GOOD AFTERNOON EVERYBODY
WELCOME TO ASSEMBLY BUDGET
SUB SIX HEARING VERY HONORED
TO BE JOINED BY A NUMBER OF
MY COLLEAGUES TODAY IN PERSON
AS WELL AS -- REMOTELY YOU
CAN SEE FROM HERE WE HAVE OUR
VICE CHAIR OF THAT COMMITTEE
THE STRUGGLE TO BECAUSE WELL
AS ARCHER OF -- SOMEONE ARE
HEALTH AND HUMAN SERVICES
BUDGET SUB COMMITTEE DR MAYBE
LABOR OF HONORED TO HAVE --
DOCTOR WHICH FEATURES ON HEALTH
COMMITTEE -- MY UNDERSTANDING
IS WE HAVE -- REMOTELY WE
HAVE ASSEMBLY MEMBER RAMOS WAS
CHAIR OF OUR HUMAN SERVICES
COMMITTEE ASSEMBLY MEMBER
BLOOM WHO CHAIRS ARE SET THREE
I BUDGETS A THREE COMMITTEE
ASSEMBLY MEMBER FONG BECAUSE
ON OUR COMMITTEE AS WELL
AS WELL AS ASSEMBLY MEMBER
LOOKING AT ANYTHING ANYBODY
ELSE ON ON THE ON THE -- OUR
SYSTEM IN THIS AREA WHO IS
CHAIR OF OUR AGING A LONG TERM
CARE COMMITTEE -- TODAY -- WE
ARE AGAIN HAVING A PHYSICALLY
DISTANT IN PERSON HEARING
WITH A NUMBER OF MEMBERS --
PARTICIPATING REMOTELY -- WE
ARE FOLLOWING STRICT DISTANCING
PROTOCOLS AND I WILL RESTATE
THIS REPUBLICAN BEGINS BUT
ANY MEMBERS OF THE PUBLIC
WHICH TO SPEAK -- THEY WILL
APPROACH THAT THE MICROPHONE
AND WE'LL HAVE ONE MINUTE A
PUBLIC COMMENT AND WE ASK THAT
AFTER THE PUBLIC COMMENT IS
MADE THAT THEY PLEASE LEAVE
THE ROOM AT THE PALACE ON THE
GENDER ARE APPEARING REMOTELY
-- IN BOTH THE CAPITAL AS
WELL AS ELSEWHERE IN THE
STATE THERE ARE ALSO PUBLIC
STATIONS AVAILABLE ACROSS
THE STATE TO ALLOW PEOPLE THE
OPPORTUNITY FOR PUBLIC COMMENT
THE GENDER CONTAINS LOCATIONS
OF THESE STATIONS INCLUDING
ONE IN CAPITOL PARK IF YOU
HAVE ANY PROBLEMS PLEASE CALL
OUR ASSEMBLY BUDGET COMMITTEE
OFFICE AT NINE ONE SIX THREE
ONE NINE TWO ZERO NINE NINE AND
STUFF WILL BE ABLE TO ASSIST
YOU IF YOU CANNOT ATTEND THE
HEARING BUT WAS TO SUBMIT
TESTIMONY PLEASE EMAIL US AT
BUDGET THE WORD SUB AS YOU
BEAT THE NUMBER THE NUMBER SIX
AT ASM DOT CA DOT GOV -- JUST
A HOUSEKEEPING ITEMS AFTER
MAKE MY OPENING COMMENTS WILL
WELCOME ANY COMMENTS FROM ANY
OF THE COMMITTEE MEMBERS -- WE
HAVE PANELISTS THAT WILL APPEAR
IN THE ORDER OF THE AGENDA IN
FINALLY -- ONCE THE MEMBERS
ASK QUESTIONS AND THAT'S
CONCLUDED I WILL OPEN THE
HEARING UP FOR PUBLIC COMMENT
NUMBER ASK THE
COMMITTEE CONSULTANT
TO PLEASE CALL THE ROLL
I'M LOOKING AT MY COMMITTEE
CONSULTANT ASKING HER TO
PLEASE CALL THE ROLL BUT TEAM
HERE ARAMBULA PRESENT BLOOM
COOPER FONG MCCARTY OBERNOLTE
WEBER HERE PLUMAS HERE
THANK YOU VERY MUCH PERFECT
-- AS YOU KNOW WE ARE HERE
TO DO -- OVERSIGHT OVERSIGHT
HEARING OVER SKILLED NURSING
FACILITIES I DO WANT TO THANK
BOTH MY COLLEAGUES DR WOODS
AND RAN TO A FOR HAVING HELD
PREVIOUS HEARINGS ON THIS
VERY ISSUE AND THE REASON WE
ARE HERE AGAIN IS BECAUSE --
SKILLED NURSING FACILITIES HAVE
ACCOUNTED FOR ABOUT FORTY FIVE
HUNDRED DEATHS BOTH AMONGST
RESIDENTS AS WELL AS STAFF IN
UNFORTUNATELY THIS IS A VERY
HIGH PERCENTAGE OF DEATHS
WITHIN OUR STATE -- BETWEEN
THIS IN OUR PRISON POPULATION
IT'S VERY UNFORTUNATE THAT
WE'VE SEEN SO MANY FATALITIES
IN BOTH OF THOSE COMMUNITIES --
WE WANTED TO REVISIT THIS ISSUE
BY TALKING TO BOTH THE AGENCIES
WHO HAVE OVERSIGHT OVER THE
SKILLED NURSING FACILITIES AS
WELL AS THOSE REPRESENTING SOME
OF THE FACILITIES TO REALLY
UNDERSTAND WHAT'S BEEN DONE
RECENTLY WHAT CHANGES NEED
TO BE DONE IN THE FUTURE WE
FULLY UNDERSTAND THAT AS THIS
PANDEMIC HIT US IN MARCH ALL
OF US WERE TRYING AS HARD AS
WE CAN TO UNDERSTAND WHAT THE
PANDEMIC MEANT AND ALSO TO
FOLLOW IN DEVELOPED PROTOCOLS
WITH MANY OF THE PROTOCOLS THAT
HAVE BEEN DEVELOPED ARE HAVE
BEEN LEARNED THROUGH EXPERIENCE
AND ALSO LEARNING MORE ABOUT
THIS CORPORATE NINETEEN VIRUS
AND HOW IT CAN BE -- CONTRACTED
AS WELL AS WELL AS HOW IS IT
SPREAD SO I THINK THIS IS A
VERY IMPORTANT HEARING FOR ALL
OF US JUST HERE BUT PROGRESS
IS MADE AND ALSO TO A LOT ABOUT
THE PUBLIC AS TO WHAT PROGRESS
NEEDS TO CONTINUE TO BE MADE
AT THE STATE LEVEL I'M GONNA
SEE IF ANY OTHER MEMBERS OF
THE COMMITTEE WOULD LIKE TO
MAKE OPENING COMMENTS MISTER
BROOKS I THANK YOU MR CHAIRMAN
I AM HONORED TO BE -- HERE IS
PART OF THIS PANEL DISCUSSING
WHAT IS PROBABLY ONE OF OUR
MOST VULNERABLE POPULATIONS
IN THE STATE OF CALIFORNIA WE
JUST WANNA MAKE SURE HERE THAT
WE ARE TAKING ALL APPROPRIATE
STEPS TO PROTECT THE POPULATION
ARE NOT JUST IF FROM KROGER
VIRUS BUT ALSO FROM THE OTHER
CONCOMITANT PROBLEMS THAT HAVE
COME ALONG WITH IS AT EPIDEMIC
AND -- I'M VERY INTERESTED IN
TAKING PART OF THAT LOOKING FOR
THE PANEL THANK YOU MR CHAIRMAN
OKAY SEEING NO OTHER COMMENTS
LET'S START WITH OUR FIRST
PANELIST WHICH IS MISTIMED
OCCUR WITH THE CALIFORNIA
PUBLIC PUBLIC HEALTH
YEAH I THINK IN ORDER
FOR THE SCREEN TO COME
COME UP YOU HAVE TO START
SPEAKING IF YOU CAN HEAR ME
HI CAN YOU HEAR ME WE CAN
HEAR YOU YES PERFECT THANK
YOU RIGHT THANK YOU AGAIN --
JIM IS THE COMMITTEE THANK YOU
AGAIN FOR HAVING ME AND I'M
HAVING TIME TODAY TO DISCUSS
THIS IMPORTANT TOPIC -- FOR
CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH CODE IN NINETEEN
RESPONSE I'M SPECIFICALLY TO --
OUR MOST FEDERAL CALIFORNIANS
AND SKILLED NURSING FACILITIES
AS STATED IN PREVIOUS HEARINGS
CDPH TOOK IMMEDIATE ACTION
TO LEARN FROM EARLY OUTBREAKS
AND IMPLEMENT NEW PROACTIVE
STRATEGIES AND SKILLED
NURSING FACILITIES AS WELL AS
TAKING NEW ACTIONS TO IMPROVE
TRANSPARENT COMMUNICATION TO
THE PUBLIC INCLUDING LAUNCHING
OUR NEW SKILLED NURSING
FACILITY COVERED NINETEEN
WEBSITE AND JULY THAT HIGHLIGHT
STRATEGIES -- PROVIDES
REAL TIME DATA AND SHARES
INTERACTIVE GRAPHS INCLUDING
COMPARISON GRAPHS TO US IN
OTHER STATES -- ANNA GIVES UP
TO DATE FACILITY INFORMATION
FOR FAMILIES CONCERNED ABOUT
THEIR LOVED ONES IN ABILITY TO
VISIT IT'S ALSO IMPORTANT EIGHT
CDPH REOPEN SKILLED NURSING
FACILITIES IN CALIFORNIA ON
JUNE TWENTY SIXTH BY REQUIRING
OMBUDSMAN ENTRANCE AND
REQUIRING OUTDOOR VISITATION
INDOOR INDOOR LARGE COMMUNAL
SPACE VISITATION AND ALL
FACILITIES AND MOST RECENTLY
AS LATEST AS LAST FRIDAY WE
ISSUED A NEW REVISION TO THIS
POLICY THAT FURTHER OPENED
UP VISITATION OPTIONS FOR IN
ROOM VISITATION AND COUNTIES
WITH LOWER SPREAD RATES IN OUR
MOST RECENT EFFORTS WE FIRST
MET WITH LOCAL PUBLIC HEALTH
OFFICERS AS PARTNERS IN ADVANCE
AND HOPES THAT WE CAN HAVE
BETTER ALIGNMENT OF OUR LOCAL
PUBLIC HEALTH ORDERS IN OUR
STATEWIDE VISITATION POLICY
I'M AS A QUICK HIGHLIGHTS
-- OUR BIGGEST PROACTIVE
ACTIONS WE TOOK FOR TARGETED
NOT CODED NINETEEN TESTING
YOUR CO HOARDING IMPLEMENTING
ENFORCING COULD NINETEEN
MEDICATION PLANTS WE GO ON SITE
AND FORCES EVERY FOUR TO SIX
WEEKS I'M EXPANDING STATEWIDE
INFECTION PREVENTION EDUCATION
RESOURCES AND IMPLEMENTING
PREDICTIVE ANALYTICS AND REAL
TIME ALERTS DASHBOARDS TO
MITIGATE HIGH RISK FACILITIES
SOME OF THE OUTCOMES OF OUR
INTERVENTIONS I'M HERE TO
SHARE WITH YOU TODAY IS THAT
SO FAR THESE ACTIONS HAVE
PROVEN TO BE NOTABLY SUCCESSFUL
WAS SIGNIFICANT REDUCTIONS IN
CASES AND MORTALITY I SNIFF
STATEWIDE WELL EVEN COMMUNITY
CASE RATES HAVE HAD SEARCHES IN
LATE SUMMER AND EVEN WHEN WE'VE
SEEN VARIOUS SPIKES DURING
PANDEMICS IN IN THE PANDEMIC
OF HOSPITALIZATIONS DESPITE THE
HIGH CASE RATES CO CASES AND
COUNTIES IN AUGUST AS WELL AS
HIGH RATES OF HOSPITALIZATIONS
IN CALIFORNIA IN LATE SUMMER
THE SKILLED NURSING FACILITY
CASE RATES MORTALITY RATES
CONTINUE TO STABILIZE AND
DECLINE INTO THE FALL FOR
EXAMPLE IN MAY THE OVERALL
MORTALITY RATE IN CALIFORNIA
IN A SKILLED NURSING FACILITY
WAS EIGHT POINT SIX AND A
COMMITMENT MID OCTOBER IT IS
NOW REDUCED TO ONE POINT NINE
THE COVERT NINETEEN MORTALITY
RATE IN MAY IN CALIFORNIA WAS
TWO POINT TWO WHICH IS NOW
BEEN REDUCED TO OAK POINT FOR
-- IN ADDITION TO THIS WHEN
WE LOOK AT COMPARISON NAME
I'M COMPARING ON CALIFORNIA
TO OTHER STATES CALIFORNIA HAS
BY FAR THE MOST NEW FACILITIES
AND RESIDENTS IN OTHER STATES
IN SOME CASES WE HAVE TRIPLE
OR DOUBLE WRITTEN SOMETIMES
QUADRUPLE THE AMOUNT ON THAT
OTHER STATES BUT THE STATE'S
MOST SIMILAR TO CALIFORNIA
THAT WE CAN COMPARE TO AS FAR
AS RESIDENT POPULATIONS ARE
NEW YORK TEXAS AND FLORIDA
WELCOME IN NINETEEN SPECIFIC
MORTALITY RATES ARE NOW LOWEST
IN NEW YORK NOW AFTER A HUGE
SPIKE IN -- OF FEBRUARY AND
MARCH CALIFORNIA HAS LOWER
KOBE NINETEEN MORTALITY RATES
IN TEXAS AND FLORIDA AND
CALIFORNIA'S OVERALL SKILLED
NURSING FACILITY MORTALITY
RATES ARE LOWER THAN ALL
STATES BY SIGNIFICANT MARGINS
AS OF MID OCTOBER FLORIDA'S
MORTALITY RATE IS FIVE POINT
ONE NEW YORK IS FOUR POINT
EIGHT TEXAS IS FOUR POINT ONE
AND CALIFORNIA IS ONE POINT
NINE -- HOWEVER WE KNOW THAT
IN PREPARE PREPARATION FOR FLU
SEASON FOR A POTENTIAL POST
FALL WINTER HOLIDAY SPIKE AFTER
HALLOWEEN THANKSGIVING EXCEPT
TRUCK AND AFTER A POTENTIAL
SECOND WAVE SURGE RECENTLY
WE'VE ALSO SEEN SOME FACILITIES
WITH NEW OUTBREAKS NINE MONTHS
IN THE PANDEMIC ALTHOUGH WE
HAVE FEWER FACILITIES WITH
THESE ISSUES WE HAVE LOOKED
AT RECENT ROOT CAUSES TO
THESE OUT LIARS TO IDENTIFY
NEW INTERVENTIONS GOING INTO
THE WINTER SEASON THE FIRST
NEW INTERVENTION THAT WE'RE
LOOKING AT IS THIS WEEK AND
NEXT CMS'S PROVIDING TECHNICAL
TRAINING AND ASSISTANCE TO
ALL OF OUR MANY STAFF OUR NEW
STAFF AND EXISTING STAFF ON
LEVERAGING FEDERAL REGULATIONS
WHICH ARE STRICTER -- IN
REGARDS TO INFECTION CONTROL
PROCESSES AND INNER VELOP
THEM INTO OUR SYSTEMS WE'VE
CREATED FOR PANDEMIC RESPONSE
THE SECOND -- APPROACH IS
THAT WE ARE EXPANDING OUR
PREDICTIVE ANALYTICS SOME OF
THE MOST RECENT OUT BREAKS
THAT HAVE HAPPENED ARE DUE TO
-- VIOLATIONS NOT NECESSARILY
UNDER CD PH IS JURISDICTION
OUT OF -- OUT OF VIOLATIONS
FROM OUR PARTNER -- COMPLIANCE
AND REGULATIONS AND SO NOW
WE WILL BE EXPANDING SOME
OF OUR HIGH RISK PREDICTIVE
ANALYTICS DATA BY PARTNERING
WITH OTHER DEPARTMENTS LIKE
DH CS DEPARTMENT I'M SORRY
DEPARTMENT OF HEALTH CARE
SERVICES DEPARTMENT OF SOCIAL
SERVICES ARE SPOTTING CAL
OSHA -- SO THAT WE CAN LOOK
AT COMPLIANCE DATA FROM OTHER
REGULATORY DEPARTMENTS AND
SEE IF THERE ARE HIGH RISK
THEMES THAT WE CAN PUT INTO
OUR ALGORITHMS WILL ALSO BE
INCLUDING FLU OUTBREAK DATA
FROM PRIOR YEARS SO THAT WE CAN
ALSO INCLUDE THAT AS FAR AS A
HIGH RISK FOR AN OUTBREAK AND
WILL ALSO BE LOOKING AT CHILD
CARE OUTBREAKS WITHIN THE SAME
ZIP CODE OF A SKILLED NURSING
FACILITY AS THAT IS USUALLY AN
EARLY INDICATOR OF A COMMUNITY
SPIKE I'M AND WE ALSO HAVE NEW
OUTBREAK DEMOGRAPHICS THAT WE
HAVE ACQUIRED FROM CMS -- THAT
WE CAN ALSO USE AS FURTHER DATA
TO USE IN A PREDICTIVE MODEL
-- WILL ALSO BE REASSESSING
STAFFING WE ARE WORKING WITH
STAKEHOLDERS TO DEVELOP NEW
STAFFING STRATEGIES FOR SEARCH
THAT WILL BE PUBLISHED IN
UPCOMING OFFICE SAUDIS LETTER
SOME OF THE STRATEGIES INCLUDE
TARGETING INFECTION CONTROL
STRIKE TEAMS TO LOCATIONS
WITH SHORT STAFFING TO RE
EDUCATE OF PROPER COURTING
AND HAVE SURVEYORS REASSESS
EMERGENCY STAFFING WAIVERS
FOR THOSE FACILITIES WHO HAVE
NOT PROVIDED ADEQUATE SAFE
STAFFING LEVEL PLANS OR WHO
HAVE NOT MAINTAIN STOUT SAFE
ENVIRONMENT FOR BOTH STAFF
AND RESIDENTS AND LAST BUT NOT
LEAST WE ARE PARTNERING WITH
THE DEPARTMENT OF HEALTH CARE
SERVICES TO LOOK AT -- QUALITY
AND ACCOUNTABLY ACCOUNTABILITY
SUPPLEMENTAL PAYMENT INCENTIVES
WE'VE NOTICED THAT MANY AND
PUBLIC HEALTH AND IN THE
HEALTHCARE DELIVERY SYSTEM
ARE EXPERIENCING BURNOUT
AND PANDEMIC FATIGUE AFTER
INCREDIBLY LONG HOURS SEVEN DAY
WORK WEEKS AN INSURMOUNTABLE
STRESSFUL SITUATIONS FOR TEN
MONTHS SOME HEALTH CARE WORKERS
AND FACILITIES HAVE SWITCHED
TO NEW PROTOCOLS ESTABLISHING
NEW NORMAL AND HOW THEY OPERATE
AND RED PANDEMIC WHEREAS OTHER
FACILITIES SADLY ARE STILL
STRUGGLING TO MAINTAIN THIS
LEVEL OF INFECTION CONTROL
PRECISION THAT IS REQUIRED
AT ALL TIMES PARTICULARLY
WHEN WORKING WITH RESIDENTS
WHO MAY NOT BE COMPLIANT AND
WEARING MASKS OR RESIDENTS
WHO MAY WANT TO RECORDED SENSE
-- CDPH IMPARTING WITH THE
PART OF HEALTH CARE SERVICES
IS WORKING ON THE CFL WHICH
PROVIDES AUSTIN SENTENCE FOR
FACILITIES TO DEMONSTRATE
COMPLIANCE WITH C.
