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Brian Lehrer: Brian Lehrer on WNYC. Of the more than 200,000 Americans who have been killed by the coronavirus, no one has been more disproportionately affected than people who live and work in nursing homes. According to The New York Times' database, American nursing homes have had 7% of the cases, but 40% of the deaths. It varies wildly from state-to-state, including here in the tri-state area.

The Times' database says, "20% of all the virus deaths in New York have come in nursing home staff and resident populations. 43% of all the deaths in New Jersey and 73% of all the virus deaths in Connecticut have been among staff or residents of nursing homes." Now, with case counts rising again and with the possibility of an all-out second wave coming now that it's fall, has there been enough change at nursing homes and the nursing home policy to avoid another all-out disaster and keep people there safe from another wave of deadly infections?

I'm joined now by Richard Mollott, an advocate for nursing home residents and policy researcher who heads The Long Term Care Community Coalition. They focus mostly on nursing homes in New York State, but he could talk more broadly too. Thanks for coming on again, Richard. Welcome back to WNYC.

Richard Mollot: Brian, thank you very much for having me. Appreciate it.

Brian: First, is the Times' database consistent with your understanding of the cases and the death rates?

Richard: I would say yes and no. One of the big issues that we have is that unfortunately in New York, they only report deaths of residents that actually take place within the nursing home. If a resident was sent to a hospital, for instance, dodgedthat death and dies there, that death is not counted. We assume that New York is probably in-line with the other states that have about 40% of their deaths resulting from COVID.

I would just also quickly want to add that a major concern for the past several months has been the residents who are suffering and dying of neglect because they're just not getting the care. They're not dying of COVID, but they're dying because COVID has exacerbated long-standing issues.

Brian: Still looking back for the moment. How has the picture changed after the first few months? Once people realized the extent of what was happening in the nursing homes, the US is still currently having about 800 deaths a day. Do you know the percentage of the recent deaths, say, the last two months that have been in nursing homes? Is it still anything close to 40%?

Richard: My understanding is-- As you know there's a New York Times database, there are a couple of databases out there, including the CDC, every nursing home since May 8th has had to report its cases and deaths and suspected cases and deaths among both residents and staff to the CDC and [unintelligible 00:03:17] again report it to the public. We tracked that. We posted it on our website as well.

The numbers actually are pretty varying. That's why, again, even between the databases, that raises some issues in terms of accuracy but my rough guess would be that in states that are seeing or communities because we've seen that a couple of places in Upstate New York that are first being hit or are seeing a wave that it's probably consistent with that 40% or so number that we've seen, but in New York, for instance, which provides the death data, we've seen a leveling-off overall of cases over the past, I would say, a couple of months.

Brian: What's the lesson from that? What are people doing differently or better to create that leveling-off?

Richard: I think the leveling-off is just the result leveling-off in the community, the changes that have happened more broadly in the New York, New Jersey, Connecticut area, that we were hit here first in the country after the Washington State Nursing Home. It was really decimated, certainly decimated nursing home residents literally and many communities. I think just the factor of that and that time down, so to speak, has resulted in lower deaths, but it raises the issue that you raised at the beginning of the show that if we have a second wave and now we're heading to the flu season as well, that are we prepared for that? I would say to a small extent, yes, but largely, no and we're not prepared.

Brian: For example, you've written that Florida, Maryland, and some other states have begun sending what they call "strike teams" made up of people from state and local health departments, local health systems, and the National Guard even to assess the safety of both residents and staffs and where necessary take over management and provide medical treatment, testing, and supplies. Is that something you like or that states in our area have considered?

Richard: It's something that we have supported, but it's really important that those strike teams come in and ensure some accountability for the nursing home. It can't be that nursing homes just sit by and allow their residents to be decimated and then have someone else come in and take care of it and then walk away. It really has to be that someone's coming in.

One, of course, addressing triaging, those residents who are suffering or in danger, but also making sure that the facility itself has put in place lasting practices, lasting protocols et cetera, to make sure it doesn't happen again. If that had happened more broadly, I think I would feel much more comfortable about where we're heading in the next few months.

