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Brian Lehrer: Brian Lehrer on WNYC. This month nursing homes are experiencing another surge in COVID cases and deaths nationwide and the disparate impacts that these facilities have been felt all through the pandemic. A report by the conservative Empire Center for Public Policy based in Albany says that between October 25th and November 29th, so just recently, nursing home residents accounted for a quarter of all COVID 19 deaths across New York state, despite making up less than half of 1% of the state population.

Why is this happening again? Didn't we get this right? Why didn't we get this right after the spring? A vaccine, of course, is seen as the light at the end of the tunnel. And it's here in New York. Vaccinations have begun for residents and staff at long-term care facilities, but New Jersey well, they'll have to wait another week.

The state didn't file the paperwork in time to get the vaccine to residents and staff at long-term care facilities this week and Governor Murphy is getting heat for it. With me now, to talk about the difficult situation yet again, in New York and New Jersey nursing homes is Richard Mollot Executive Director of the Long Term Care Community Coalition. Richard, thanks for coming on again. I'm unhappy that it's necessary, but welcome back to WNYC.

Richard Mollot: [laughs] Brian, thanks so much for having me appreciate it.

Brian: First on this New Jersey story, do you have a good idea of what happened with respect to that one-week delay in getting vaccines to nursing homes compared to what it could have been?

Richard: I saw the report online earlier this morning. I do want to be fair, excuse me to the governor and so I would be hesitant to comment on that.

Brian: All right. That report I mentioned from the Empire Center think tank saying that New York nursing homes are still acutely vulnerable, their words to the deadly COVID 19, and those stats I'll repeat them and ask if you think they reflect reality they come from one think tank with a political bent, but nevertheless, 25% of all the recent deaths in New York state in nursing 4homes when they represent only one-half of 1% of the state population. Does that sound about right to you?

Richard: I think that's actually a significant underestimation of the-

Brian: Underestimation?

Richard: Yes, unfortunately, obviously. New York, for some reason has not reported the deaths of residents that take place outside of the nursing home, so we've always been concerned about as have many legislators, as a matter of fact, be concerned about the under-reporting of deaths of resident due to COVID directly, but also there's a significant number of deaths of residents that are just from, I shouldn't say just but are the results of neglect or failure to drive isolation that there's-- one study found that actually every two deaths directly related to COVID, there's another death of a resident due to neglect or substandard care.

Brian: How did we get here? Because everybody knew by the middle of the spring that nursing homes were particularly vulnerable. How are we having such a large percentage of the COVID deaths take place there again? Why couldn't they be protected?

Richard: Just like at the beginning in March, April, and May, it's honestly a failure at every level, a failure of the nursing homes to take their responsibility to their residents and their staff seriously. It's a failure of the state to enforce just the essential standards for nursing home care and then it's the failure of the federal government to hold New York state and the other states accountable for doing it.

We come to the early winter now of 2020 and what we're seeing, it's a failure on top of failures to learn the lessons and to enforce the rules to make sure that facilities-- we knew there was going to be a second wave and we were pretty sure the experts were saying that, and there's just been virtually no preparation and even-- not to move ahead, but even in terms of the vaccine, there's been virtually no preparation to enable people to make informed decisions about it. It's just constant ignoring, frankly, of this tragic situation.

Brian: Are we seeing race and class disparities rear their heads in terms of nursing home outcomes?

Richard: Well, we always do. I think that just as with the way that this was so catastrophic for so many residents and their families from the very beginning of the COVID pandemic, we have always had really significant underlying racial disparities, both for the residents who are most affected by poor care, by low staffing, and by the care staff, most of whom are people of color, most of whom are women, et cetera. Yes, I think that the ramifications or the amplification of the problems in nursing homes that we've seen so tragically, again during the COVID pandemic has been exacerbated for those communities without a doubt.

Brian: Listeners help us report this story, if you work in a nursing home, we want hear from you, report on conditions there and barriers that you may see to COVID safety. If you have a loved one in a nursing home, same thing, call and report on what you're seeing that may be better than in the spring maybe not 646-435-7280. If you're a resident of a nursing home, and you're listening to the show right now, same thing, 646-435-7280, 646-435-7280. On prevention, on vaccine distribution, or anything related for Richard Mollot Executive Director of the Long Term Care Community Coalition or you can tweet a question @BrianLehrer. Let's take a phone call. Cheryl in Irvington in Westchester. Hello, Cheryl, you're on WNYC.