DPH COVERED MEDICATION
REQUIREMENTS AND THIS WILL GO
INTO EFFECT IN JANUARY CDPH
WAS ONLY ABLE TO EFFECTIVELY
IMPLEMENT THESE STRATEGIES AND
FURTHER STRENGTHEN FACILITY
INFECTION CONTROL RESPONSE BY
WORKING IN REAL TIME WITH OUR
LOCAL PUBLIC HEALTH DEPARTMENTS
COUNTY LEADERS AND ALSO BY
WORKING TOGETHER WITH OUR
FELLOW DEPARTMENTS WITH THE
DEPARTMENT OF AGING DEPARTMENT
OF SOCIAL SERVICES CAL OSHA
JOSH BUT CALLAWAY YES I'M SORRY
TO NAME A FEW I ALSO WANT TO
THANK THE MANY STAKEHOLDERS AND
GERIATRIC SPECIALIST INCLUDING
THE DIRECTOR COUNCIL WHICH
IS TODAY'S PANEL CHARLENE
HERRIN TINA'S ON AS WELL AS
TODAY'S PANELISTS LIKE WHITE
MIKE WASSERMAN WHO PARTNERS
ON WEEKLY STATEWIDE WEBINARS
WITH CDPH WE DEEPLY APPRECIATE
THESE OPPORTUNISTIC CONTENT
ENGAGE WITH SOMETIMES ON A
DAILY IF NOT WEEKLY BASIS TO
DISCUSS OF SHORT TERM PANDEMIC
RESPONSE AND LONG TERM NEEDED
REFORMS AND FINALLY BEFORE WE
OPEN IT UP TO THE REST OF THE
PANELISTS I WANT YOU ALL TO
KNOW AND FOR THOSE OF MY STAFF
WERE LISTENING TODAY HOW DEEPLY
GRATEFUL I AM TO ALL OF OUR C.
PH STAFF WHO WAS SPENT THESE
LAST TEN MINUTES OF TEN MONTHS
AWAY FROM THOSE THEY LOVE TO
HELP CALIFORNIA ESPECIALLY ALL
OUR STAFF IN THE FIELD WHO ARE
HIV INFECTION CONTROL STRIKE
TEAMS ARE FACILITIES SURVEYORS
TO GET TESTED WEEKLY AND ANSWER
FACILITIES SEVEN DAYS A WEEK
SOMETIMES HOURS AWAY FROM HOME
DURING THE LONG DAYS AND NIGHTS
THROUGH WILDFIRE EVACUATIONS
AND PUBLIC SAFETY POWER SHUT
OFF EMERGENCIES TO HELP MAKE
SURE ALL CALIFORNIANS ARE
SAFE THEY'RE HUMANS BY BIRTH
CIVIL SERVANTS BY CHOICE BUT
THEY'RE ABSOLUTELY HEROES
IN THIS PANDEMIC THANK YOU
THANK YOU NEXT WE ARE GOING
TO GO TO LEADING KERRY TERM
WITH THE HEALTH CARE SERVICES
WAS TESTIFYING ON THE PHONE
YES TWENTY HEARING KERR DEPUTY
DIRECTOR FOR HEALTH CARE
FINANCING WITH THE DEPARTMENT
OF HEALTH CARE SERVICES I'M
I'D LIKE TO THANK THE COMMITTEE
MEMBERS FOR THE OPPORTUNITY
TO PROVIDE INFORMATION TODAY
REGARDING SKILLED NURSING
FACILITY WITHIN THE MEDICARE
PROGRAM AND THE MEDICAL PROGRAM
REIMBURSES FREESTANDING NURSING
FACILITIES -- LEVEL B.
AND FREESTANDING TUB ACUTE
NURSING FACILITY LEVEL B.
-- ON OUR COST BASE FACILITY
STILL BE SPECIFIC PER DIEM
REIMBURSEMENT RATE BUT IT
DEVELOPED BY THE DEPARTMENT
UTILIZING A RATE METHODOLOGY
BASED ON FIVE COP CATEGORY
SUBJECT PLACENTA OUTCAST THE
RATES ARE UPDATED ANNUALLY
BASED ON THE MOST RECENT
AUDITED COST REPORT DATA AND
KILLER INSTABILITIES ARE ALSO
REQUIRED TO PAY A QUALITY
ASSURANCE BE UNDER TOTAL
BAD DAYS REGARDLESS OF PAYER
FIFTY AMOUNT IS CALCULATED
ANNUALLY BASED ON AGGREGATE
FACILITY CATEGORY REVENUE AS
REPORTED BY THE CALIFORNIA
OFFICE THAT STATEWIDE HEALTH
PLANNING AND DEVELOPMENT
THE MEDIC HOW PER DIEM RATE
INCLUDES AN ADJUSTMENT TO
FIND THE FACILITY FOR THE FIA
PROCEEDED WITH THEIR MEDICARE
OUT THAT DAY IS BOTH THE RATE
METHODOLOGY AND THE QUALITY
ASSURANCE BEAVER RE AUTHORIZED
IN STATE FISCAL YEAR TWENTY
ONE TRICK BUDGET TRAILER BILL
WHICH EXTENDED THE METHODOLOGY
THROUGH DECEMBER THIRTY FIRST
OF TWENTY TWENTY TWO AND
INCLUDED IT -- THE FOLLOWING
UPDATE THIS METHODOLOGY
THE READING PERIOD OF BEING
CONVERTED TO A CALENDAR YEAR
WITHIN AUGUST THROUGH DECEMBER
THIRTY ONE TWENTY TWENTY RATE
IT AS A BRIDGE FOR THE BRIDGE
FACILITY YOU WILL RECEIVE A
THREE POINT SIX TWO PERCENT
WEIGHTED AVERAGE RATE INCREASE
WILL RECEIVE A THREE POINT FIVE
PERCENT INCREASE PER CALENDAR
YEAR TWENTY TWENTY ONE AND A
TWO POINT FOUR PERCENT INCREASE
PER CALENDAR YEAR TWENTY TWENTY
TWO WE ALSO UPDATED THE PEER
GROUP FOR DETERMINING ABOUT
COST CATEGORY CAPS AND PEER
GROUP RATED AVERAGES -- AND
THOSE HAVE BEEN REDISTRIBUTED
AND INCREASED FROM SEVEN TO
ELEVEN CARE GROUPING THIS WILL
PROVIDE A MORE ACCURATE RATE
OF LOCAL COST CONDITIONS AND
PREVENT THE METHODOLOGY FROM
ARTIFICIALLY INFLATING BANGKOK
CAP THE BENCHMARK HAPPY PAYMENT
FOR DIRECTLY BIRD AN INDIRECT
LABOR COSTS WERE INCREASED FROM
NINETY PERCENT TO NINETY FIVE
PERCENT IN ORDER TO FURTHER
INCENTIVIZE PATIENT CARE
EXPENDITURES THE QUALITY AND
ACCOUNTABILITY SUPPLEMENTAL
PAYMENT PROGRAM ALSO KNOWN AS
CLASS WHAT EXTENDED THROUGH
APRIL THIRTIETH OF TWENTY
TWENTY TWO DHF IS PARTNERING
WITH CDPH FOR AND ALL THE BILL
THE LETTER WHICH PROVIDE OFTEN
FINANCED WITH WITH THE LADY WHO
DEMONSTRATE COMPLIANCE WITH THE
CDPH COBIT NINETEEN MEDICATION
HER CHOIR MEANT AND THAT'S
WILL GO INTO EFFECT IN JANUARY
ADDITIONALLY THE DEPARTMENT OF
THAN THE INTRODUCTORY STAGES
THE CONSIDERING HOW THE NEXT
ITERATION OF THE PAYMENT
METHODOLOGY FOR FREESTANDING
NURSING FACILITIES THAT WOULD
TAKE A FACT AND JANUARY ONE
TWENTY TWENTY THREE HE WILL
CONVENE A STAKEHOLDER PROCESS
NO LATER THAN SEPTEMBER
FIRST OF TWENTY TWENTY
ONE TO DEVELOP A FIX AFTER
SUPPLEMENTAL PAYMENT OR QUALITY
BASED PAYMENT METHODOLOGY
EACH YEAR THE BIG EXPLORING
ADDITIONAL METHODOLOGY
CHANGES SUCH AS UTILIZING THE
EXISTING INFRASTRUCTURE OF
THE CLOCK PROGRAM TO INCLUDE
AN APPROPRIATION OF THIRTY
TO FIFTY FIVE PERCENT OF THE
ANNUAL WEIGHTED AVERAGE RATE TO
INCREASE QUALITY BENCHMARK THAT
MEASURES YOUR COSTS INCREASE
QUALITY PAYMENT FREQUENCY OR
INCLUDE QUALITY PAYMENT AS
AN ADD ON TO THE REGULAR PER
DIEM BASE RATE RELATED TO
THE CODE NINETEEN PANDEMIC
RESPONSE DHT ACT PROVIDED A
TEN PERCENT RATE INCREASE TO
HELP COVER THE COSTS RELATED
TO CO THE BANKING THESE COSTS
COULD INCLUDE BUT ARE NOT
LIMITED TO INCREASE STAFFING
COSTS MEDICAL EQUIPMENT COSTS
FANTASIZING COSTS P.
P.
H.
