00:00 Thank you, Mr. Chairman.
00:01 Mr. Secretary, it's good to see you.
00:04 As you may know, I spent nearly three decades in health care
00:07 as a therapist, rehabilitation services manager,
00:10 and a licensed nursing administrator
00:14 prior to being elected to Congress.
00:17 I served patients from rural communities
00:20 throughout central Pennsylvania during that time.
00:22 And I learned the unique barriers
00:23 these communities face in accessing
00:26 quality, affordable health care.
00:29 While I appreciate your stated goals of expanding coverage
00:31 and access to care that you detailed in your testimony,
00:36 your agency's recently finalized rule
00:38 establishing minimum staffing requirements for nursing homes
00:42 seems to lie in the face of these goals.
00:46 Mr. Secretary, do you believe that nursing homes
00:48 across the country today have enough staff
00:51 to meet their current needs?
00:55 Congressman, first, thank you for the work
00:57 that you did in this space, because it's
00:59 essential for so many families.
01:01 There's obviously something going on within the nursing
01:03 home industry, where while they represent about one less than--
01:09 about one third of 1% of all Americans
01:11 living in nursing homes, when COVID hit,
01:14 we saw 20% of people dying living in nursing homes.
01:19 That disparity shows that there's something going on.
01:22 Mr. Secretary, I will say that was
01:23 because one of the huge contributing factors of that
01:27 was bad policy by governors, like my former governor, who
01:31 required the readmission of nursing home residents
01:36 diagnosed with COVID back into these populations.
01:42 Many of these people died as a result of bad public policy
01:46 that was put forward.
01:47 So I mean, but getting back to my original question,
01:52 do you believe that nursing homes across the country
01:56 today have enough staff to meet their current needs,
01:59 yes or no?
02:00 I believe that too many of these long-term care facilities
02:04 are not providing the staffing.
02:05 In fact, the comments we received to our rule
02:08 made it clear when people are talking
02:10 about having five CNAs, Certified Nurse Assistants,
02:15 available for 55 residents, clearly that's not enough.
02:19 When people are talking about a resident had a stroke
02:21 and was on the floor for more than 15 minutes
02:24 because it was breakfast time, not enough staff knew,
02:27 and it wasn't until they were collecting the food trays
02:30 that they discovered there was this person on the floor who
02:32 had suffered from a stroke, clearly there
02:35 are not sufficient numbers of qualified people.
02:37 Obviously, I keep close contact, obviously,
02:39 having worked with older adults and specifically
02:42 in many different capacities, including, I think, perhaps,
02:45 the only former licensed nursing home
02:47 administrator between the House and the Senate.
02:49 I may be wrong about that.
02:51 But I think that may be accurate.
02:53 It's certainly not what I've heard from nearly
02:54 every provider in my district.
02:56 So I would encourage you to engage with these providers
02:59 more closely to learn about current conditions
03:02 on the ground.
03:03 It's important for federal agencies
03:05 to engage with local providers and stakeholders.
03:08 And I would encourage you to do more of that, certainly,
03:11 in the future.
03:12 According to your department's own estimates,
03:14 under the proposed staffing minimums,
03:16 nursing homes around the country would
03:18 need to hire nearly 13,000 registered nurses and 76,000
03:23 nursing assistants.
03:25 That's actually where I started my career,
03:27 working as a nursing assistant as I worked my way
03:30 through my undergraduate degree.
03:34 Can you certify here today that not one senior
03:36 across the country will lose access to care
03:39 as a result of this proposal?
03:42 Carson, what I can certify is that if one single American,
03:47 your loved one, my loved one, is going
03:49 to go into a nursing home, we're going
03:51 to try to make sure that they are provided with safe,
03:53 quality care because there will be the staff necessary
03:56 to provide that care.
03:58 But in terms of access, having available facilities
04:00 that are still open is an incredibly important part
04:03 of that.
04:03 Do you believe that nursing homes in rural areas that already
04:06 face staffing shortages will be forced to close their doors
04:10 or drastically reduce the number of seniors
04:13 that they serve if this minimum staffing mandate takes effect?
04:17 The rule takes into consideration
04:19 rural health facilities, nursing home facilities,
04:22 as well as smaller nursing home facilities.
04:24 We provide them with a longer transition time
04:27 to adopt these new rules.
04:28 We also provide them with a hardship exemption.
04:31 They can show that it would be tough for them
04:33 to meet the standards.
04:34 They have more time.
04:35 So we've listened to a lot of the facilities,
04:39 and especially those in rural communities
04:41 and those that are small.
04:42 So in terms of listening, how do you
04:43 expect nursing homes to pay for the cost of implementing
04:46 this rule, which your agency estimates
04:49 will cost between $1.5 billion to $6.8 billion
04:53 to fully implement?
04:56 Congressman, the way I ask the question is,
04:58 what kind of operation do you have now
05:00 if you're saying you don't have the people you need to take
05:03 quality care, to provide quality care to the people who
05:06 are your residents?
05:07 Because what we're simply saying is, you
05:09 should have a minimum level.
05:10 We're not telling them they have to hire more than that.
05:12 We're just saying have a minimum level
05:14 so you don't have the situation as occurred in Ohio,
05:16 where an individual who was in a nursing home
05:20 was suffering from a wound.
05:21 Because they didn't get wound care and diaper changes
05:24 and feeding, ultimately that wound became a bed sore.
05:27 That sore then got to the bone and ultimately--
05:30 Having worked many years in nursing homes,
05:32 both as a delivering that care and as an administrator,
05:35 I certainly understand that.
05:37 But I also understand that when you're
05:39 dictating and mandating from Washington
05:43 without bringing the people to the table that
05:46 provide the care, what you're doing
05:48 is actually creating a decrease in access to care at a time
05:52 where a population is aging.
05:54 Thankfully, most people age with dignity
05:56 and don't go into a nursing home.
05:59 Gentleman's time has expired and now recognize--
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