Brian: Listeners help us report this story. Do you work in a nursing home? Do you have a loved one who lives in a nursing home? Are you listening in a nursing home right now? Are things better? Is your nursing home or the one you're associated with, in some way, better prepared to stave off infections from the coronavirus and the resulting deaths that would certainly come as a result of people in nursing homes getting the virus at different rates and in the general population? Are things better now than they were a few months ago where you work or where you live or where a loved one of yours lives? Help us report this story. 646-435-7280. 646-435-7280 for Richard Mollott, an advocate for nursing home residents with the Long Term Care Community Coalition. 646-435-7280 or tweet @BrianLehrer.

One of the reasons we're doing this now, the news hook is that there's a new bill that would boost the number of staff members in nursing homes that's required. That's been approved in the New Jersey State Senate and Assembly. This is something that labor unions and elder-care advocates in the state have wanted for years. Unions and advocates always called for more staffing for whatever affects them. They want more members, the unions do and more staff to do necessary duties and better staff to patient ratios. Everybody wants that in their ideal world, but how would you describe staffing needs versus actual staff and their consequences in the past?

Richard: It's such an important issue. Staffing is key to quality care. Study after study has shown this over the academic studies, not just the union saying that or consumer advocates saying that. We know that to be a fact and we know, especially having both a CNA or nurse aid staff who provide 90% of resident bedside care as well as having an RN there, are both incredibly important indicators of the quality and safety of a nursing home.

Yes, everyone has called for more staffing. I think that the government has as well. It's been recognized as, I would say, the most serious deficiency or underlying problem in the nursing homeworld. The problem is that we don't really have a numerical staffing standard nationally so we have about 35 states now that have a minimum staffing standard and very glad to see. I think it's really critical that New Jersey is moving forward.

We've long been urging that in New York State, but the data indicate that about 75% of facilities don't have enough staff to even meet the basic clinical needs of a typical nursing home resident. When I say clinical, it doesn't include being careful with dignity, being treated like a human being, having appropriate activities, just to sustain their clinical well-being. Again, 75% of nursing homes in our country fail to provide that level of staffing.

Brian: There's that proverb, "The best time to plant the tree was 20 years ago. The second best time is now." That might ring true in this case, but why has this measure taken so long because I understand that some version of that same bill landed on former Governor Chris Christie's desk back when he was in [unintelligible 00:09:53]. Do you know why he didn't sign it?

Richard: Of course I can't speak for him specifically, but the nursing home industry is very, very powerful in our state capitals, especially here in New York and New Jersey, which are the wealthier states and more populous states, so that brings in a lot of money and it makes the nursing home industry, essentially an industry in those states. It's equally true, if not more so in Washington. We have, unfortunately, from my perspective, at least, a lot of lobbying voices that are constantly contributing to politicians and making sure that their interests are put forward or sustained in policy debates like this.

When it comes to caring for residents, the staffing is the most expensive portion of that. Unfortunately, as I said, it's the most important, but it's also the easiest to cut. For instance, you couldn't put two residents in a single bed and cut down on your mattress supplies and your sheets, but you can cut out an RN on a shift and do that without any repercussions because of the lack of enforcement nationwide, and especially in our states, but also because of lack of those numerical staffing standards.

Brian: Our lines are full. Let's talk to some callers. We have a doctor, a geriatrician calling in from Manhattan. Jeffrey, you're on WNYC. Hello, doctor?

Dr. Jeffrey Farber: Hello, Brian and Richard, thank you.

Brian: What would you like to add?

Jeffrey: I'm Jeffrey Farber. I'd love to contribute a perspective here like Richard, a lifelong nursing home advocate. I'm a geriatrician for 20 years now, dedicate my career to helping older adults. We run a non-profit health system that's 172 years old. That's been in our location here on the Upper West Side in Manhattan since 1883. We've been working diligently throughout these past six, seven months, doing everything we can to fight this pandemic. I just thought it'd be helpful to share a perspective on some of the things that we do that I also think position us very well for a second wave of infections, which I think it's probably already started here in New York City.

