Hearing of the House Ways and Means Committee - Opening Statement of Rep. Doggett, Hearing on the COVID-19 Nursing Home Crisis

Hearing

(As prepared for delivery)

On February 27th, the Life Care Center of Kirkland, Washington first reported an outbreak of COVID-19 cases to local health officials. This was the first major outbreak in the U.S., resulting in 37 deaths. Tragically, this story quickly became a common headline. Four months later, more than 50,000 nursing home residents have died from COVID-19, and many believe that is an undercount, with many lapses in data and a slow start to testing. Less than 1% of the U.S. population accounts for nearly half of all COVID deaths.

To understand what went wrong and how to move forward, we invited CMS Administrator Seema Verma, the person responsible for overseeing nursing homes, to testify. She was offered her choice of dates and times and could have appeared in person or virtually from her desk. She could have offered a substitute. But this Administration--more terrified of transparency and accountability than of coronavirus, did not have the courage to face responsibility for thousands of deaths. Following repeated unanswered requests since early June, we are proceeding with today's expert panel.

We will hear about years of regulatory rollback and relaxed oversight efforts that worsened a crisis that existed long before COVID-19 and left facilities even more ill-prepared to deal with the current emergency.

We will learn from the on-the-ground truthtellers--a sister grieving the too-early loss of her brother, a licensed practical nurse who took it upon herself to purchase PPE with her own funds for her staff, and a local ombudsman who has been locked out of facilities, inhibiting her ability to assist residents in advocating for their rights, including preventing evictions to inappropriate settings such as homeless shelters, similar to the shocking report Sunday by Jessica Silver-Greenberg and Amy Julia Harris of the New York Times that thousands of nursing home residents are being evicted to homeless shelters and other inappropriate settings, in part because nursing homes have a financial incentive to take more lucrative patients including those with COVID-19.

We will also receive insights from national experts who have spent years studying nursing homes and federal regulations and enforcement, as well as the perspective of a facility navigating this crisis.

Much of this crisis could have been prevented by effective federal leadership. The Trump Administration's response to the pandemic has been characterized by the three D's: denial, delay, and ongoing deception, but the Administration performance grade is one F after another.

Since the Kirkland outbreak, CMS waited 97 days--more than 3 months-- to publish initial data about nursing home preparedness and infection and death counts. What they did publish was incomplete, riddled with errors, and excluded any information during their long period of delay prior to May, as well as demographic information, despite stark racial and income disparities marking this crisis. As local journalists sifted through the piles of poor information, along with policymakers and anxious family members, it became clear that this was not responsive in disclosing the true scope of this crisis, where it has had the largest impact, or which facilities are struggling the most. To date, over 800 facilities still haven't even reported data, including over 100 Texas nursing homes.

And while we have known from the beginning that the essential tools to protect frontline workers are personal protective equipment (PPE) and comprehensive testing, it took CMS 80 days to call for a single baseline test of all residents and staff, and 61 days until FEMA announced the distribution of a two-week emergency supply of PPE--much of which was junk. On testing, the announcement did not come with resources or logistical coordination, despite Congress appropriating $25 billion specifically for testing and billions more that can be used on testing. Once again, states were left to fill the national leadership vacuum and it is unclear whether even the inadequate goal of a single baseline test has been fulfilled.

What little PPE the Administration sent has frequently been unusable--glorified trash bags to serve as gowns and cloth masks instead of N95s. Despite warnings since early January from health experts, the Trump Administration not only belatedly invoked the Defense Production Act in limited circumstances, but also encouraged the export of PPE until early March. States and providers were left to fight over the scraps.

Building on the oversight efforts of the Select Subcommittee on the Coronavirus Crisis, today's hearing is also seeking concrete solutions. We will explore regulatory, legislative, and enforcement changes necessary to better protect the over 1 million Americans residing in nursing homes. We will also examine measures to ensure accountability when a facility fails a resident, including prohibiting mandatory arbitration clauses in resident contracts as our colleague Linda Sanchez has proposed, and assuring facilities do not receive blanket immunity from wrongdoings.

In some cases, responsibility for this catastrophe is shared with the Administration by various failures at the state level--Texas, for example, hid information about the identity of infected nursing homes and delayed testing and provision of PPE. Sometimes individual nursing homes were culprits and in other cases they were themselves victims of Administration indifference. I salute those homes that are doing all they can to protect both their patients and staff. But many are not.

This Congress should also accept some responsibility. In recent months, we have appropriated huge amounts of taxpayer monies to nursing homes and other health care facilities without meaningful guardrails, knowing full well that these funds would be distributed by an Administration indifferent to the wellbeing of residents and for whom accountability and transparency on any subject are always anathema.

As Laura Garcia at the San Antonio Express-News uncovered, $9.3M was awarded, no strings attached, to a local nursing home with no COVID cases, a one-star rating, signifying "much below average," on Medicare.gov and which, even under relaxed Trump enforcement, had received 11 health citations on its most recent inspection conducted about a year ago.

This week we have seen a Life Care nursing home openly firing a whistleblower, who spoke to Reuters about substandard conditions, we have no idea how nursing homes, which have received millions, have used those funds to ensure the safety of their residents.

Hopefully, today's discussion will offer more understanding of both the failures and the best path forward.

Source