HERE AT THE CURRENTLY
DEVELOPING A METHODOLOGY TO
AUDIT BECAUSE THE NINETEEN
RELATED EXPENDITURES AS
PART OF OUR ANNUAL CONTRA
AUDITING PROGRAMS TO ENSURE
THAT FACILITIES ARE SPENDING
A TEN PERCENT INCREASE OF
FIND AN APPROPRIATE WAY TO
MAXIMIZE INFECTION PREVENTION
AND CONTROL INTERNATIONAL
INVESTMENT CENTER FOR SENIORS
HAVING CARE THE AVERAGE
MEDICAID INCREASE COUNTRYWIDE
WHAT'S FIVE PERCENT IN RESPONSE
TO THE PUBLIC HEALTH EMERGENCY
FOR EXAMPLE OREGON PROVIDED
A TEN PERCENT RATE INCREASE
FROM APRIL FIRST THROUGH JUNE
THIRTIETH OF TWENTY TWENTY THE
DISTRICT OF COLUMBIA PROVIDED
A TWENTY PERCENT RATE INCREASE
TO NURSING FACILITY THROUGH
THE END OF THE NATIONAL PUBLIC
HEALTH EMERGENCY WASHINGTON
STATE PROVIDED A PER DIEM ADD
ON REIMBURSEMENT OF TWENTY NINE
DOLLARS WHICH WILL AND THE LAST
DATE OF BACK CALENDAR QUARTER
IN WHICH THE PUBLIC HEALTH
EMERGENCY AND FOR COMPARISON
THE CALIFORNIA TEN PERCENT IN
EQUITY ON AVERAGE TO A TWENTY
FOUR DOLLAR INCREASE IT IS
TOO EARLY TO DETERMINE -- THEM
OR MEASURE THAT THE IMPACT ON
THE RATE INCREASE ON FACILITY
THAT THAT HIGH AND YOU TO LACK
OF DATA BUT I THINK AS YOU
HEARD FROM -- THE PREVIOUS
-- PANELISTS WE ARE SEEING
THEIR -- GREAT THING AND --
OUR FACILITY IS NOW WITHIN
OUR OUR FACILITY FOR MEDICARE
ALL -- CLINICAL LABORATORY
PROVIDERS PROVIDING SPECIMEN
COLLECTION FOR KOBE NINETEEN
TESTING PER RESIDENTS AND STILL
THERE THINK THE PHILIPPINES ARE
ELIGIBLE TO BILL MACCALLUM THE
CLINICAL LABORATORY PROVIDERS
ARE ELIGIBLE BILL FOR THE
DIAGNOSTIC TESTS AND SPECIMEN
COLLECTION SERVICES SEPARATELY
EACH FOR KOBE NINETEEN TAPPING
FOR STILL NURSING FACILITY
WORKERS COVERAGE FOR THE COST
OF TESTING WILL BE REVIVED
THE SPECIFIC CIRCUMSTANCES OF
THE WORKER OR SKILLED NURSING
FACILITY WORKERS WHICH SPENT ON
THE COMING NINETEEN INSPECTION
OR WHO HAVE BEEN EXPOSED TO
SOMEONE WOULD COME IN NINETEEN
WORKERS CAN BE TESTED AT ANY
TESTING PROVIDER AND THEIR
HEALTH PLAN MUST COVER THE FULL
COST OF THE CAST FIRST BILL
NURSING FACILITY WORKERS DO
NOT HAVE BEEN DONE OR AND OR A
KNOWN OR SUSPECTED EXPOSURE TO
SOMEONE WITH CALVIN NINETEEN
THEIR STATE REGULATED HEALTH
PLAN NOT COVER THEIR CODE IN
NINETEEN PASSED HOWEVER THE
WORKER MUST GO THROUGH THEIR
HEALTH PLAN TO BE TESTED IN
THE NETWORK AND THE WORKER IS
LIABLE OR NORMAL COST SHARING
AGAIN I WANT TO THINK THAT THE
COMMITTEE FOR HAVING ME HERE TO
TESTIFY AND AND -- LOOK FORWARD
TO YOUR QUESTIONS AFTER THE
THANK YOU VERY MUCH NEXT WE
HAVE A DOCTOR MICHAEL WASSERMAN
WHO IS A PAST PRESIDENT OF THE
CALIFORNIA ASSOCIATION OF LONG
TERM CARE MEDICINE DR OSMAN
THANK YOU -- GERMAN CAME
COMMITTEE MEMBERS THOSE WHO SAY
WE DIDN'T KNOW WHAT WAS COMING
TO NURSING HOMES IN MARCH AND
APRIL WEREN'T LISTENING TO
THE EXPERTS IN GERIATRICS AND
LONG TERM CARE MEDICINE ON
MARCH NINTH I TOLD NBC NEWS
THAT THE CORONA VIRUS WAS THE
GREATEST THREAT TO NURSING
HOME RESIDENTS THAT WE'VE SEEN
ON MARCH TWENTY FIFTH I TOLD
CBS THAT NURSING HOMES COULD
BECOME ARE KILLING FIELDS MY
EXPERIENCE AS A CLINICAL AND
QUALITY EXPERT IN ADDITION
TO HAVING BEEN THE CEO OF THE
LARGEST NURSING HOME CHAIN IN
CALIFORNIA GIVE ME A UNIQUE
PERSPECTIVE INTO CODE NINETEEN
AND THE MEASURES THAT NEED
TO BE TAKEN TO REDUCE ITS
IMPACT AND DEVASTATION I WANT
TO THANK ASSEMBLYMAN WORD FOR
BRINGING AB TWENTY SIX FORTY
FOUR INTO LAW ITS REQUIREMENT
OF A FULL TIME EQUIVALENT OF
INFECTION PREVENTION US IN
EVERY NURSING HOME IS THE TYPE
OF WORK FORCE CHANGE THAT IS
NECESSARY TO PROTECT VULNERABLE
NURSING HOME RESIDENTS BUT
IT'S ONLY THE BEGINNING I COME
HERE TODAY IS IMMEDIATE PAST
PRESIDENT OF THE CALIFORNIA
ASSOCIATION OF LONG TERM CARE
MEDICINE AND CURRENT CHAIR OF
OUR PUBLIC POLICY COMMITTEE
TO MAKE RECOMMENDATIONS THAT
ARE ACTIONABLE AND SUSTAINABLE
AS WE MOVE FORWARD TODAY'S
NURSING HOMES ARE ESSENTIALLY
MANY HOSPITALS REGARDLESS
OF WHETHER THEY DELIVER POST
ACUTE CARE OR PROVIDE LONG TERM
CARE TO THE MOST FRAIL COMPLEX
AND CHALLENGING POPULATION OF
PATIENTS IN OUR HISTORY THE
AVERAGE NURSING HOME RESIDENT
HAS MULTIPLE CHRONIC CONDITIONS
COGNITIVE IMPAIRMENT REQUIRES
PROFESSIONAL OVERSIGHT AND
CARE FROM A BROADER WAY OF
CARE GIVERS AND HEALTHCARE
PROFESSIONALS HISTORICALLY
A MAJOR ROLE OF THE NURSING
HOME ADMINISTRATOR HAS BEEN TO
PUT HEADS IN BEDS THE MEDICAL
DIRECTOR BY FEDERAL REGULATION
IS SUPPOSED TO BE THE CLINICAL
LEADER OF A NURSING HOME IN
USUAL PRACTICE UNFORTUNATELY
MEDICAL DIRECTORS ARE OFTEN
SEPARATED FROM CLINICAL POLICY
DISCUSSIONS AND DECISIONS
REGISTERED NURSES AT PROTEST
PROFESSIONALS WHO ARE TRAINED
TO ASSESS PATIENTS ARE
SOMETIMES NOT AVAILABLE TO
MAKE NECESSARY ASSESSMENTS IN
REAL TIME HOW DO WE RUN MANY
HOSPITALS WITHOUT THE CLINICAL
LEADERSHIP AND STAFFING THAT
ARE SO VITAL COBIT NINETEEN HAS
BRUTALLY EXPOSED THIS WEAKNESS
THERE IS NOW AMPLE LITERATURE
TO DEMONSTRATE THE TWENTY FOUR
HOUR ARE IN COVERAGE AND A
MINIMUM OF FORTY FIVE MINUTES
OF OUR IN STAFFING RESIDENT PER
DAY ALONG WITH ENOUGH ALBION
AND CMA COVERAGE LEADS TO FEWER
COVERT NINETEEN OUTBREAKS AND
DEATHS CONSULTANT PHARMACISTS
MUST ALSO BE ENGAGED TO THE
FULLEST EXTENT I CAN TELL YOU
BASED ON OVER THIRTY YEARS
OF EXPERIENCE IN THE FIELD OF
GERIATRICS THEY'RE HAVING A
COMPETENT AND ENGAGE MEDICAL
DIRECTOR TO WORK WITH THE
NURSING STAFF AND THE INFECTION
PREVENTION NEST AS WELL AS
THE GUIDED MINISTRY -- SURE OF
LITTLE CLINICAL EXPERTISE HAS
PLAYED AN IMPORTANT ROLE IN
BATTLING THE SCOURGE THROUGHOUT
THE STATE AND COUNTRY I AM
A FACULTY MEMBER FOR THE
AMERICAN BOARD OF POST ACUTE
AND LONG TERM CARE MEDICAL
DIRECTOR CERTIFICATION COURSE
AS I RECENTLY PARTICIPATED
IN THE THREE DAY COURSE THAT
COMPLETES THE TRAINING ALL
I COULD THINK OF WAS WHAT A
DIFFERENCE IT WOULD HAVE MADE
IF EVERY NURSING HOME IN THE
STATE HAD A CERTIFIED MEDICAL
DIRECTOR OVER THE PAST EIGHT
MONTHS I GUARANTEE YOU THAT
IF THAT HAD BEEN THE CASE
AND IN CONJUNCTION WITH THE
APPROPRIATE NURSE STAFFING
LEVELS FAR FEWER NURSING HOME
RESIDENTS WOULD HAVE DIED
EVERY NURSING HOME IN THE STATE
ALREADY HAS A MEDICAL DIRECTOR
AND NURSING HOME OWNERS
ALREADY SPENT A SIGNIFICANT
AMOUNT OF MONEY ON MEDICAL
DIRECTOR STIPENDS BY REQUIRING
CERTIFICATION YOU WILL SURE
THAT NURSING HOME MEDICAL
DIRECTORS HAVE THE TOOLS THE
SKILLS AND THE PROFESSIONAL
OBLIGADO DR WERE PROVIDED ALL
OF WHITE OVERSIGHT DR OSMAN CAN
YOU HOLD ON FOR ONE SECOND --
YEAH GETTING A JOB -- -- ONE
OF THE REMOTE MEMBERS CANNOT
HEAR THE SPEAKER IS THERE A
WAY TO CAN YOU CHECK THE AUDIO
YEAH -- NO THAT'S PROBABLY
BECAUSE OF THE SAME ISSUE
-- YEAH THANK YOU FOR
YOUR PATIENCE DOCTOR
WANTS ME TO JUST HOLD ON
ONE SECOND OH NO PROBLEM
YEAH TESTING ONE TWO TESTING
ONE TWO THE FIRM -- THERE CAN
CAN ONE OF THE MEMBERS WHO
TEXTED ME JUST TEXT ME BACK
GOOD POLICY GIVE KEEPER IF YOU
COULD KEEP SPEAKING DR OSMAN
JUST TEXT ME BACK TO CONFIRM
THAT YOU CAN HEAR DR OSMAN
OKAY SO EVERY NURSING HOME
IN THE STATE ALREADY HAS A
MEDICAL DIRECTOR AND NURSING
HOME OWNERS ALREADY SPEND A
SIGNIFICANT AMOUNT OF MONEY
ON MEDICAL DIRECTOR STIPENDS
BY REQUIRING CERTIFICATION
YOU WILL SURE THAT NURSING
HOME MEDICAL DIRECTORS HAVE
THE TOOLS THE SKILLS AND THE
PROFESSIONAL OBLIGATION TO
PROVIDE QUALIFIED OVERSIGHT
THIS WILL NOT INCREASE COSTS
TO THE STATE OR THE INDUSTRY
BUT IT WILL IMPROVE QUALITY
AND ACCOUNTABILITY THERE IS
ALSO EVIDENCE BASED LITERATURE
THAT DEMONSTRATES A CORRELATION
BETWEEN FOR PROFIT STATUS AND
THE SIZE OF COVERT NINETEEN
OUTBREAKS AND DEATHS THE
MOTIVATION FOR PROFIT MUST
SOMETIMES BE REINED IN TO
AVOID HARMING THE CUSTOMER
MANIPULATION OF EXISTING
RELATED PARTY TRANSACTION
REPORTING CAN ALSO SKEW ACTUAL
FACILITY LEVEL PROFITABILITY
THIS IS WHY WE MUST HAVE
COMPLETE TRANSPARENCY AROUND
THE OWNERSHIP STRUCTURE AS WELL
AS GIVING STRONG CONSIDERATION
TO A MEDICAL LOSS RATIO
PARAMETERS FOR NURSING HOMES
LAST BUT CERTAINLY NOT LEAST
CNA'S THE TRUE HEROES OF THIS
PANDEMIC MUST BE TREATED WITH
THE RESPECT AND DIGNITY THEY
SO RICHLY DESERVE AND FINALLY
EARN A LIVING WAGE I ALSO
ENCOURAGE YOU TO PAY EXTRA
ATTENTION TO THE COMMENTS OF
NICOLE HOW AND DR CHARLENE
HARRINGTON I RESPECT AND VALUE
THEIR INSIGHT AND OPINIONS
THANK YOU FOR THIS OPPORTUNITY
AND I LOOK FORWARD TO ANSWERING
YOUR QUESTIONS THANK YOU DR
AWESOME AND COULD WE HAVE
NEXT WE HAVE MARIA CARMEN
WHO'S A CERTIFIED NURSING
ASSISTANT REPRESENTING S.
C.