One is just to be clear, what we do now is we've done and yesterday I had my 21st COVID, nasal pharyngeal swab test. We've done over 23,000 tests of our employees. We're currently testing every week. We've also procured, largely on our own, all of the PPE that's necessary to safely care for patients and protect our workers. We have well over a 60-day supply on hand of all necessary elements. We've been working 24/7 on connecting our loved ones. We recognize as Richard said, how incredibly powerful and I think this is underappreciated out there, the difficulty of the isolation without visitors has been.

In Manhattan alone, we've done over 4,500 video visits. We started doing window visits. Very recently, thankfully, because of the somewhat more supportive guidance from the state with a two-week timeframe, without having any employee or resident test positive, we've been allowed to have visitors back in which has been a real dream come true for us and our residents.

We do services, we broadcast things, residents in their rooms can participate in those. In terms of COVID and what's happened here, we haven't had a case in a couple of months. I think the large part of it is what's reflected by the community prevalence. I do anticipate, as I mentioned, that we'll probably see a second surge that's already starting and we recognize in the days ahead.

Brian: Richard Mollot, you want to talk to Dr. Farber about any of the protocols that he's describing or the issues that he raised?

Richard: I think everything that you're saying sounds really good, and along the lines of the things that we've been recommending, from the start, ensuring safe visitation. It's a shame, I think, that the federal government and to some extent the states are our responsibility here as well, but particular federal government didn't provide better access to testing and to PPE for nursing homes. I think, again, that exacerbated a lot of the issues that nursing home residents were facing.

I just want to quickly add that I'm very glad to hear about some of the things that you've undertaken. One of the issues from what we've seen, what our research has shown is that the nursing home industry is more and more operated by for-profit and doctor, I think is running a not-for-profit and the for-profits, again, without any kind of requirement or meaningful requirement for staffing and putting money into resident care as opposed to profit, without that clear guidance and requirements around that, there are too many for-profit facilities especially are diverting the money that they're getting away from resident care, and so they may not be following the protocols that you are.

Brian: Doctor, thank you very much for calling in. Listeners if you're just joining us, we're talking with Richard Mollot from the Long Term Care Community Coalition about whether with a second wave of coronavirus possible, nursing homes are better prepared than they were during the first wave. The staggering statistic from The New York Times database as of a couple of weeks ago, 40% of all the coronavirus deaths in America have come in nursing homes. Carol in Bergen County. You're on WNYC. Hi, Carol.

Carol: Thank you so much, Brian. As I always say when I get through, you are a treasure and your show is a treasure. I'm going to have to directly argue with Dr. Farber as I was an intern in his home earlier this year and late last year. What I found when I first got there was a facility that was old, and there's nothing wrong with old, but not clean.

Brian: You're talking about the same facility that our previous caller works at?

Carol: Yes, Dr. Farber's facility. That's where I did my fellowship internship in my academic program. What I found was a facility that is old, and old is not wrong. Old is perfectly viable. I'm old and we care for old people, but not maintained is an issue. I think this gets back to something. This is more than just PPE and handwashing. A facility that is not maintained and clean, is a facility that can be open to infection. When bathrooms are not cleaned enough, when elevators are not cleaned enough, when the facility is not working properly, these are all issues that are very important and do not get enough research, both quantifiable and qualifiable, and enough attention. This was, in fact, something that greatly distressed me about this facility. I only noticed and I was going to talk about this generically, but Dr. Farber got on the phone before me.

What I noticed was that between the beginning of my internship and when my internship ended, because of COVID, that there was a complete change in how the place was cleaned, but when I first got there, it was not unusual for me to go into residence rooms and find that they were not clean; the floors were littered with medical debris and things like that, but the bathrooms were not clean for staff.

These are all really important things. If we're going to control such an infection, and if we're going to control infection in senior housing and in senior nursing homes, then we have to look at how we put people in these facilities. Is the airflow working properly? That means heating and air conditioning. Do the windows open? If they don't open, is their a source of alternative air? Is there enough staffing of everyone involved, and it's more than just the CNAs? It goes down to having the correct number of janitorial services available.