Cheryl: Hi, Brian. Good morning I'm calling because my mother is in a nursing home in Great Neck in Long Island with dementia. Regarding the vaccine priority for nursing home residents, we were, of course, elated to know that they'll soon be vaccinated, the residents, but in the interim, it's been very hard to get information about when the vaccination will be taking place.

I know they're saying before the end of the year for the first dose for nursing home residents, but I have to say it's dozens of calls and emails to actually find out any concrete information about it. In the interim, her nursing home has already nine reported cases. I say reported because in the spring there were 26 reported deaths, but if you died in the hospital, it wasn't counted as a death.

I think the numbers-- we all have to look at the numbers and the data and make our own assessments about it. We're very thankful for the priority for nursing home residents, but my sister lives in Florida and so I'm very attuned to what DeSantis is doing in Florida and he put out a list of all the facilities that will be getting the vaccine.

He started last week instead of this week I just think we could definitely do better. I think DeSantis has his own data issues and certainly there's been challenges. I'm not a fan of DeSantis, but I just think we need to-- in New York it's a very vulnerable large community. A little information would go a long way because we're really in a race against time.

Brian: Cheryl, thank you, Richard, can you help her with respect to getting vaccine information for her mother, in particular, and to the larger point?

Richard: This is an issue that we've seen as Cheryl noted throughout the pandemic. What I've generally been recommending to people is to call your local legislative office, either congressional office or state legislator, because they can push the facility or they can push the department of health to get some information too, but it really, it does come from the facilities. It is governed by the department of health and we see that the ball has been dropped here, a number of times as Cheryl noted, as I mentioned earlier and so to get the information, I tell people, "Push some buttons and see if that can help."

Brian: Cheryl, I hope that helps. Thank you very much for your call. This might be an oddity and an anomaly. I wonder if it's any pattern that means anything. A friend of my parents wrote them an email about her mother in a nursing home in Connecticut and I can't vouch for the accuracy of this, but this comes from someone who works as an editor so I think she's generally attuned to facts and she said her mother's nursing home has 30 residents, 22 of them recently tested positive, but they were all asymptomatic. Assuming she got her facts right, is that unusual?

Richard: I'm not a clinician, but I would say that it does sound unusual. I have heard of residents who are aged and in a medically compromised as residents often are, who were asymptomatic, but for the most part older adults, especially people who have multiple comorbidities tend to have symptoms, but I guess it is possible. We're hearing from Britain now about different strains, the ones in Britain, of course, being more virulent but again, I'm not a clinician, but I'm wondering if maybe there were less virulent strains as well.

Brian: Katie in Garden City you're on WNYC with Richard Mollot. Hi, Katie.

Katie: Hi. How are you?

Brian: Good. How are you?

Katie: Thanks for taking my call. It's an adjacent issue, but I just wanted to bring up as we're talking about the people that are struggling in nursing homes the many people that have significant disabilities that are supported by state funding as the nursing homes with Medicaid that are in group homes.

The group homes, at least, we haven't seen the statistics recently of the number of deaths, but the budget cuts have been huge from the state. The day programs have been pretty much closed so these guys that are varying ages and varying disabilities have been home since March with minimal to no-day program at all. The funding is continually cut. Initially, they were not included in the vaccines with the other long-term care facilities, but they're living in long-term care facilities, and the governor's cutting back and cutting back and cutting back. Honestly, there's not a lot of press about it.

Brian: Richard, are you familiar with this?

Richard: I'm very familiar with this. This has to me been the biggest underlying issue since early March. What I worried about most when I talked to people about it, of course, nursing home are residents are extremely vulnerable, but you have a population in adult care facilities ranging from assisted living to group homes of people who also are very vulnerable, but who are not included in the general system of even tracking the data, even having any standards around who's providing care, who's overseeing your care. In a nursing home, they're supposed to have an RN every day and the RN is the only one who could provide a resident assessment to see, is the person sick?