ARE YOU
AND SHE'LL BE TESTIFYING
WITH THE ASSISTANCE OF
A TRANSLATOR SO PLEASE
PLEASE GO AHEAD MISS CARMEN
ELLEN THE SILICON
HI MY NAME BOSKALIS I'M A
SKILLED NURSING FACILITY
FOR COUNTRY VILLA INVESTOR
I NEVER MEANT DRESSER AT SUCH
A TOUGH PANDEMIC WERE ALWAYS
EXPOSED TO DIFFERENT VIRUSES
YEAH AS MUCH AS I
TRIED TO PROTECT MYSELF
I BECAME INFECTED
AND I AM AFFECTED MY FAMILY
--
YEAH YEAH TO ALL MY KIDS
TO MY GRANDKIDS MY DAUGHTER
IN LAW AND MY GRANDSONS
YEAH DURING THE WEEK THERE
WAS A LOT OF PATIENTS INFECTED
IN A LOT OF NURSES INFECTED
BY MY HUSBAND HAD A BAD
HE HAD HE WAS TEN DAYS
INTO BED IN THE HOSPITAL
OKAY I CREATED YEAH I COULDN'T
BE THERE WITH HIM BECAUSE
HOSPITALS ARE NOT ALLOWING
MEMBERS TO BE THERE WITH
PATIENTS IN THE HOSPITALS
YEAH YOU CAN YEAH WE HAVE
TO WEIGH INTO THE NINE
TIME FOR A NURSE TO DO US
A FAVOR TO KEEP ON THAT
DATE SO THAT WE CAN SEE HIM
YEAH AND THAT'S HOW WE
LIVED THAT NIGHTMARE FOR
TEN YEARS FOR TEN DAYS
YEAH YEAH YEAH FOR US OUR
NAME IT WAS OVER AFTER
THE TEN DAYS BEFORE MY
HUSBAND HAD JUST STARTED
ONE
WHEN HE WOKE UP HE WOKE
UP WITH A SENSE TIED IN
WITH THE TO OPEN HIS MOUTH
HE THOUGHT HE WAS KIDNAPPED
BECAUSE HE COULDN'T REMEMBER
ANYTHING THAT HAPPENED TO HIM
HE DIDN'T KNOW HE WAS
IN THE HOSPITAL OR WHAT
WAS GOING ON WITH HIM
THE STARTED TO EXPLAIN
TO HIM THAT HE WAS
INFECTED WITH COLBERT
WHAT THE AND HE THOUGHT
THAT ME AND MY SON WERE
IN ANOTHER HOSPITAL
PROBABLY THE SAME OR WORSE
THANK YOU ALSO THOUGHT
THAT WE WERE DEAD BECAUSE
WE WERE NOT WITH HIM WHEN
HE USED TO TALK TO US
WE WE WILL CONTINUE TO BE LIKE
THIS WAY FOR ABOUT FIVE WEEKS
HE DIDN'T KNOW THAT
WE WERE ALL INFECTED
EIGHTY SEVEN CHANGE
AT THE CONVALESCENT
CENTER WHERE I WORK
WE STILL WHERE SIMPLE
GOWNS IN SIMPLE MASS
FROM THE
OKAY
BUT THIS MONDAY MAKE IS
VERY STRONG YOU CAN CARRY IN
YOUR HAIR OR IN YOUR SHOES
THEY HAVE YEAH ANYTHING
YEAH YEAH YEAH
YEAH IN ORDER TO YEAH
THIS SPENDING HAS BEEN
VERY HARD IT HAS AFFECTED
ME EMOTIONALLY FINANCIALLY
AS WELL I STOPPED WORKING
SINCE JULY TENTH MY HUSBAND
IS ALREADY RETIRED AND I'M
RUNNING OUT OF MY SAVINGS
YEAH UHHUH UHHUH
UHHUH UHHUH YEAH YEAH
YEAH AND RIGHT NOW I AM SCARED
TO GO BACK TO WORK BECAUSE I
FEAR TO BECOME INFECTED AGAIN
INTEL'S AND ALSO TO IN FACT
MY HUSBAND HE MADE IT THROUGH
THIS WAVE I DON'T KNOW IF HE
WILL MAKE IT THROUGH THE NEXT
ONE AND SO I AM VERY SCARED
YEAH
THAT
WHAT IS THE PROBLEM YEAH
AND I DON'T KNOW THIS IS
A REAL GENTLEMAN THIS IS
NO SIMPLE FLU THIS IS REAL
RIGHT
YOU HAVE
AND I MEAN I DO NOT GO
ON THE STREETS I FEAR
OF GETTING INFECTED OR
TO INFECT OTHER PEOPLE
THE BILL
YEAH
OKAY IS IT OKAY YEAH
BUT I MEAN THAT ATTY
THAT IS NOT YEAH
YEAH
YEAH OKAY
YEAH IT IS VERY SAD AND SCARY
TO BE INFECTED IT IS REALLY SAD
TO HAVE YOUR FAMILY DROPPING
FOOD ON THE DOOR FEELING LIKE
YOU'RE SOME KIND OF SOME KIND
OF INFECTED WITH SOME KIND OF
WE DISEASE I'VE ALWAYS BEEN A
VERY INDEPENDENT WOMAN I ALWAYS
WORK HARD TO SUPPORT ME AND MY
FAMILY I HAVE NEVER DEPENDED
ON ANY GOVERNMENT AGENCIES OR
ANY GOVERNMENT SERVICES I'VE
ALWAYS SUPPORTED MYSELF AND
IT'S REALLY TOUGH TO SEE YOUR
FAMILY DROP FOOD ON YOUR DOOR
AND NOT BE ABLE TO TOUCH THEM
ANYTHING
YEAH
I HUSING USED TO HEAR THE
PRESIDENT SPEAKS SOME STUFF
THAT I DON'T BELIEVE BECAUSE I
WENT THROUGH IT WITH MY FAMILY
I DON'T KNOW WHAT ELSE WERE
YOU GUYS YOU GUYS LIKE TO KNOW
OKAY THANK YOU VERY MUCH MISS
CARMEN WE VERY MUCH APPRECIATE
YOUR TESTIMONY FRANKLY FOR
YOUR SERVICE -- WE'RE GOOD
AT ITS BUSINESS COMMANDANT
OKAY WE ARE GONNA HI IF
YOU COULD STAY BILLABLE FOR
QUESTIONS WE'RE GOING TO
MOVE TO OUR NEXT SPEAKER
WHICH IS NICOLE HOW THE
EXECUTIVE DIRECTOR OF ON
BOTH MEN SERVICES OF CONTRA
COSTA SOLANO IN ALAMEDA
MISS HOW WOULD YOU START
SPEAKING THE IT'LL MOVE TO YOU
WONDERFUL THANK YOU THANK YOU
THANK YOU CHAIRMAN TEAM FOR
INVITING ME TO TESTIFY BEFORE
YOU AND THIS DISTINGUISHED
SUBCOMMITTEE MY GOAL TODAY
IS TO HELP PAINT A PICTURE
FOR YOU AND THE OTHER MEMBERS
PARTICIPATING TODAY AS WELL AS
THE PUBLIC ABOUT THE STATE OF
LONG TERM CARE IN CALIFORNIA
EIGHT MONTHS INTO THE PANDEMIC
AND AS WE LOOK AT LONG TERM
CARE I WANT US TO THINK OF
A BROADER VIEW OF WHAT THIS
LOOKS LIKE WE'RE TALKING ABOUT
SKILLED NURSING FACILITIES
BUT I ASKED WE CONSULT ALL
THREE HUNDRED EIGHT THOUSAND
INDIVIDUALS LIVING IN LONG
TERM CARE IN CALIFORNIA IN BOTH
RESIDENTIAL CARE FACILITY FOR
THE ELDERLY AND SKILLED NURSING
FACILITIES SO AS YOU KNOW AS
A LONG TERM CARE OMBUDSMAN I
ALONG WITH THOUSANDS OF PEOPLE
ACROSS THE COUNTRY ARE CHARGED
WITH ASSISTING RESIDENTS AND
FAMILIES TO RESOLVE ISSUES OF
THE COLLECT POOR CARE BEDSORES
EVICTION AND DISCHARGES AND
OFTEN WE ARE THE ONLY PEOPLE
WHO FAMILIES HAVE TO TURN TO TO
HELP THEM RESOLVE THESE ISSUES
BUT FOR NEARLY SIX MONTHS
LONG TERM CARE OMBUDSMAN LIKE
SO MANY LICENSING AGENCIES
WERE PREVENTED FROM ENTERING
FACILITIES LEAVING BUT
RESIDENTS HIGHLY VULNERABLE
TO POOR CARE AND LACK OF
SUPPORT ADVOCACY AND I THINK
SOMETIMES WHAT WE HEAR THESE
HEARINGS WE HEAR THE AMAZING
STATE PLANS BUT WE DON'T ALWAYS
UNDERSTAND HOW DOES THE FACT
THE INDIVIDUALS ON THE GROUND
AND SO I LIKE ALL OF YOU DON'T
NESTLE PARTICIPATE INDIVIDUAL
CARE MEETINGS BUT LAST WEEK I
HAD A STAFF OUT ON VACATION AND
SO THEY LET THE BOSTON AND HELP
OUT AND I HEARD EXACT PERFECT
EXAMPLE OF WHAT HAS BEEN
GOING ON IN SKILLED NURSING
FACILITIES SINCE OMBUDSMAN HAVE
NOT BEEN PART OF THE DAY TO DAY
OPERATIONS WE HAD A RESIDENT
WHO'D BEEN SKILLED NURSING
FACILITY FOR MANY YEARS WHO
THE GREAT FAMILY THEY HAD A
CARE GIVER THAT HELP TO PROVIDE
CARE TWENTY FIVE HOURS A WEEK
BUT DURING COLLEGE SHE'D LOST
NEARLY TWENTY POUNDS SHE BEGAN
TO DEVELOP PRESSURE SORES SO
THE FAMILY IN GOOD FAITH GOT
MEDICARE HOSPICE INVOLVED THAT
IS PAID FOR BY MEDICARE SHE
WAS ARTIFICIALLY RT BEING PAID
BE A MEDIC CAL THE CARE GIVER
THAT WAS COMING IN THE FACILITY
WAS OUT FEEDING HER SOME OF HER
MEALS EACH DAY AND WAS TAKING
THE TIME THAT SHE I NEEDED
IN ORDER TO ENSURE THAT HER
SHE RETAIN WEIGHT I WE TALKED
WITH THE SILLY BAD ENSURING
THAT SHE HAD ADEQUATE -- WOUND
CARE AS WELL AS SOMEONE TO
SIT WITH HER JUST TWICE A DAY
AND SPEND TWENTY FIVE MINUTES
BEATING HER THE RESPONSE WAS
WE DON'T HAVE TIME FOR THAT AND
I THINK THAT IS THE TRUE STORY
OF WHAT WE'RE SEEING WHICH IS
FACILITIES MAY BE WELL MEANING
WHO ARE VERY BUSY WITHOUT
PROPER OVERSIGHT WE'RE SEEING
A SIGNIFICANT DECLINE IN CARE
AND THE QUALITY OF LIFE FOR
RESIDENTS AND I THINK THIS IS
A GREAT EXAMPLE OF THE ISSUES
THE COPA NINETY SIX WEIGHTED
THEY'RE NOT HIGHLY TECHNICAL OR
COMPLEX THEIR BASIC ISSUES OF
STAFFING MANAGEMENT LEADERSHIP
AND INFECTION CONTROL NOW IN
CALIFORNIA FACILITIES -- THIS
SUMMER WHEN THEY WERE PATIENTS
WITH ONE COPA NINETEEN FACTION
AT THOSE FACILITIES HAD ON
AVERAGE TWENTY FIVE PERCENT
FEWER REGISTERED NURSES IN
THE BUILDING AT THE END OF TWO
THOUSAND NINETEEN THAT SHOULD
TELL YOU A LOT OF THINGS BUT
ONE OF THOSE THAT ARE AND TAKE
NO GUFF AND IF THEY ARE IN
BUILDINGS AND PRESENT BUILDINGS
THEY DRASTICALLY IMPROVE CARE
THE OTHER PART OF IT IS THAT AS
OF THIS SUMMER ABOUT NINETY ONE
PERCENT OF THE FACILITIES THAT
HAD ACTED COLLUDED NINETEEN
OUTBREAKS NINETY ONE PERCENT
OF THOSE HAD A PRIOR VIOLATION
RELATED TO INFECTION CONTROL
THAT MEANS THEY WERE CITED
FOR ISSUE WHEN THEY KNEW THAT
THE LICENSING ENTITY WAS THE
BUILDING AND I DON'T THINK THIS
TO INDICT THE FACILITIES BUT I
DO THIS TO SAY THAT WE'VE HAD A
DEMONSTRATED HISTORY OF A LACK
OF ENFORCEMENT IN FACILITIES
AND WE COULD IDENTIFY WHERE
THE PROBLEM ISSUES WERE GOING
TO HAPPEN NOW POOR STAFFING
IN LONG TERM CARE FACILITIES
WAS AND CONTINUES TO BE
THE GASOLINE TO COPE WITH
NINETEENTH MATCH WITHIN THE
LONG TERM CARE INDUSTRY DIRECT
CARE WORKERS ON AVERAGE EARN
ONLY ONE TO TWO DOLLARS MORE
PER HOUR THAN MINIMUM WAGE TO
DO THE MOST CRITICAL WORK THAT
WE HAVE TO CARE FOR OLDER AND
DISABLED ADULTS THESE DEDICATED
PEOPLE WORK SIXTY TO EIGHTY
HOURS PER WEEK OUT OFTEN AT
MULTIPLE LOCATIONS TO PAY THE
MOST MODICUM OF AND MODEST OF
RENT AND EXPENSES MEANWHILE YOU
MAY HAVE A CARE GIVER BECAUSE
OF THE SYSTEM THAT IS WORKING
AT MULTIPLE LONG TERM CARE
FACILITIES MEANING THEY COULD
BE WORKING AT THE FACILITY
EIGHT WHERE THERE IS A CURRENT
ACTIVE OUTBREAK AND THEY COULD
THEN BE GOING TO CARE FOR A
FEE AT FACILITY B.
AND THIS PRACTICE IS NOT
EXPRESSLY PROHIBITED BY OUR
LICENSING BODIES NO IN ORDER
TO ADDRESS THESE CRITICAL
ISSUES I'VE RAISED YOUR DEBT
I WANT TO TALK ABOUT A COUPLE
RECOMMENDATIONS AND THE FIRST
AND I THINK THIS ECHOES DR
WATERMAN SENTIMENTS IS WE
NEED TO REQUIRE LONG TERM
CARE FACILITIES TO IMMEDIATELY
RAISE COMPENSATION FOR
CERTIFIED NURSING ASSISTANTS
AND CAREGIVERS THIRTY PERCENT
AND I KNOW THAT'S MIGHT SEEM
LIKE A LOT TO YOU BUT I WANT
TO GIVE YOU A SENSE OF WHAT
THAT REALLY IS TALKING ABOUT
THREE DOLLARS AN HOUR THESE
PEOPLE ARE DOING CRITICAL WORK
AND WE NEED TO HELP MAINTAIN
AND RETAIN THE INDUSTRY AND
AGAIN YOUR PUBLIC BUT NICOLE
WE ALREADY DON'T HAVE ENOUGH
CARE GIVERS AND THAT'S WHAT
I'M GONNA TELL YOU A LITTLE BIT
A LITTLE WORN WHICH IS THAT I
HAVE A PLAN FOR THAT IN CONTRA
COSTA COUNTY WE'VE CREATED
TO HEALTH CARE CAREER PATHWAY
WHICH IS A COMPREHENSIVE
TRAINING PROGRAM FOR CERTIFIED
NURSING ASSISTANTS THAT IS BOTH
PERSON CENTERED IS BASED IN
REALITY AND HAS COMPREHENSIVE
SUPPORT FOR THE STUDENTS AND WE
HAVE NEARLY A HUNDRED PERCENT
GRADUATION RATE AND WE HEAR
FROM THE FACILITIES THAT THE C.
N.
A.'S THAT COMPLETE THAT PROGRAM
OR MORE AKIN TO PEOPLE WHO'VE
BEEN WORKING FOR A YEAR IN THE
INDUSTRY AND WHAT'S IMPORTANT
ABOUT THAT IS THAT IT'S VERY
CHALLENGING TO CREATE CERTIFIED
NURSING ASSISTANT PROGRAMS
THE REQUIRED -- THE CURRICULUM
BY CDPH IS PARTICULARLY
PRESCRIPTIVE AND RESTRICTIVE
AND ALLOWS VERY LITTLE MOVEMENT
FRANKLY NONE FOR WHAT THE
REALITIES OF CARE GIVING OUR SO
I ASK YOU TODAY TO DEDICATE A
STATEWIDE TASK FORCE TO REVIEW
THE CURRENT TRAINING PROTOCOLS
FOR CNA'S AND ALLOW THIS
TASK FOR TO BE BOLD AND TO BE
INNOVATIVE AND PROPOSED UPDATES
THE TRAINING CURRICULUM AND
THE TESTING PROCESS THERE ARE
CURRENTLY CNA'S WHO COMPLETED
TRAINING DURING QUARANTINE
DURING KOBE THEY COMPLETED
THEIR TRAINING BUT THEY'VE BEEN
UNABLE TO TEST BECAUSE THERE
IS SUCH A BACKLOG AT TESTING
CENTERS MEANWHILE WE HAVE
ISSUE STOPPING WAIVERS TO ALLOW
SKILLED NURSING FACILITIES TO
OPERATE AT LESS THAN OPTIMUM
STAFFING NEXT I LIKE THIS
TO TALK ABOUT THE CREATE
COMPREHENSIVE STRAIGHT TEAM
I HAVE SEEN WHEN THERE IS AN
OUTBREAK THERE IS STILL A GAP
BETWEEN THE LICENSING ENTITY BE
THAT CDSS WERE C.