I'm aware that the majority of nursing homes in this country work with Medicaid and Medicare. I know that Medicaid reimbursement is some of the lowest around, but if we are going to honor old people, and if we are going to have nursing homes, whether they are for-profit or non-profit, then the basis has to be cleanliness. You can wear all the PPE you want--

Brian: Carol, let me get a response from our guest. Obviously, I should say, we're not equipped here to vet whether an accusation against a particular facility is accurate or not, or whether the denials that I'm sure would come are accurate or not, but the caller says what she says. Richard, to the generic issue that she's raising or set of issues there, having to do with cleanliness and ventilation and so forth, what would you say and do you think there's been a curve in general of places rushing to get their act together in these respects since COVID hit?

Richard: Again, and as you said, Brian, of course, I can't speak to a specific facility either. I think what this caller is saying is spot on. These are the issues that relate to infection control and prevention directly and that includes having appropriate protocols in place for how sheets are clean, how food is handled. There are and has been some really interesting reporting on the last several years looking at how many residents die or get sick just from inappropriate food handling. Of course cleanliness, sanitation are incredibly important.

One of the biggest issues I would say right now and the reason why I don't feel very confident about how we can handle this in the future is that we have not held nursing homes accountable for improving their protocols for infection control and prevention and that [unintelligible 00:20:30] include the cost, excuse me, it would include making sure that they're clean, making sure that they are sanitary.

These are such basic issues. Just to be fair, I attend a lot of the programs that are provided for nursing homes at this time to help address the COVID-19 issues. It'll come back to the same thing; hand-washing and sanitation as this caller is saying. This is basic stuff. This is stuff people learn when they're five years old; you go to the bathroom and you wash your hands, that you, of course, sanitize things that are dirty before you insert them into someone's body or have them come in contact with vulnerable individuals, but nursing homes aren't doing them. The problem is fundamentally is that nursing homes are not held accountable for meeting the minimum standards of care and safety because all these things that the caller talked about are addressed in the standards. The standards are just not enforced.

Brian: You had written a New York Times op-ed way back at the end of April that said the most important precautions against infection are inexpensive and simple and the most common violations involve simple sanitation and hygiene practices like hand-washing and that those were the most frequently cited violations in nursing homes last year. Even before the pandemic, there were problems with infection control and prevention at nursing homes across the country. I guess, the difference is without the pandemic, they weren't getting this attention.

Richard: Exactly. Exactly.

Brian: Let's take at least one more. Let's see. How about, Jacquelyn in Pompton Plains. Jacqueline, you're on WNYC. Thank you for calling in.

Jacqueline: Thank you very much. I have a different point. I live in a non-profit community in Erickson community and I must say I'm very lucky to be able to afford it. I don't know where I would be or where my husband would be if we weren't able to afford it. The Erickson community has handled the endemic very, very well. We're very fortunate. We had relatively few cases and the difference between those who have and those who haven't, make it a life and death issue.

Brian: Jacqueline, thank you very much. I'm going to go on to Carolyn in the East Village who, I guess, I should say first because she told our screener, lost her dad, and has another take on some of this. Carolyn, first of all, welcome to WNYC. If I understand what you told our screener correctly, I'm so sorry for your loss, and thank you for calling in.

Carolyn: Oh, yes. I also told the screener I might get too emotional to talk, but-

Brian: It's okay.

Carolyn: -I would love to express a couple of things which is, of course, as everyone says, Brian, yay for you and your guests as well. I definitely feel like my dad died from the isolation and he was in Long Term Care. I really wanted to get him out and then take care of him myself. That could go for a really long story.

To try to make a long story short. He was a huge person who believed in rehab and healing and he couldn't even get a walk a day. They weren't able-- I feel like the staff-- It was a good place. The staff was just really overextended. They couldn't give him even a simple walk for sure every day. The week he died, they couldn't accommodate a Zoom. After months, he was allowed a 20-minute visit with a family member, one a week with all the social distancing and stuff, which I understand and they needed to keep their masks on.

Once in a while, my mom would sneak a peek of her face so my dad could see her smile but depending on who is the chaperone, they could get in trouble or some people who worked there had hearts of gold, but some people were mean and were mean to me as well, trying to be his advocate. I know that everyone's overextended and they need to have certain limits and protocols and stuff, but the isolation-- He even had in his belongings this article from The Boston Globe about the trouble with isolation in nursing homes.