You don't have that in most assisted living or group homes and so who's there? Then the same thing with activities, nursing homes, they have to have activity staff, even though we're seeing that a lot of them are not fulfilling that. At least, we know those data and we can present that to policymakers and say, "Look, this is what's going on in the living adults homeworld." We just don't have those data. We don't have even information about past violations and so it's very hard to protect those individuals and to provide them with the services, the resources, and the support that they need.

Brian: Katie, thank you for that important call. Norah, on Staten Island you're on WNYC. Hi, Norah.

Norah: Hi, Brian. How are you?

Brian: I'm okay, how about you?

Norah: I'm good. Thank you. I twice was a resident in two different nursing homes in the therapy department for recovery from orthopedic surgery and in both situations, I noticed that they are greatly understaffed. My personal opinion, the reason is because they have under law the right to be a profit-making organization. I think that's the solution. The law has to be changed to require that all medical facilities are non-profit

Brian: Norah, thank you. Are you finding in your research and your monitoring as an advocate a difference between for-profit and non-profit nursing homes in COVID respects?

Richard: In COVID respects, we don't have the data, to be honest yet to track that very carefully. Part of that is we started to do that over the summer. Again, because for New York State, they just weren't publishing those data in a way that's accurate. For instance, just very quickly, we don't know how many nursing homes sent residents to the hospital to die and therefore we can't really judge how many based upon the published death rates, what the outcomes were.

We've seen for years and I agree with the caller that the for-profit nursing homes, they tend to staff less, they put less money that they receive in public reimbursement, Medicare, Medicaid, they put less of that money that they receive into care than do the non-profit and the publicly-owned facilities. It's a significant issue and it's a growing issue as we've seen the for-profit sector grow in New York and across the country.

Brian: Do you agree with her that there should be legislation requiring that all nursing homes be non-profit?

Richard: I think that's a possible, I wouldn't say solution, but I think that it's a potentially good step. We have not-for-profit hospitals here in New York only for-profit hospitals, and they're not necessarily providing great hospital care. I don't know if it's a panacea. I think what we're really looking at is making sure that whether you're for-profit or not-for-profit that you are putting a substantial amount of money into providing resident care and that's something New Jersey did.

New Jersey has really been a leader in the country in this regard since we all got hit by the pandemic here in March, April, May, and June, that they passed and the governor signed into laws, a requirement that a certain amount of money has to go to resident care and that is, I think, will make a profound difference going forward, whether it's for-profit or not-for-profit.

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 as we have a few minutes left to talk about New York and New Jersey nursing homes. Again, seeing COVID spikes this fall with Richard Mollot executive director of the Long Term Care Community Coalition, which advocates for nursing home residents and staff.

I have a question about treatment of nursing home patients who get COVID, the treatment that President Trump got when he started developing symptoms, those polyclonal antibodies, as I understand it, they are supposed to help keep mildly symptomatic people, especially older ones at risk of severe disease from winding up in the hospital or worse. The president called it a miracle. Are those antibodies being given routinely now to people who get COVID in nursing homes?

Richard: Not that I'm aware of. I haven't heard that at all frankly.

Brian: I'm curious if there's a movement, even something that you might take on as an advocate to get polyclonal antibodies to everyone who needs them.

Richard: That's a very interesting idea. Thank you. Again, my understanding is that it's pretty rare. We know that members of the president's cabinet and his advisors like Rudy Giuliani got it, I believe and the former governor of New Jersey got it, but I've not heard them widely use. Again, I'm not a clinician, I'm a policy advocate, but I think that giving people the best care possible is obviously central to our mission.

Brian: I don't want to get ahead of the science. They call that an experimental treatment as it is so I don't know how proven it is, but if it is proven, then it seems to me, there should be a movement to get polyclonal antibodies to everybody who gets sick with early COVID symptoms in nursing homes now. I'm just throwing that out there since it seems to be particularly useful for people who are elderly and at risk of severe disease from the reporting that was around at the time of the president's hospitalization. All right, one more call Catherine in New Rochelle you're on WNYC with Richard Mollot. Hi, Catherine.