PH AND LOCAL PUBLIC HEALTH AND
THE PROBLEM IS BECAUSE THOSE
ENTITIES ARE NOT NORMALLY IN
FACILITIES EVERY DAY THERE
IS A LACK OF DISCERNMENT FOR
THOSE BAD ACTORS WHO WOULD
CHOOSE TO USE THIS SITUATION
TO NOT BE ENTIRELY TRANSPARENT
ADDITIONALLY WHEN THERE IS A
PROBLEM WITH STAFFING ALL TOO
OFTEN FACILITIES ARE GIVEN A
LIST AND TOLD TO CALL STAFFING
AGENCIES WHEN WHAT WE NEED
TO AS ENFORCEMENT ENTITIES
WE NEED TO CALM WITH TRAINS
YOU NAY TO HER TO WORK ON THE
GROUND IMMEDIATELY WE CANNOT
SIMPLY SEND IN WELL MEANING
AND WELL TRAINED EMTS WHO
ARE NOT ABLE TO ACTUALLY DO
THE WORK AND THIS ACTUALLY
PROLONGS THE OUTBREAK AND I
BELIEVE DIMINISHES CARE WE
NEED TO DIRECT CITY PH ANSI
PSS TO ADOPT A MORE PROACTIVE
APPROACH AS IT RELATES TO
EMERGENCY PLANNING WE CAN NO
LONGER SIMPLY SAY TO REVIEW AN
EMERGENCY PLAN A FACILITY THERE
NEEDS TO BE AN APPROVAL AND
A CLEAR DISTINCTION TO ENSURE
THAT THEIR PLANS ARE ARE READY
FOR EXAMPLE IN CINEMA COUNTY
THERE WAS EVACUATIONS AND
FACILITIES EVACUATED TO A LOCAL
EVACUATION CENTER SLATED FRAIL
AND OLDER ADULTS IN THE MIDDLE
THE NIGHT TO A PLACE WHERE THEY
ARE ON MANY MORE PEOPLE WITHOUT
A PLAN TO MOVE THOSE PEOPLE TO
ADDITIONAL FACILITIES WE NEED
TO BE CLEAR ABOUT WHEN WE'RE
EVACUATING WHERE RESIDENTS ARE
GOING AND THE TRANSPORTATION
PLAN TO GET THEM THERE WE ALSO
NEED TO GET A CLEAR COMMITMENT
FROM BOTH CD PH AND CDSS ABOUT
THE RETURN TO NORMAL OPERATIONS
AND ENSURE THAT NO ONE REVERTS
TO TECHNICAL ASSISTANCE WE NEED
OUR ENFORCEMENT AGENCIES TO BE
ENFORCEMENT AGENCIES AND TO BE
ENFORCING THE REGULATIONS THAT
WE THE PEOPLE OF CALIFORNIA
HAVE SPOT FOR OVER MANY YEARS
THANK YOU SO MUCH FOR YOUR
ATTENTION TO THIS ISSUE I HOPE
THE WILL CONTINUE TO FOCUS
ON THIS LONG AFTER COPING
NINETEEN AGAIN ISSUES WE'RE
SEEING HAPPEN TODAY ARE NOT
SO MUCH ISSUE OF COCA NINETEEN
BUT A FAR TOO LONG WE HAVE
NOT GIVEN ENOUGH ATTENTION TO
THOSE OLDER AND INDIVIDUALS
EXPERIENCES ABILITIES
THANK YOU SO MUCH THANK YOU
MICHELLE NEXT WE HAVE DOCTOR
CHARLENE HARRINGTON WHO'S A
PROFESSOR AT THE UNIVERSITY
OF CALIFORNIA SAN FRANCISCO
DR HARRINGTON THANK YOU SIX
THANK YOU VERY MUCH FOR THE
INVITATION TO SPEAK TODAY
ON BEHALF OF MYSELF AND MY
COLLEAGUES AT UCSF AT KAT
CAL HOSPITAL COMPARE AT UC
DAVIS AND USC SINCE MARCH
CALIFORNIA NURSING HOMES HAVE
FACED A HUMANITARIAN CRISIS
RESIDENTS ARE LESS THAN ONE
HALF OF ONE PERCENT OF THE
POPULATION BUT ACCOUNT FOR
TWENTY SEVEN PERCENT OF ALL
CALIFORNIA DEATHS THE GOOD
NEWS IS THAT LEGISLATIVE
CHANGES CAN BE ADOPTED THAT
WILL SAVE LIVES BY ADDRESSING
THREE AREAS ONE IMPROVEMENTS
IN STAFFING AND WAGES TO
INCREASE FINANCIAL TRANSPARENCY
AND ACCOUNTABILITY AND THREE
INCREASED OVERSIGHT AND
ENFORCEMENT FIRST MY COLLEAGUES
AND I HAVE CONDUCTED TWO
RECENT STUDIES AND CALIFORNIA
NURSING HOMES SHOWING THAT
NURSE STAFFING LEVELS ARE THE
MAJOR FACTORS THAT PREVENT
COBIT INFECTIONS AND DEATHS
HIGHER TOTAL STAFFING HOURS
AND ARE IN HOURS REDUCE
COVET INFECTION AND DEATH
RATES BY HALF WE FOUND THAT
CALIFORNIA'S MINIMUM STAFFING
STANDARD OF THREE POINT FIVE
HOURS PER RESIDENT PER DAY
IS SIMPLY TOO LOW TO PROTECT
RESIDENTS WE URGE INCREASING
THE STATE'S MINIMUM STAFFING
LAW TO FOUR POINT ONE HOURS PER
RESIDENT DAY FOR TOTAL NURSING
INCLUDING FORTY FIVE MINUTES
OF OUR IN TIME AND TWENTY
FOUR HOUR ARE IN COVERAGE
WE ALSO STRONGLY RECOMMEND
ELIMINATING ALL STAFFING
WAIVERS WHICH ONLY SERVED
TO REDUCE AND KEEP WAGES LOW
IN ADDITION A WE FOUND THAT
NURSING HOMES WITH OVER FIFTY
PERCENT TURNOVER RATES HAD
THIRTY PERCENT MORE WORDS
THIRTY PORT PERCENT MORE
LIKELY TO HAVE HIGHER INFECTION
RATES WE URGE REQUIRING A
FIFTEEN PERCENT INCREASE IN
NURSING ASSISTANT WAGES IN
THE COMING YEAR TO REDUCE
TURNOVER TO REDUCE THE STAFFING
SHORTAGES AND PREVENT WORKERS
FROM WORKING IN MULTIPLE
DIFFERENT FACILITIES AND TO
INCREASE WORK PRODUCTIVITY
SECOND EARLY IN THE PANDEMIC
CALIFORNIA FOR PROFIT NURSING
HOMES HAD FOUR TO FIVE TIMES
HIGHER COALBED INFECTION
RATES COMPARED TO NON PROFIT
AND GOVERNMENT FACILITIES
PROBABLY BECAUSE THEY WERE
NOT SPENDING ADEQUATE AMOUNTS
OF DIRECT CARE SERVICES SO WE
HAVE TWO RECOMMENDATIONS ONE
REQUIRING THAT NURSING HOMES
SUBMIT AN ANNUAL CONSOLIDATED
FINANCIAL REPORT BY A CERTIFIED
AUDITOR FOR ALL RELATED PARTY
ORGANIZATIONS AND ENTITIES
INCLUDING PARENT MANAGEMENT
AND PROPERTY COMPANIES AND
SECOND ESTABLISHING FINANCIAL
LIMITS ON ADMINISTRATIVE COSTS
AND PROFITS ON THE ENTIRE
NURSING HOME COMPANY SO THAT
THE REMAINING FUNDS CAN BE USED
FOR DIRECT CARE SERVICES NEW
JERSEY HAS JUST PASSED SUCH A
LAW REQUIRING NINETY PERCENT
OF EXPENDITURES FOR DIRECT
CARE SERVICES THIRD CALIFORNIA
HAS A LONG RECORD OF THE WEEK
SURVEY AGENCY OVERSIGHT AND
ENFORCEMENT WE RECOMMEND TWO
THINGS ONE ESTABLISHING CLEARER
QUALITY CRITERIA FOR ANY NEW
OWNER OR ANY CHANGES IN OWNERS
OR MANAGEMENT OF NURSING HOMES
AND ACTUALLY ENFORCING THESE
REQUIREMENTS IN ORDER TO FORCE
A SALE OF FACILITIES TO MORE
RESPONSIBLE OWNERS WHEN IT
BECOMES NECESSARY AND SECOND
STRENGTHENING THE OVERSIGHT AND
ENFORCEMENT IN ESPECIALLY IN
IT AT RISK FOR FACILITIES USING
PENALTIES BANS ON ADMISSION
AND TEMPORARY MANAGERS AND AT
RISK FACILITIES INCLUDE THOSE
WITH LOW STAFFING HIGH TURNOVER
FOR PROFIT OWNERSHIP LARGE
FACILITY SIZE AND FACILITIES
WITH HIGH PERCENTAGES OF
MINORITY RESIDENTS WITH
MALE RESIDENTS AND -- OLDER
RESIDENTS FINALLY TO PROVIDE
BETTER TOOLS FOR MONITORING
OVERSIGHT AND POLICIES WE ALSO
RECOMMEND HAVING CD P.
H.
AN ARCH BREAD ASSORTED TO
OBTAIN DATA ON RESIDENT CAN'T
CHARACTERISTICS AND PAY ROADS
STOPPING FROM CMS AND TO MAKE
THESE AVAILABLE PUBLICLY AND
TO USE THOSE FOR MONITORING
HIGH RISK FACILITIES AND
FINALLY ESTABLISHING A CENTER
FOR CALIFORNIA NURSING HOME
RESEARCH THAT COLLECTS AND
INTEGRATES RELEVANT DATA AS
SOON AS IT BECOMES AVAILABLE
IN ORDER TO DO RAPID CYCLE
RESEARCH TO SUPPORT POLICY AND
LEGISLATIVE DEVELOPMENTS SO IN
CLOSING BY ADDRESSING STAFFING
AND WAGES TRANSPARENCY AND
OVERSIGHT AND ENFORCEMENT THE
LEGISLATURE CAN PROTECT THE
HEALTH AND SAFETY OF RESIDENTS
AND STAFF FROM FURTHER COALBED
INFECTIONS AND DEATHS AND AT
THE SAME TIME IT CAN TACKLE
THESE LONG STANDING QUALITY
PROBLEMS THAT CALIFORNIA
NURSING HOMES HAVE HAD THANK
YOU VERY MUCH THANK YOU
VERY MUCH DR HARRINGTON OUR
FINAL SPEAKER WILL BE GREAT
CORNETTO CEO PRESIDENT OF
THE CALIFORNIA ASSOCIATION OF
HEALTH FACILITIES MISTER CORNET
THE CALIFORNIA ASSOCIATION OF
HEALTH FACILITIES WE REPRESENT
OVER NINE HUNDRED SKILLED
NURSING FACILITIES AND OVER
FOUR HUNDRED INTERMEDIATE CARE
FACILITIES FOR THE DEVELOPMENT
DISABLED IN CALIFORNIA I
APPRECIATE THE OPPORTUNITY
TO PROVIDE COMMENTS TODAY AND
HOW ABOUT HOW SKILLED NURSING
FACILITIES ARE RESPONDING
TO THE KOBE PANDEMIC AND
THE CONTINUING CHALLENGES WE
FACED FROM OUR PERSPECTIVE
AND WHAT IMPROVEMENTS IN STATE
REIMBURSEMENT OVERSIGHT AT
COULD HAVE A POSITIVE IMPACT
ON THE QUALITY OF PATIENT
CARE GOING FORWARD I WANT TO
START OUT BY JUST FIRST OF ALL
THANKING THE TRIP THE THE WORK
FORCE THE TREMENDOUS A TIRELESS
WORK FORCE AND ALL HEALTHCARE
US LONG TERM CARE FACILITIES
IN OUR STATE WHO DO THE BEST
EVERY DAY TO KEEP OUR FRAGILE
ELDERLY POPULATION SAFE AND
PROTECTED CAST MEMBERS AND ALL
OF OUR LONG TERM HEALTH CARE
WORKERS SHOULD BE RECOGNIZED
FOR THEIR DEDICATION AND
SACRIFICE I ALSO WANT TO TALK
A LITTLE BIT ALSO ABOUT THE HOW
WE HAVE STEPPED UP TO THE PLATE
AND WE ARE SEEING SIGNIFICANT
STABILIZATION OF PATIENT CARE
THROUGH IMPROVED DETECTION
CONTAINMENT AND PREVENTION OF
CORONAVIRUS YOU HEARD IT STEIN
OCCURRED EARLIER IN THE --
HEARING -- GIVE ME A LATEST IT
JUST TAKES THEIR WELL OUTLINED
IN PAGES FOUR AND FIVE OF YOUR
AGENDA AS WELL AS OF YESTERDAY
ARE -- THERE WERE ABOUT SEVEN
HUNDRED UP POSITIVE RESIDENTS
OF RESIDENTS IN SKILLED NURSING
LEE OUT OF OVER A HUNDRED
THOUSAND BETWEEN A HUNDRED AND
FRIENDLY A HUNDRED TWO HUNDRED
TWENTY THOUSAND ABOUT SEVEN
HUNDRED POSITIVE RESIDENTS AND
ONLY ABOUT EIGHT POSITIVE STAFF
OUT OF ABOUT A HUNDRED FORTY
THOUSAND STAFF TO THERE'S BEEN
TREMENDOUS IMPROVEMENT BUT
THERE ARE STILL CHALLENGES THAT
REQUIRE CONTINUED STATE SUPPORT
GOING FORWARD I'D LIKE TO START
OUT BY JUST TELLING YOU LITTLE
BIT MORE ABOUT WHAT WE'RE
DOING NOW AND YOU HEARD SOME
OF THIS FROM HEIDI FIRST EACH
FACILITY IS REQUIRED TO HAVE
AND IT HERE TO A COMPREHENSIVE
COBIT NINETEEN MITIGATION PLAN
APPROVED AND MONITORED BY CDPH
MITIGATION PLANS ARE LIVING
DOCUMENTS AND THEIR FREQUENTLY
UPDATED TO ADDRESS CURRENT
CIRCUMSTANCES BACK AT THE
TESTING IS ESSENTIALLY REQUIRED
ELEMENT OF OF THE FACILITY
PREVENTION AND CONTAINMENT OF
COVERT NINETEEN RESIDENTS ARE
MONITORED DAILY AND ARE TESTED
IF THEY HAVE BEEN EXPOSED TO A
COPA NINETEEN POSITIVE RESIDENT
ARE HEALTHCARE WORKERS ANYONE
WITH SYMPTOMS IS NOT ADMITTED
AND RESIDENTS AND STAFF SHOWS
SHOWING SYMPTOMS ARE TESTED
IMMEDIATELY IF RESIDENTS OR
STAFF OUR COBIT POSITIVE THEY
QUARANTINE FOR FOURTEEN DAYS
AND FOLLOW SPECIFIC PROTOCOLS
SAID CMS AT THE FEDERAL LEVEL
AND CDPH BOTH REQUIRE WEEKLY
TESTING OF STAFF WHICH INCLUDES
WHICH GET -- COINCIDES WITH
-- TESTING REQUIREMENTS IN
MANY LOCAL GOVERNMENTS AS WELL
TESTING HAS IMPROVED GREATLY IN
RECENT MONTHS AND THE RESULTS
ARE COMING BACK MORE QUICKLY
-- AND THEY ALSO REPORTED TO
CDPH AND TO AND TO SEE A MASS
AND THE CENTERS FOR DISEASE
CONTROL IN WASHINGTON THIRD
SKILLED NURSING FACILITIES ARE
USING A VARIETY OF REQUIRED --
PERSONAL PROTECTIVE EQUIPMENT
PP TO PROTECT THEIR HEALTHCARE
WORKERS AND RESIDENTS WITH
MANDATORY USE OF GALLONS GLOVES
AND MASKS THIS PP IS MUCH
BETTER AVAILABLE NOW THAN IT
WAS IN PREVIOUS MONTHS AND I
WOULD RECOMMEND -- S.
B.