I know that that was a huge component and that if he had more love in there and more contact with family and more things he could depend on. Even his newspapers, some days he wouldn't get his newspaper, which was another lifeline to him. When he would ask for it, one day someone threw it at him, and slowly he was being cut-off from all the things he loved.

I have to look at it in a big picture. I don't know why he had to experience this and why this had to be the way his end of life for the family but I hope that there are some lessons there, especially concerning exactly what you're talking about that level of isolation. If there's some way that we can get through and have more contacts and more love given through the gowns, through the masks because that is so dangerous for all of us really, to be isolated. Anyway, thank you for letting me stumble through that, and thank you for your show and all of your everything.

Brian: Carolyn, thank you so much. You did much more than stumble through it. Richard, is there a policy response here? I hate to go right to a policy question from such a human tragedy as that and Carol's individual story and Carol's courage, frankly, for calling up and telling that story on the air and public, but I could tell she did that because she wants to save other people's lives from isolation in the ways that she was describing contributing to their declines.

Richard: There is and I want to express my condolences as well. Unfortunately, a lot of the stories that I've heard as I think I mentioned earlier for several months, I would say personally from mid-April on, it was more calls about the impact of neglect on nursing home residents. I was hearing from family members and from people who work with them as well as just the-- What would one death [unintelligible 00:27:32] called the failure to thrive due to COVID-19 isolation. It is absolutely heartbreaking, but there are policy answers.

One thing that we're telling people to do is to contact their state and federal legislators and let them know that this is important to them, but there are some bills that, as you noted before, New Jersey has really moved on some bills to, I think, be very progressive in terms of ensuring that nursing home residents are protected and that we get the quality of care to which every human being is entitled, of which we pay, whether it's Medicare or Medicaid. Yes, there are different rates, but that's what nursing homes accept when they voluntarily participate in those programs and become licensed nursing homes.

That is really important. We're all entitled under the federal rules to the same quality of care and treatment with dignity and services that are tailored to our needs and our desires. As I've been telling people, we started doing some trainings on this, just because of a story such as Carol's that are so heartbreaking is that there have been a number of rules that have been relaxed by the Trump administration and even more so under COVID-19 and the pandemic, but that quality of care, the right to access to treatment with dignity, to the services that you need to maintain your psychosocial well-being as well as your clinical well-being, those have not gone away. They're still there.

The problem is that the states haven't been going into nursing homes the way they normally would, just when residents needed the most, the federal centers for Medicare and Medicaid services told the states to pull back and not do regular surveys. Now that's coming back into effect. They reversed that on the federal level but it doesn't address the long-standing issues in respect to failures to enforce basic standards of dignity of quality. What we saw here was it being, as Carol's dad experience, it being exacerbated by COVID-19. There's just no excuse for that.

Brian: There's so much more we could say. We've talked mostly, for example, about the residents of nursing homes, but providing care at nursing homes is extremely demanding work. It is staff as well as residents who've been dying at disproportional rates compared to the rest of the population and for Certified Nursing Assistants, CNAs, in particular, the pay isn't great. To make it even harder, staff are at greater risk for infection too. The CDC has confirmed that. This is an issue that's a workplace issue and we know who nursing home staff are disproportionately so it's a disparity issue as well. It's a people of color issue. It's a women versus men issue.

All the disparities that we've been talking about throughout the pandemic. You put a microscope on a nursing home and you're going to see every single one of them there. I want to thank you for your work, Richard Mollot, an advocate for nursing home residents and a policy researcher who heads the Long Term Care Community Coalition. Thank you for joining us.

Richard: Brian, thank you very much. I appreciate it.

Brian: This is WNYC FM HD and AM New York, WNJT FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are in New York and New Jersey Public Radio, where it's time for the latest news with Kerry Nolan. Hi, Kerry.