Catherine: Hi, Brian, thank you so much. Happily, somebody asked one of my two questions which was the whole thing about proprietary versus not-for-profit nursing homes, which is an area I think really needs to be looked at much more closely. My other question is about the staffing and the necessity of shift changes because any nursing home has multiple people in the course of a week coming in and out, and you can do all the testing you want as we all know, a test tells you that you do not have, or do have Coronavirus right now.

It doesn't tell you anything about what's going to happen tomorrow or the next day. The nursing home that I'm most familiar with which is where there's someone whom I'm responsible for, and they're doing very well test all its employees once a week and that's wonderful. That doesn't tell you anything about the day after that people are tested. It's a very difficult problem. I don't know how you work to solving that. I see the shift changes as being part of the problem here.

Brian: Richard?

Richard: Of course, you're right about the testing. I think what's most important is that we know how to prevent the spread of the Coronavirus. We know using mask, we know handwashing is important. One of the things that has been most personally upsetting to me over the past nine months is that too many nursing homes, not all of them, but too many of them are still not undertaking the basic protocols ensuring that the staff are washing hands, ensuring that there are sanitizing equipment, ensuring that they are using mask appropriately.

This is really basic stuff that any 10-year-old would know all those things and a five-year-old would know most. We are not holding nursing homes accountable. That's what I mentioned before. What has been so concerning when Brian asked me about why are we seeing a second wave of these proportions is because we never held the nursing homes accountable for meeting basic r and prevention standards.

That would make a huge difference no matter who's coming to the facility. I think I should say that one of the biggest concerns we hear is family members who have been locked out from their residence for nine months and growing now. As I mentioned to Brian, before, how many residents are dying, not from COVID, not even from the substandard care that we're hearing about, but from loneliness, from failure to thrive due to COVID isolation? That's really unforgivable.

Brian: Last question, Richard. The disproportionate toll of the Coronavirus on nursing homes has damaged people's image of those facilities. A headline in the Wall Street Journal reads, "COVID spurs families to shun nursing homes. A shift that appears long-lasting." Of course, we don't know long-lasting once this virus year era ends, but maybe it will be because people will be afraid of the next thing. Is that something you're worried about or should be worried about?

Richard: Well, it's something that I'm not worried about. I'm actually glad about. I think that one if you can avoid nursing home care, and this is for both long-term care and for rehab. Rehab is not a panacea as many people think for getting better care as that lady said, even when you go into rehab, the staffing can be very short. There was an excellent report a couple of years ago, from the Office of Inspector General for HHS which found that one out of three people who go to nursing home from rehab are harmed within an average of two weeks.

Just utterly astounding. We've had a lot of wake-up calls, but those of us who work on these issues and then I think this was a wake-up call for the general public and hopefully, for our leaders that we need to make a change in the industry as one caller said today, moving away from the profits hearing, but also to have more accountability, and to have other model.

Brian: On that staffing just as a quick follow-up. If we assume that it's primarily staff who are going home to the outside world bringing in the virus, tell me if you think that's a correct or wrong assumption, is there and should there be mandatory pretty tight rotation testing of nursing home staff considering the vulnerability of the residents?

Richard: I think that's right. I think what we're seeing, and again there's been a number of studies out and they're getting better and better as we have more data. Generally, we think that it is largely coming from staff and that makes sense. Who else is coming in and out of a nursing home now to such a high degree? I think that again the testing is not perfect even if we did it every other day.

I think that it really comes down to being smart about staffing, being smart about staffing patterns, paying people hazard pay so they're not doing other jobs on the side, and really fostering a stronger dedicated staff that has consistent assignment within the facility, all the things that we and other researchers have known about for years.

Just again, getting to what the last caller was talking about changing the model, moving away from the for-profit, do what you please nursing home model that we've had for too many years now to something that really holds providers accountable for what we're entrusting them with which is a very vulnerable population.

Brian: Richard Mollot, is executive director of the long-term care community coalition. Thank you for your work and thank you for coming on with us again.

Richard: Brian, thanks so much. You have a happy holiday and New Year.

Brian: You too.

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