge. and in this environment that is further highlighted. not bey be coming ill or providing patient care, if there at a high risk of getting covid. so there are challenges to training, making sure that there is adequate training, not only for infections you can control but appropriately movie residents to the appropriate care. that is another challenge. host: betty in georgia. caller: hello. host: you are on the air. caller: i want to say that nursing homes have big problems, and had big problems before the pandemic. my daughter after having surgery had to go to a nursing home at least two times. she was in the hospital for

maybe about a year. gone from stonebridge to the nursing home. bed was on the whole time i was writing -- riding to the nursing home. the pewter workers low wages. you will not be excited about helping people when you pay them $10 an hour. not seem that enthusiastic about helping people. host: we have talked about the workers a little bit. what about the response from congress? this report requested by senator wyden and others, what is expected from congress in terms of reaction to the report? guest: so, separate from our report and our ongoing work, where we will continue to do work for committees of congress

and congress as a whole, but certainly the cares act, which was a large effort by congress to provide some funding, trying to provide for the protections. rther protections. my need to go to nursing homes to make sure that they are purchasing protective equipment and things. so there have been preliminary steps. authority,existing have been strengthening guidelines and inspections. that is something we will continue to evaluate. and we will report our findings to congress, if there are further lessons to be learned from -- from the pandemic. host: brenda in south carolina. caller: good morning. thank you for taking my call. i have a a lot of feelings about

nursing homes. can you hear me? host: yes, we can. caller: my daughter was born in 1969. her nerves -- all came out the back, so that made her crippled. she has been in a wheelchair all these years. she has been to nursing homes. she stayed out one for a pretty good while. hill, got her to rock where i live. ot arthritis ag while back. thatas staying at a home she was out for a long time. we loaded over there. it was two miles from my house. i could drive there. and take care of my daughter. host: do you have a question or comment for our guest? caller: yes, i do. we need new nursing homes built.

inneed -- my daughter lives one across from the spartanburg hospital in spartanburg. they took her down there. and made me think they were taking her to magnolia manor in rock hill. i was getting ready to visit here, to go over here to visit was in spartanburg 100 miles away from me. host: we will let you go. we are about the let john dicken go, but any thoughts on that call? guest: it raises the issue of many families having loved ones where the families are not proximate, where they have to go a great distance to the nursing home. that is a concern. some nursing homes are closing. and why there has been a move also to other types of long-term care settings.

people may not needed for nursing home, or may need different types of assistance. a new reportcken, just issued on infection control and prevention in nursing homes ac >> we are waiting for a briefing with the governor of california, gavin newsom. he's expected to talk about the protests in his state following the death of george floyd and california's response to the coronavirus pandemic. while we wait for the governor, we have the segment from this morning's "washington journal." 's leadership in this time of unrest and civil disturbance. (202) 748-8001 for republicans. (202) 748-8000 for democrats. (202) 748-8002 for independents. th