Kerry Nolan: Hey, Brian. It's 69 degrees and sunny in New York City and here's what's happening. More than 92,000 people in New York and New Jersey applied for unemployment last week, a slight decline from the previous week. The US Department of Labor says more than 66,000 people in New York filed claims, a 4% decrease, and more than 26,000 people did so in New Jersey. That was a 6% increase. New York saw an uptick in people applying for benefits mid-September due to layoffs and food services and construction. About 837,000 people across the country filed for unemployment last week. The New York City Board of Elections is under renewed scrutiny after about 100,000 Brooklyn residents received mislabeled absentee ballots. WNYC's Brigid Bergin reports the board is blaming the problems on a printer error.

Brigid Bergin: At their weekly public commissioners' meeting, they addressed the situation. They put the blame squarely at the foot of a print company called Phoenix Graphics. BOE executive director, Mike Ryan said this error appeared to be isolated to Brooklyn and only impacted one print run of ballots but the number is still eye-popping, about 100,000 people may have received these misprints out of 140,000 ballots gone out in the borough so far.

Kerry: The BOE says it will send out new absentee ballot packages to all affected voters. New Jersey State watchdog says staff in the governor's office were in close touch with an official accused of hiring relatives and friends while she led the state's Schools Development Authority. The State Commission of Investigation said it found frequent communication between the former CEO of the agency and members of Governor Phil Murphy's staff.

Lizette Delgado-Polanco resigned as the agency's chief executive in April of 2019 following reporting in The Record newspaper that she improperly hired relatives and friends to agency positions for which they were not qualified. Murphy declined to comment on the report. Some New York City restaurants began serving customers indoors for the first time in more than six months. Nidia Marino is a manager at Mezcal's, a Mexican restaurant in Brooklyn.

Nidia Marino: It's really nice going back to normal kind of situation. We're going to see how it goes. We're just starting today and we just got to go day by day.

Kerry: Restaurants are allowed to open indoor dining at 25% of their normal capacity. They'll also have to take customers' temperatures and collect diners information to provide to contact tracers in case someone on-site later tests positive for the coronavirus.

The Yanks are moving onto the playoffs in record-breaking fashion. They beat the Cleveland Indians 10-9 last night to win the American League Wildcard Series. The game was the longest nine-inning game in major league history at four hours and 50 minutes, and that's not including two rain delays that totaled 76 minutes. The Yanks will now play the Tampa Bay Rays in a best of five division series in San Diego starting Monday.

We'll have sunny skies for the rest of today with highs in the mid-70s clouds rolling tonight. We have a chance of showers after midnight and lows in the mid-50s and a cloudy start to your Friday with a chance of showers then turning partly sunny with highs in the mid-60s. Right now 69 degrees and sunny. That's the latest from the WNYC newsroom. I'm Kerry Nolan.

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Brian: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Now we continue our election series 30 Issues in 30 Days. We're up to issue nine: Climate Change and Energy. Now climate, it was one of the official topics at Tuesday night's debate, but they only spent a few minutes on it. What there was has been pretty much drowned out in the post-debate media coverage, with all the focus on the chaotic tone of the debate and the president practically soliciting armed militia groups to stand by in the streets, but it was there.

Let's hear some of what the candidates had to say and get some fact-checks and analysis with Time magazine energy and environment reporter, Justin Worland. He also has an article about Amy Coney Barrett and how she could affect climate policy if she's confirmed for the Supreme Court. Justin, thanks so much for doing this. Welcome to WNYC.

Justin Worland: Thanks so much for having me on.

Brian: Let's start with a clip of Joe Biden. This begins with a question from the moderator, Chris Wallace.

Chris Wallace: You propose $2 trillion in green jobs. You talk about new limits, not abolishing, but new limits on fracking. Ending the use of fossil fuels to generate electricity by 2035 and zero net admission of greenhouse gases by 2050. The president says a lot of these things would tank the economy and cost millions of jobs.

Joe Biden: He's absolutely wrong, number one. Number two, if in fact, during our administration in the Recovery Act, I was able to-- I was in charge, able to bring down the cost of renewable energy to cheaper than or as cheap as coal and gas and oil. Nobody's going to build another coal-fired plant in America. No one's going to build another oil fire plant in America. They're going to move to renewable energy, number one. Number two, we're going to make sure that we are able to take the federal fleet and turn it into a fleet that's run on their electric vehicles. Making sure that we can do that, we're going to put 500,000 charging stations on all of the highways.

 

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