TWO SEVENTY FIVE WHICH PASSED
THIS SESSION WHICH REQUIRE
STOCKPILING OF PP TO HAVE IT
ON HAND FOR FUTURE PANDEMICS
FOURTH FACILITIES HAVE
INCREASED INFECTION PREVENTION
AND CLEANING EACH FACILITY HAS
A CLINICAL STAFF MEMBER WITH
ADVANCED TRAINING DESIGNATED
FOR INFECTION PREVENTION AND
CONTROL THE TRAINS OTHER STAFF
ON INFECTION CONTROL PROCEDURES
EXTENSIVE CLEANING OF RESIDENT
ROOMS COMMON AREAS AND HIGH
TOUCH SERVICES HAVE ALSO
INCREASED AND THOSE OF HELP
REDUCE THE POTENTIAL COVERT
EXPOSURE I POINT OUT ALSO --
-- MISTER WOODS -- EIGHTY TWO
SIX FOUR FOUR WHICH PASSED
THIS YEAR AND REQUIRES EACH
FACILITY TO HAVE AN INFECTION
PREVENTION NEST ON STAFF WE
APPROPRIATE TRAINING FOR ALL
STAFF MEMBERS FIFTH NURSING
FACILITIES HAVE INCREASED
STAFFING HOURS TO ALLOW MORE
PERSONALIZED RESIDENT CARE
AS IN AS COMMUNAL DINING AND
GROUP ACTIVITIES HAVE BEEN
CANCELED -- SCREENING TESTING
AND REPORTING THE CODE BY RICK
SCOBEY STATUS OF RESIDENTS
AND STAFF TO MULTIPLE AGENCIES
ALSO REQUIRES ADDITIONAL
STAFF TIME EVERY EXTRA STAFF
TIME IS BEING UTILIZED TO
FACILITATE RESIDENT INTERACTION
WITH FRIENDS AND LOVED ONES
ACTIVITY STAFF HAVE TRANSITION
TO PROVIDING ROOM VISITS AND
ACTIVITIES TO ENGAGE RESIDENTS
AND KEEP THEM AS ACTIVE AS
POSSIBLE AND FINALLY I WANT
TO MENTION VISITATION HALF MY
ORGANIZATION STRONGLY SUPPORTS
SAFE VISITATION PRACTICES IF
THEY ARE IMPORTANT FOR THE
EMOTIONAL WELL BEING AND HEALTH
OF OUR RESIDENTS WHETHER IT'S
OUTDOOR OR INDOOR GUIDELINES
HAVE BEEN ESTABLISHED BY THE
FEDERAL GOVERNMENT AND BY CDPH
THE GUIDELINES DEPEND ON THE
POSITIVITY RATE NEEDS COUNTY
-- SIGNIFICANT RESTRICTIONS TO
VISITATION BASED ON A VARIETY
OF FACTORS OF THEIR HELD
MOST OFTEN OUTDOORS WHENEVER
PRACTICAL INDOOR VISITATIONS
ALLOWED IF THERE IS NO RESPONSE
TESTING OR OUTBREAK VISITS ARE
CONDUCTED ARE CONDUCTED ONE OF
THE TIME LIMIT IS LIMITED AND
VISITS ARE HELD IN THE SINGLE
ROOM WERE DESIGNATED AREA THE
CORE PRINCIPLES ARE MAINTAINED
FOR VISITATION TO OCCUR WHICH
INCLUDE SCREENING HAND HYGIENE
SOURCE CONTROLLED PHYSICAL
DISTANCING AND THE LIKE I WANT
TO ALSO THANK THE COMMITTEE FOR
LOOKING AT THE ISSUE IMPORTANT
ISSUES OF OF -- NURSING
HOME FINANCING AND THANK THE
COMMITTEE FOR THE SUPPORT OF
THIS YEAR'S BUDGET AND EIGHTY
EIGHTY ONE THAT BILL CONTAINED
IMPORTANT REFORMS TO MEDICARE
FINANCING FOR NURSING HOMES
AND I WANT TO HIGHLIGHT A FEW
OF THOSE BUT YOU PASSED THIS
YEAR YOU CONTINUE THE COST BASE
SPECIFIC A COST BASED FACILITY
SPECIFIC A MEDIC CAL RATE
REIMBURSEMENT STRUCTURE AND
YOU IMPROVE FUNDING FOR DIRECT
LABOR COST -- YOU MAY NURSING
HOME FACILITIES ACCOUNTABLE
FOR THE CLOVER NINETEEN
RESPONSE AS A CONDITION OF
RECEIVING ADDITIONAL INCREASE
REIMBURSEMENT YOU'RE SURE
THAT THE FEDERAL DOLLARS FOR
THE PANDEMIC OR UTILIZED AN
AUDITING AUDITED FOR SPECIFIC
PANDEMIC COST YOU CREATED THE
PENALTIES FOR FACILITIES THAT
ARE ADDITIONAL PENALTIES THAT
ARE NOT CONFER FACILITIES THAT
ARE NOT COMPLIANT WITH STAFFING
WAIT REQUIRED OUT BUT I WOULD
JUST POINT OUT TO EVEN WITH THE
PASSAGE OF THIS RECENT BUDGET
BILL MEDIC CAL STILL UNDER PAYS
NURSING FACILITIES FOR PATIENT
CARE THEY PROVIDE THE MEDICARE
PROGRAM IS THE PRIMARY PAYER
FOR NURSING FACILITIES MAKING
UP ABOUT SEVENTY PERCENT OF
THE LONG TERM CARE POPULATION
THE MEDICARE REIMBURSEMENT
STRUCTURE IS STRUCTURED WITH
SIGNIFICANT COST CONSTRAINTS
AND LIMITATIONS FACILITIES
ARE INCENTIVIZED TO SPEND MORE
DOLLARS ON STAFF WAGES BUT THEY
ONLY RECEIVE A PORTION OF THOSE
COSTS THE MEDIC HELP PROGRAM AS
REIMBURSEMENT DUE TO INHERENT
CAPITATION ON FUNDING FOR
LABOR THERE ARE SOME FACILITIES
HAVE AN ONGOING SHORTAGE OF
CERTIFIED NURSE ASSISTANTS AS
WELL AS LV ENDS AND RN'S THIS
HAPPENED LONG BEFORE THE COPA
-- NINETEEN PANDEMIC AND IT
HAS BEEN EXACERBATED WITH THE
CHALLENGES AS NORTH AS SKIP AS
HEALTHCARE WORKERS -- MAY NEED
TO QUARANTINE FOR FOURTEEN DAYS
CHILD CARE CONCERNS THE FEAR
OF CONTRACTING CO THAT HAVE
ALSO MADE THIS MORE DIFFICULT
BUT EVEN WITH ALL THIS WE HAVE
SEEN GREAT PROGRESS IN IN THE
CONTROL THE VIRUS TO LOOK AT
IMPROVING STAFFING IN NURSING
HOMES THAT'S THEM PAIRED
THAT THE STATE BE PREPARED TO
ACTUALLY PAY FACILITIES FOR
THEIR LABOR COST SO THAT THEY
CAN AFFORD THE WAGES NECESSARY
TO RECRUIT AND RETAIN HEALTH
CARE WORKERS IN ADDITION
THE STATE NEEDS TO ASSIST
FACILITIES IN RECRUITING AND
RETAINING OF THE NEEDS OF WORK
FORCE -- THROUGH WORKFORCE
DEVELOPMENT FINALLY BEYOND
LOOKING AT MORE ADEQUATE
MEDICAL HEALTH FINANCING FOR
LABOR COST WE WANT TO SUGGEST
A COUPLE OF OTHER ITEMS --
GOING FORWARD THAT WOULD HAVE
AN IMMEDIATE POSITIVE IMPACT
CONTINUING TO PRIORITIZE
NURSING FACILITY RESIDENTS AND
STAFF IN EVERYTHING THAT THE
STATE DOES OF THIS WILL INCLUDE
THE VACCINE THE DISTRIBUTION
OF THE VACCINE AND I CAN
TALK MORE ABOUT THAT AND THE
QUESTIONS THERE'S A LOT OF
POSITIVE THINGS HAPPENING AT
TO PREPARE FOR THE VACCINE
INCREASING THE ACCESS OF
NURSING FACILITIES TO TESTING
KITS THAT PROVIDE TIMELY
RESULTS ALTHOUGH TESTING IS
GETTING BETTER THERE ARE STILL
HURDLES AND COST CONSTRAINTS
ALSO I JUST WANTED TO MENTION
A FEW OTHER THINGS FOR THE
PURPOSES OF ITS EXISTING AND
PUBLIC TRANSPARENCY ALSO RIGHT
NOW THERE IS NO CLEAR WEBSITE
WHERE ANYONE CAN ACCESS ALL
FEDERAL STATE REQUIREMENTS
AND LOCAL REQUIREMENTS IN ONE
PLACE WE HAVE URGED THE STATE
TO DIVERT TO DEVELOP SUCH
SUCH A UP A PORTAL SO EVERYONE
CAN UNDERSTAND EVERYTHING AT
ONCE IN ONE PLACE A DEDICATED
PP FOR SKILLED NURSING HOME
CARE WORKERS IT'S GOING TO
BE IMPORTANT GOING FORWARD
AS WE WILL SEE GAPS PROBABLY
CONTINUE IN THE AVAILABILITY
OF EQUIPMENT AND LASTLY BUT NO
LESS IMPORTANT THE STATE MUST
PROVIDE FUNDING FOR NURSING
FACILITIES TO COVER THE COST
ASSOCIATED WITH SIGNIFICANT
LIABILITY AND WORKERS COMP
RATES DUE TO THE PANDEMIC
NURSING FACILITIES RATES ARE
SKYROCKETING FOR PANDEMIC
COVERAGE AND WHAT IT AND THAT
WHEN THEY ARE LUCKY ENOUGH TO
EVEN BE ABLE TO FIND INSURANCE
COVERAGE IN MOST CASES --
FACILITIES ARE NOT FINDING
CHARACTER CARRIERS THAT WILL
COVER THEIR LIABILITY OR THEIR
WORKERS COMP RISK RELATED TO
COPE WITH THE LAST POINT I
JUST WANNA MAKE THIS CHAIRMAN
OTHERS IS SKILLED NURSING
FACILITIES ARE NOT ISLANDS THE
ENTIRE HEALTHCARE PROVISION OF
PROFESSION IS STILL LEARNING
A LOT ABOUT THE DISEASE HOW IT
SPREADS AND HOW TO CONTAIN IT
UNFORTUNATELY NEITHER SNIFFS
IN OUR HOSPITALS OUR ISLANDS
AND WE ARE ALL PART OF THE
COMMUNITY OUR COMMUNITIES
OUR EMPLOYEES LIVE IN THE
COMMUNITY AS TO THE VENDORS AS
TWO PHYSICIANS AND SPECIALISTS
AND OTHERS WHEN VISITING
RAMPS UP WE WILL HAVE FAMILY
MEMBERS FROM THE COMMUNITY
TO FACILITIES THAT HAVE
TAKEN AGGRESSIVE PREVENTIONS
PRACTICES BUT THEY ARE NOT
ISOLATED AND WHAT HAPPENS
IN THE COMMUNITY FREQUENTLY
FINDS ITS WAY INTO BUILDINGS
EVEN WITH THE MOST AGGRESSIVE
PREVENTION PRACTICES THANK
YOU VERY MUCH MR CHAIRMAN
I'M HAPPY TO ANSWER QUESTIONS
THANK YOU VERY MUCH GOOD
QUESTION FROM THE COMMITTEE
MISTER MONTE I HAVE A COUPLE OF
QUESTIONS FOR THE CDPH FORGET
MISS STEIN OCCURRED -- BACK
OTHERS YOU YEAH
I AM BACK THANK YOU VERY MUCH
SO I KNOW THAT WE ALL SHARE A
CONCERN ABOUT THE FACT THAT THE
LACK OF VISITATION HAS HAD ON
THE EMOTIONAL AND PSYCHOLOGICAL
PSYCHOLOGICAL HEALTH OF THE
RESIDENTS OF THESE FACILITIES
SO I'M WONDERING IF THE
CDPH HAS SOME DATA ON THOSE
STATISTICS -- AND EFFECTIVE
IS THE LACK OF THE STATIONS
HAD ON THEM I BECAUSE I HAVE
NOT -- I'VE NOT SEEN ANY DATA
ON THAT THANK YOU SENT I WE
HAVE BEEN WORKING WITH THE
CALIFORNIA DEPARTMENT OF AGING
AND THE OMBUDSMAN PROGRAM --
TO LOOK AT DATA -- ONE OF THE
PARTNERSHIPS THAT WE'VE HAD
WITH THE CALIFORNIA DEPARTMENT
AGING IS WORKING WITH -- I'M
BUDS MEANT TO FIND -- ARE
THEIR CONCERNS I'M FOR THOSE
THAT EITHER HAPPENED BACK IN
ITS FACILITIES OR WE ARE ALSO
PROVIDING TECHNICAL ASSISTANCE
TO THE OMBUDSMAN SO THAT THEY
CAN GET INTO THE FACILITIES --
AND SEE IF WE CAN GO ON OUT ANY
TYPES OF QUALITY OF CARE DATA
EXCEPT TRUCK -- WE ALSO WHEN WE
GO INTO FACILITIES AS LICENSE
-- AND CERTIFICATION SURVEYORS
WE'RE NOT JUST LOOKING AND
FACTION PREVENTION WHEN WE'RE
THERE WE'RE LOOKING TO SEE
ARE THERE ISSUES WITH QUALITY
OF CARE OTHER ISSUES WITH
LEADERSHIP OTHER ISSUES WITH --
WITH NUTRITION AND THERE HAVE
BEEN MANY CITATIONS THAT WE'VE
GIVEN THROUGHOUT -- THE COURSE
THE PANDEMIC OR HAD TO TAKE
EVEN MORE AGGRESSIVE OPTIONS
-- LIKE PUTTING IN TEMPORARY
MANAGERS -- OR DOING -- ARE
REVOCATION EXCEPT TRACK ON TO
THOSE SITUATIONS BUT ONE OF
THE THINGS THAT DOES GIVE ME
A LITTLE BIT OF HOPE -- AFTER
-- YOU KNOW FOR YOUR QUESTION
ABOUT WHAT ARE THE LONG
TERM EFFECTS OF SOME OF THIS
ISOLATION AS WE WERE LOOKING AT
OVERALL MORTALITY RATE TO SEE
IF THE OVERALL MORTALITY RATE
IS HIGHER THIS YEAR -- AND THEN
LAST YEAR OR IN PREVIOUS YEARS
AND LOOKING AT WHAT THE EFFECTS
OF YOU KNOW COPD MORTALITY
VERSUS OVERALL MORTALITY -- WE
ARE SEEN LOW RATES AND LOWER
RATES OF MORTALITY IN OUR AND
SKILLED NURSING FACILITIES
-- BUT WE THINK THAT THAT
COULD BE BECAUSE THE INFECTION
CONTROL PRACTICES ARE SO MUCH
GREATER NOW THAT PERHAPS --
PEOPLE ARE NOT EXPOSED TO
OTHER POTENTIAL YOU KNOW AS
COMMUNICABLE DISEASES WITH
THEN AND AND OTHER THINGS
THAT CAN CAN HAPPEN -- BUT
THAT'S NOT TO SAY THAT THERE
AREN'T ISSUES WE ARE TRACKING
WHAT TYPES OF COMPLAINTS WERE
RECEIVING AS WELL AS FACILITY
REPORTED INCIDENCES ON AND
MOST OF OUR COMPLAINTS AROUND
THIS TATIAN -- AND AS I SAID
IN MY TESTIMONY ONE OF THE
THINGS THAT WAS A FACTOR IS
THAT WHEN WE ISSUED AND RE
OPENED FACILITIES ON JUNE
TWENTY SIX -- THE STATE MIGHT
HAVE YOU KNOW SAID HEY WE'RE
REOPENING REQUIRING VISITATION
BUT MANY LOCAL CUT CUT PUBLIC
AND HEALTH OFFICERS HAD
MORE STE -- STRICTER LOCAL
PUBLIC HEALTH ORDERS THAT
RESTRICTED ON BUSSMANN --
WOULD RESTRICT VISITATION ON
AND SO WHEN THOSE CAME OUT --
WE THEN STARTED TO MEET WITH
PUBLIC HEALTH OFFICERS ONE
ON ONE TALK THROUGH WHAT THE
CONCERNS WERE BECAUSE WE DO
HAVE CONCERNS ABOUT ISOLATION
AND OF COURSE THEY DO AS WELL
BUT WE'RE TRYING TO PARTNER
TOGETHER ON THE SCIENCE AND
USING SCIENCE BASED PRACTICES
TO SAY HEY VISITATION SHOULD
BE A REQUIREMENT IS IS PATIENT
RIGHT -- AND SO WE WANT TO MAKE
SURE THAT WE HAVE C.
PROTOCOL TO DO SO SO THAT'S
WHY BEFORE WE ISSUE THE SECOND
VISITATION AFL TO RE OPENED
FURTHER WE DID A DIFFERENT
PRACTICE WE FIRST MET WITH
ALL THE PUBLIC HEALTH OFFICERS
ASKED FOR THEIR FEEDBACK
AND SO WHEN WE ISSUE THAT ON
FRIDAY OUR HOPE IS THAT OVER
THE NEXT WEEK OR SO WE HOPE
THAT THE LOCAL PUBLIC HEALTH
-- OFFICERS THAT HAVE --
STRICTER GUIDELINES WELL NOW
-- MORE ALIGNED THEMSELVES
WITH THE STATE RE OPENING
BUT AGAIN WITH SAFE PRACTICES
AND PROTOCOLS THAT WE HAVE
LISTED OUT IN OUR POLICY THANK
YOU ARE THE REASON I RAISE
THE ISSUE IS THAT I HAVE HAD
PERSONAL CONTACT FROM QUITE
A FEW CONSTITUENTS BUT I'M
SURE PROBABLY EVERYONE ON THIS
DíAS HAS WELL VERY CONCERNED
ABOUT LOVED ONES THAT ARE IN
SKILLED NURSING FACILITIES THAT
THEY ARE UNABLE TO ESTABLISH
VISITATION WITH AND -- I DO
NOT SHARE YOUR CONFIDENCE
THAT THE ABRIDGEMENT ARE GOING
TO BE ABLE TO HIGHLIGHT THE
EXTENT OF THIS EMOTIONAL AND
PSYCHOLOGICAL PROBLEMS BECAUSE
THE DATA THAT I HAVE SAYS THAT
WE HAD ALMOST SEVEN THOUSAND
A BUNCH BEEN VISITS TO SKILLED
NURSING FACILITIES A YEAR AGO
IN OCTOBER AND THAT THIS MONTH
IT'S BEEN AROUND A THOUSAND SO
I'M CONCERNED THAT WE MIGHT NOT
BE GETTING THE FULL PICTURE OF
HOW PERVASIVE THIS PROBLEM IS
AND I KNOW THAT IT'S SOMETHING
THAT OUR CONSTITUENTS ARE VERY
CONCERNED ABOUT SO I DON'T HAVE
TO ASK IF WE CONTINUE TO WORK
ON THIS BECAUSE I THINK THAT
THERE IS PROBABLY A PROTOCOL
THE CAN BE ESTABLISHED THAT
THAT -- ENHANCES VISITATION
WHILE STILL PROTECTING THE
HEALTH OF THE RESIDENTS OF THE
FACILITY A GREAT GREAT ALSO
MY SECOND QUESTION IS ABOUT
THE STATE'S VA FACILITIES
-- I KNOW THAT THEY SERVE --
VERY LARGE POPULATION IN THEIR
SKILLED NURSING FACILITIES
BUT I DON'T BELIEVE THAT
WE'VE HAD ANY MAJOR COVERT
OUTBREAKS IN THOSE FACILITIES
AND I WONDER IF YOU CAN TALK
A LITTLE BIT ABOUT WHY THAT IS
AND WHAT IT WHAT DISPARITIES
MIGHT EXIST BETWEEN THE VA
AND THE OTHER SKILLED NURSING
FACILITIES IN THE STATES
BECAUSE I FOUND THAT VERY ODD
THAT'S AN INTERESTING
OBSERVATION -- ABOUT THE THAT
THE ACE I CAN TAKE THAT BACK
AND LOOK MORE INTO THAT DETAIL
BECAUSE I WANT TO BE ABLE TO
PULL THAT TO PULL THE DATA ON
THAT TO SEE BECAUSE I DON'T
HAVE ENOUGH INFORMATION AT
THIS TIME TO BE ABLE TO KIND
OF SPEAK TO WHY THAT MAY BE A
WAY THAT NOT BE IT MAY BE --
BUT I WILL DEFINITELY TAKE THAT
BACK IS IT IS IT SOMETHING TO
LOOK INTO FOR OUR ANALYTICS
OKAY WELL THANK YOU AND IF YOU
CAN CALL MY OFFICE ON THAT I
I WAS VERY INTERESTED IN THAT
YEAH NOW THAT IS INTERESTING
THAT AND IF THERE MIGHT BE
SOME GOOD LESSONS LEARNED
THERE BECAUSE OBVIOUSLY THOSE
FACILITIES ARE DOING SOMETHING
RIGHT IF WE'RE NOT SEEING THE
SAME DEGREE OF OPERATE THERE
IS WE ARE ELSEWHERE THANK YOU
THANK YOU NEXT GRAB THE DOCTOR
REGULAR THANK YOU MISTER CHAIR
AND -- IF I COULD I WANT TO
START -- WITH THE THANK YOU
AS WELL TO MONEY ACKERMAN
WHO HAD GOTTEN INFECTED WHILE
WORKING IN A SNAP I THINK IT'S
IMPORTANT TO RECOGNIZE THOSE
WHO ARE ON THE FRONT LINES
HAVING BEEN A PROVIDER MYSELF I
UNDERSTAND AND APPRECIATE WHAT
PANDEMIC FATIGUE LOOKS LIKE
AND OFTEN TIMES THAT'S WHEN
WE DON'T START APPRECIATING
THOSE WERE WORKING SO HARD
RIGHT NOW SO MARIA CARMEN I
JUST WANTED TO MAKE SURE YOU
FELT IT FROM US HERE ON THE
DIESS THAT WE'RE HERE TRYING
TO FIGURE OUT HOW TO HELP TO
SUPPORT YOU BUT I DID WANT TO
TALK ABOUT WHAT CREEK CORNETT
SAID BECAUSE HE SAID WE DON'T
HAVE A CNA PROBLEM OR WE DID
HAVE A CNA PROBLEM BEFORE WE
STARTED THIS PANDEMIC AND I
THINK WE REALLY HAVE TO LOOK
TOWARDS WAYS WE CAN SUPPORT
OUR WORK FORCE BE A RETENTION
OR RECRUITMENT AND WANTED
TO HEAR FROM YOU REGARDING
THE WORK FORCE DEVELOPMENT
THAT YOU SPOKE ABOUT AND
THEN IF I CAN I'M GOING TO BE
QUEUING UP NICOLE HOW OLD TO
COME UP AND SPEAK ABOUT THE
HEALTH CARE PATHWAYS THAT SHE
REFERENCED IN HER COMMENTARY
SO IF WE COULD START WITH CRANK
CORNET ONE YES YES BANK THANK
YOU DR ARAMBULA THE WORK FORCE
IS WORKFORCE IT'S SO IMPORTANT
TO THE SECTOR BUT IT'S NOT
JUST US IT'S ALL PRETTY
MUCH EVERYONE IN THE ENTIRE
HEALTHCARE SECTOR RIGHT NOW
WORKFORCE IS A MAJOR ISSUE -- I
WAS A MEMBER OF THE MASTER PLAN
FOR AGING STAKEHOLDER GROUP
THAT IS JUST FINISH AT WORK AND
THERE'S A MAJOR SECTION THERE
ABOUT WORKFORCE DEVELOPMENT
THIS IS GOING TO TAKE ALMOST A
NATIONAL OR OUR STATE STATEWIDE
EFFORT IN TERMS OF TRAINING
BRINGING IN MORE HEALTHCARE
WORKERS ESPECIALLY C.
N.
A.'S BUT REALLY IN THE NURSING
AND AND THE LPN AND RN --
AREAS AS WELL -- AND YOU'VE
ALSO HEARD TODAY THAT THE SOME
OF THE IDEAS OF PUTTING MORE
MONEY IN FOR PAY FACILITIES
WOULD LOVE VERY MUCH TO BE
ABLE TO PAY MORE BUT AT THIS
POINT THERE THEY WILL NEED TO
HAVE INCREASES IN RATES TO DO
THAT -- THEY'RE JUST THEY'RE
JUST NOT ENOUGH MONEY IN THE
SYSTEM TO DO THAT -- I KNOW
THIS IS A MAJOR ISSUE AT THE
FEDERAL LEVEL -- RIGHT NOW AND
RIGHT NOW AS WELL I WOULD JUST
POINT OUT CALF FOR EXAMPLE WE
HAD A -- A GRANT RECENTLY TO
ESTABLISH MORSE FACILITY BASED
WORKFORCE TRAINING PROGRAMS
THAT WAS VERY SUCCESSFUL
BUT WE ARE SO FAR BEHIND THE
CURVE ON THAT IT'S GOING TO
TAKE IT'S GONNA TAKE A WHILE
THE NOTION OF BEING ABLE TO
INCREASE THE WORKFORCE IN A
REALLY FAST WAY IS I THINK
IT'S VERY DAY DIFFICULT TO
MATCH BECAUSE THE STATE AND IN
THIS QUESTION WILL BE DIRECTED
TOWARDS -- THE STATE BUT WHAT
HAVE WE EVER LOOKED AT ANY
OUTRAGE OR PR CAMPAIGNS THAT
MAY HELP US TO RECRUIT MORE
PEOPLE INTO CNA'S -- I THINK
IT'S PARTICULARLY IMPORTANT
NOW AS WE LOOK AT THE ECONOMIC
CONDITIONS OF OUR STATE TO BE
PROVIDING PATHWAYS FOR MANY
PEOPLE WHO MAY HAVE CULTURAL
OR LINGUISTIC COMPETENCIES
HI THIS IS A SENATOR FROM
CALIFORNIA PART OF PUBLIC
HEALTH AND WE HAVE ACTUALLY
PUT INTO PLACE I'M TAKING A
LOOK AT ALL THE DATA BASE FROM
PREVIOUS CNA'S THAT WE HAVE
AND TRYING TO MATCH THEM TO
FACILITIES WHERE WE SAY THAT
THERE ARE OPENINGS WE KNOW
THAT THERE'S REGION'S THAT NEED
MORE STAFFING -- WE'VE DONE
SOME CREATIVE THINGS AROUND
THAT AROUND THE PANDEMIC BUT
WHEN IT COMES TO -- KIND OF
PR CAMPAIGNS I'M ONE OF THE
THINGS I WOULD LOVE TO WORK
WITH SOME OF OUR STAKEHOLDERS
I'M PARTICULARLY AND I'M I'M
CHARLENE AND I WANT TO TALK
TO NICOLE HOW AFTER THIS --
-- TESTIMONY BECAUSE I I WANT
TO KNOW MORE ABOUT WHAT THEIR
PROGRAM DOES BECAUSE ONE OF
THE THINGS I'VE NOTICED THAT
WE NEED TO DO AS A STATE IS
EVEN PARTNER BEYOND PUBLIC
HEALTH BUT PARTNER WOULD LOVE
TO PARTNER WITH DEPARTMENT
OF EDUCATION -- AND START TO
PROVIDE VOCATIONAL EDUCATIONAL
OPPORTUNITIES -- MUCH LIKE
WE USED TO YOU KNOW DECADES
AGO -- IN EVEN K.
THROUGH TWELVE AND
COMMUNITY COLLEGE AND AND
REALLY HAVE THAT -- C.
N.
A.'S AND ENTERING THE WORK
FORCE AND HAVING INTERNSHIPS
AT THE YOUNG AGE AS REALLY
HAVING A PATHWAY ON INTO OUR
HEALTH CARE WORK FOR SYSTEM
THANK YOU AND WITHOUT -- IF WE
CAN HEAR FROM NICOLE HOWLAND
-- I WILL JUST SAY IT WAS --
SO PLEASANT TO HEAR FROM YOU
I AM SO USED TO HEARING THE
COLEMAN BUT I UNDERSTAND WHY
SHE GAVE YOU THE SEATS TODAY
SO CAN WE HEAR FROM ABOUT
HEALTHCARE PATHWAYS FROM YES
I THANK YOU I APPRECIATE THE
OPPORTUNITY -- THE HEALTH CARE
KERR PATHWAY IS IN ITS SECOND
YEAR IT IS A COLLABORATIVE
PARTNERSHIP BETWEEN MY
PROGRAM OMBUDSMAN OPPORTUNITY
JUNCTION A LOCAL JOB TRAINING
ORGANIZATION AND MOUNT DIABLO
ADULT EDUCATION AS WELL AS
BILLION SUNGAI A SKILLED
NURSING PARTNER AND WHAT WE
REALIZE IS THERE WAS A DEARTH
OF CNA'S BUT MORE IMPORTANTLY
THERE IS A DEARTH OF RELEASE
YOU NAMES WHO WERE COMMITTED
TO PERSON CENTERED MODELS OF
CARE AND SO OUR MODEL WAS WE
NEED TO SEEK OUT INDIVIDUALS
WHO HAVE ADDRESSABLE BEARS
MEANING WE ARE LOOKING FOR
STUDENTS WHO MAY HAVE SOME
CHALLENGES IF YOU COULD GO AND
PAY UP FOR PRIVACY NAY PROGRAM
VAST ON OUR STUDENTS WE WANT
STUDENTS TO MAYBE THEY'RE THE
FIRST IN THEIR FAMILY TO GO
TO POST SECONDARY EDUCATION
MAYBE THEY'VE BEEN HOMELESS
IN THE PAST MAYBE IT HAD SOME
ADDICTION ISSUES WE BELIEVE
THAT THOSE PEOPLE REALLY
UNDERSTAND THE PLIGHT OF THOSE
WHO ARE IN SKILLED NURSING
FACILITIES BECAUSE I'M GONNA
TELL YOU A SECRET FOLKS ARE IN
SKILLED NURSING FACILITIES HAVE
NOT ALWAYS HAD EASY LIVES AND
SO WE NEED OTHER PEOPLE WHO'VE
MAYBE NOT ALWAYS HAVE EASY
LIVES TO UNDERSTAND ABOUT LOOKS
LIKE AND ARE SYMPATHETIC TO
THAT AND SO WE CREATED A NEARLY
THIRTEEN WEEK TRAINING PROGRAM
THAT IS COMPREHENSIVE IN NATURE
SO NOT ONLY DO WE HAVE LUNCH
BROUGHT IN EVERY DAY THROUGH
LOAVES AND FISHES THE STUDENTS
GO HOME WITH FOOD FROM THE FOOD
BANK EVERY WEEKEND IT IS VERY
LOW COST OR NEARLY FREE FOR THE
STUDENTS WE WORK WITH SKILLED
NURSING THAT OTHERS TO FIND
FUNDING SOURCES WHEN A STUDENT
HAS A CHALLENGE IF THEY SHOW
UP LATE OR THEY'RE ANGRY WE
DON'T ASSUME THAT THE PROBLEM
IS THE STUDENTS WE USE ROOT
CAUSE ANALYSIS TO LOOK AT WHAT
OUR RESTORED MODELS TO ADDRESS
THE SITUATION WHAT SYSTEM
BARRIERS ARE HAPPENING AND WE
HAVE JUST WE GRADUATED A THIRD
CLASS IN THE MIDDLE OF COLD AND
WE HAD A DRIVE UP GRADUATION
-- WE HAVE A VERY INCREDIBLY
HIGH GRADUATION RATE -- AND
OUR STUDENTS NOT ONLY WHEN
SOMEONE CAME IN A PROGRAM WHOSE
CHALLENGE BEFORE THAT WHEN
THEY HAVE A SKILL AND A JOB
THEY WALKED DIFFERENTLY THEY
TALK DIFFERENTLY AND WE HEAR
FROM FACILITIES HOW AMAZING
THEY ARE IN THE FACILITY YEAH
THERE'S A COUPLE OF KEY THINGS
ABOUT THIS PROGRAM I BELIEVE
COMMITTEE COLLEGES ARE AN
IMPORTANT PART THIS EDUCATION
SYSTEM BUT IT DON'T SCHOOLS ARE
THE HIDDEN GEM OF COMMUNITIES
MANY PEOPLE WHO MIGHT BE DRAWN
TO THIS OR MAYBE FIRST IN
THEIR FAMILY PURSUE THIS KIND
OF ENTRANCE AND ALLIED HEALTH
CARE THEY MAYBE WOULDN'T FEEL
SUPER COMFORTABLE ON A BIG
COMMUNITY COLLEGE CAMPUS ADULT
SCHOOLS ARE SMALLER THEY ARE
COZIER AND WHEN YOU PAIR THAT
WITH A COMPREHENSIVE NETWORK
OF THE ONLY SOFT SKILLS OR
HELPING THEM TO LEARN BUT ALSO
COMPREHENSIVE WRAPAROUND CASE
MANAGEMENT SUPPORT SERVICES
THEY CAN DO AMAZING THINGS I
WANT TO TELL YOU WHAT'S HARD
ABOUT THIS IS THE REQUIRED
CURRICULUM FROM CDPH IS
INCREDIBLY PRO SCRIPTED SO IT'S
VERY HARD TO SLIDE IN WHEN YOU
TALK ABOUT DEATH AND DYING WHEN
YOU TALK ABOUT PERSON CENTERED
CARE WHEN DO YOU ADDRESS
THESE THINGS A REALITIES OF
WORKING IN THE SYSTEM WHEN
THE CURRICULUM THE BROUGH
CURRICULUM DOESN'T NECESSARILY
ALLOW THAT WE NEED A SPECIAL
WHAT I CALL A SANDBOX WE NEED
A WAIVER PROGRAM TO ALLOW US
TO LOOK AT THESE PROGRAMS WHAT
IT WOULD TAKE TO REALLY FIND
THEM AND HOW CAN WE EXPAND THAT
ACROSS THE STATE WE ALSO NEED
PATHWAY PROGRAMS WE NEED REAL
PROGRAMS WHERE WE'RE WORKING
TO BUILD A HOME HEALTH AIDE
PROGRAM ON THAT AND AT THE
END WE NEED STACKABLE PROGRAMS
WERE INDIVIDUAL NOT HAVING TO
REPEAT CURRICULA BUT WE HAVE
A CONSTANT STEERING OF REALLY
QUALIFIED CERTIFIED NURSING
ASSISTANTS AND CAREGIVERS AND
ALSO WHEN THEY AND IN THERE FOR
A PERIOD OF TIME AND THEY'VE
MASTERED THAT SKILL BE ABLE
TO TAKE THAT AND MOVE ON TO LV
INTO OUR AND BECAUSE AS CRAIG
SAYS WE HAVE A LACK OF L.
THE END OF OUR ENDED FACILITIES
TO AND THE NEED IS ONLY GOING
TO GROW I WANT TO APPRECIATE
YOUR -- ANSWER AND IF I CAN
I WANT TO FOLLOW UP WITH MY
STAFF I THINK YOU ARE SETTING
AN EXAMPLE THAT MANY OF US
WILL WANT TO LOOK AT AND SEE
IF THERE'S POTENTIAL FOR US
TO SCALE AND SO WOULD REALLY
LIKE AN OPPORTUNITY TO GET MORE
INFORMATION -- WELLNESS DINERS
COMING TO THE -- MICROPHONE
I I WILL JUST COMMENT THAT
-- IT'S HARD NOT TO LOOK AT
THE GRAPH ON PAGE FOUR AND
NOTICED SOME CORRELATION
BETWEEN WENT ON FUNDS MAN WENT
BACK INTO FACILITIES AND WE
START NOTICING IMPROVEMENTS
BUT WANTED TO JUST APPRECIATE
YOU MISS STEIN OCCUR FOR
THE SIGNIFICANT REDUCTION IN
BOTH CASES AND MORTALITY IT'S
IMPRESSIVE WHAT WERE LOOKING
HARD AND JUST WANTS TO MAKE
SURE YOU HEAR THAT FROM THOSE
OF US HERE ON THE DYESS BUT I
WANT TO TURN TO PAGE FIFTEEN
IF I CAN AND IN THAT THERE
IS DISCUSSIONS REGARDING --
FLU VACCINATIONS FOR SNIFF
WORKFORCE AND STAFF AND SO
MISDIAGNOSIS HOPING TO SPEAK
WITH YOU IF I COULD THERE
ARE ESTABLISHED NATIONAL
GOALS FOR SMITH'S TO HAVE
NINETY PERCENT COVERAGE OF
THIS NETWORK FORCING STAFF
AND I'M WONDERING WHAT IS
CALIFORNIA'S CURRENT WORK FOR
STAFF FLU VACCINATION COVERAGE
SO CRAIG CORNET MAY PERHAPS BE
ABLE TO PROVIDE A LITTLE BIT
MORE INSIGHT TO THIS AS WELL
AS WE'VE BEEN TALKING MOST
RECENTLY ABOUT FLU COVERAGE I
AM AND I BELIEVE IT'S IN THE
MID NINETIES -- LAST -- THAT
I HAD HEARD -- SO CRAIG OF
IT'S JUST IF CORRECT ME IF I'M
WRONG BECAUSE I KNOW THAT YOU
HAD TO STOP YES IT'S IN THE
UPPER NINETIES ACTUALLY FOR
FOR FOR FLU VACCINATION FOR
RESIDENTS FOR STAFF IT'S NOT
QUITE AS HIGH BUT THE WAY THE
RULES OF WORK OVER THE YEARS
FOR FLU VACCINATION FOR STAFF
IS IT IF STAFF DO NOT REFUSE
TO HAVE A A FAX A VACCINATION
THEY HAVE TO WEAR ADDITIONAL
PP AND MASS WRAP THE ENTIRE
FLU SEASON THIS IS GOING TO
BE A DIFFERENT CONVERSATION
GOING FORWARD NOW OBVIOUSLY ON
THE KOBE BAXEEN BUT THE REST
OF THE THE VACCINATION FOR
FOR RESIDENTS IS IN THE UPPER
NINETY PERCENT AND THAT GIVES
ME COMFORT CRAIG BECAUSE -- IN
THE AGENDA IT HIGHLIGHTS THAT
APPROXIMATELY SIXTY PERCENT
NATIONALLY IS WHAT THE AVERAGES
FOR WORK FORCE OF CALIFORNIA
IS LEADING THE WAY ON THAT
I THINK THAT'S IMPORTANT I'M
FINAL QUESTION IF I CAN FROM
THE STEIN OCCUR AND -- I'M I
AM TRYING TO THINK A STEP AHEAD
AND -- IF NOT IF WHEN WE HAVE
A COVERT NINETEEN VACCINE I
THINK THERE'S GOING TO BE A
DISCUSSION ABOUT PRIORITIZATION
AND I THINK IT'S AN IMPORTANT
CONVERSATION FOR US TO THINK
ABOUT SHOULD WE BE PUSHING OUR
FIRST RESPONDERS TO THE FRONT
OF THE LINE BUT I BELIEVE WE
ALSO NEED TO LOOK TOWARDS OUR
CONGREGATE CARE SETTINGS ARE
SNAPS AND I WOULD LOVE TO HEAR
-- -- -- HI STEIN OCCUR WHAT
YOUR THOUGHTS ON WHETHER OR NOT
-- SNAPS SHOULD BE PRIORITIZED
AND KOPEN VACCINATIONS WELL
ABSOLUTELY AND -- WE DO HAVE A
A VACCINE WORK FORCE TASK FORCE
RIGHT NOW -- THAT IS LOOKING
AT ALL THE PRIORITIZATION
IS ACROSS ALL OF OUR HEALTH
CARE FACILITIES AS WELL AS
LOOKING AT WHO ARE THE MOST
VULNERABLE POPULATIONS -- THE
VACCINE OBVIOUSLY MANY OF THE
DIFFERENT OPTIONS OF VACCINES
RIGHT NOW -- DO PRESENT SOME
-- OPERATIONAL IMPLEMENTATION
CHALLENGES -- FOR EXAMPLE EVEN
THE FIZER VACCINE THAT HAS TO
BE -- STORED AT SUB SEVENTY
DEGREES -- AND THEN CAN ONLY
HAVE LIKE A TWELVE HOUR THOUGHT
TIME BEFORE THEN YOU CAN --
YOU KNOW VACCINATE OTHERWISE
IT'S A LONGER EFFICACIOUS --
SOME HAVE THERE IS LEVELS OF
EFFICACY FOR DIFFERENT TYPES
OF POPULATIONS INCLUDING --
MANY WHO WOULD RESIDE IN A
SKILLED NURSING FACILITY --
AND SO I THINK THE IMPORTANT
MESSAGE THAT WE'RE GOING TO
HAVE TO COME OUT VERY STRONGLY
AND CLEARLY IS MUCH LIKE WE
HAVE HAD -- COME CAMPAIGNS AND
INFORMATION ABOUT HOW IMPORTANT
IT IS THAT YOU MASK EVEN IF
YOU'RE YOUNG TWENTY THIRTY
HEALTHY YEAR OLD YOU KNOW
OUT THERE IT'S IMPORTANT THAT
YOU ABIDE AND YOUR DECISIONS
AND WEARING A MASK IN WHAT
YOU CHOOSE TO DO TO REMAIN
PHYSICALLY DISTANCE AND NOT DO
THESE HUGE GATHERINGS AND AND
SUCH THAT DIRECTLY AFFECTS --
ARE SKILLED NURSING RESIDENTS
AND OUR MOST VULNERABLE AND SO
MUCH LIKE WITH VACCINES -- YOU
KNOW WE ENCOURAGE VACCINES FOR
ALL AGES IN ORDER TO PROTECT
THOSE WHO ON THE VACCINE MIGHT
NOT BE AS EFFICACIOUS FOR SO
IT'S IMPORTANT THAT WE KIND
OF LOOK AT IT NOT JUST FROM
A PRIORITY TO GET THE VACCINE
BUT ALSO I'M HAVING VERY
STRONG -- PUBLIC -- SERVICE
ANNOUNCEMENTS NOT NONSENSE
OUT THERE ABOUT WHY IT'S SO
IMPORTANT THAT EVERYONE CHOOSES
-- TO DO -- THE PUBLIC HEALTH
THINGS LIKE VACCINES AND -- AND
MASCHINEN PHYSICAL DISTANCING
TO PROTECT THOSE -- WHO THEY
MIGHT NOT BE A -- THEY MIGHT
HAVE INTERACTION WITH THANK YOU
FOR DOCTOR REGULAR IF I COULD
ADD ON TO THE VACCINE ISSUE IN
THE LAST WEEK THE CENTERS FOR
DISEASE CONTROL AND WASHINGTON
HAS ANNOUNCED A PRIORITY
ITS PRIORITIZATION FOR THE
DISTRIBUTION OF THE FACTS THE
IN THE FEDERAL LEVEL AND TIER
ONE AND THE VERY FIRST PRIORITY
IS GOING TO BE SKILLED NURSING
RESIDENTS CONGREGATE CARE
RESIDENTS AND STAFF THE STATE
THAT THE FEDERAL GOVERNMENT
CDC HAS ALREADY ESTABLISHED
A PARTNERSHIP PROGRAM TO
DISTRIBUTE THE VACCINES AND
COME TO THE FACILITIES TO
VACCINATE PRESIDENT AS SOON
AS THE -- VACCINE IS AVAILABLE
AND SAFE AND READY TO GO THAT'S
GOING TO BE A HUGE LEAP FORWARD
THE STATE WILL BE WORKING WITH
FEDERAL GOVERNMENT TO ESTABLISH
THAT THE HOW THEY'RE GOING
TO ROLL OUT THE VACCINE FOR
THAT FOR HEALTHCARE WORKERS
BUT BUT THIS IS WHAT THIS IS
WELL UNDERWAY IT IS THAT CAN
BE A DAUNTING CHALLENGES YOU
CAN IMAGINE AND WE DON'T KNOW
WHICH VACCINE IS GOING TO BE
THE THE MOST EFFICACIOUS AT
THIS POINT SOME HAVE TO BE WAS
STORED AT MINUS EIGHTY DEGREES
BUT THE THE FOLKS WHO ARE GOING
TO COME IN TO SKILLED NURSING
FACILITIES TO VACCINATE THE
RESIDENTS WILL HAVE ALL OF THAT
THEY'LL HAVE THE PP THEY'LL BE
ABLE TO DO THOSE VACCINATIONS
WE'RE VERY MUCH LOOKING FORWARD
TO THAT THANK YOU VERY MUCH
THANK YOU KNOW WE HAVE MISTER
FOR HAD SOME QUESTIONS I YES
-- THANK YOU CURRENT THING FOR
US FOR HAVING THIS -- HEARING
UP I GUESS MY FIRST -- GOOD
QUESTIONS WILL BE TWO MISSED
AND -- THANK YOU FOR ALL
YOUR ASSISTANCE FOR US IN THE
CENTER VALLEY I THINK HE AT
THE BEGINNING OF THE PANDEMIC
WE HAD A NUMBER OF CONGREGATE
HOTSPOTS -- AND YOU WERE VERY
INSTRUMENTAL IN HELPING WITH A
NUMBER OF FACILITIES ESPECIALLY
KERN COUNTY UNTIL EIGHT --
I DO WANT TO ASK THOUGH IN
TERMS OF IT AS YOU AS YOU'VE
LEARNED A NUMBER OF LESSONS
TO THE PANDEMIC ARE THERE WAYS
TO IMPROVE THE COORDINATION
BETWEEN THE SKILLED NURSING
FACILITIES THE COUNTY -- PUBLIC
HEALTH DIRECTORS AND -- WE ASK
AND THE STATE I KNOW THAT THE
AT LEAST MY PERSONAL EXPERIENCE
IN DEALING WITH ONE FACILITY --
TIME IS OF THE ESSENCE AND AS
AN OUTBREAK IS HAPPENING WE'RE
TRYING TO DETERMINE IF WE NEED
TO MOVE RESIDENTS OUT IF WE
NEED TO TEST -- IMMEDIATELY WE
HAVE -- WE HAD A CLEARLY AND
IN THE SITUATION KERN COUNTY
-- OF THE THE LEADERSHIP AND
AND THE FACILITY WAS CODE
POSITIVE -- AND THERE SEEM TO
BE KIND OF LIKE IT'S A LITTLE
BIT OF A DELAY AND AND AND
TRYING TO ADDRESS ALL THOSE
ISSUES AND THEN EVENTUALLY --
-- STRIKE TEAM WAS SENT AND
IT WAS PROBABLY OF A FORTY
EIGHT TO SEVENTY TWO HOUR TIME
-- TIME TIME LAG AND SO I WAS
TRYING TO MAYBE UNDERSTAND
MAYBE LESSONS YOU'VE LEARNED
AND HOW YOU KIND OF ADDRESS
THAT IF AT ALL ABSOLUTELY THANK
YOU FOR YOUR QUESTION IN FACT
THAT THE SCENARIO YOU ARE --
PAINTING OR ONE OF THE VERY
FIRST OUTBREAKS THAT I RECALL
-- -- THAT WE LEARNED A LOT
FROM TO BE ABLE TO CREATE A
AND A MORE RESILIENT AND AND
MORE AT A QUICK I TURN AROUND
WHEN IT CAME TO INTERVENTION
AFTER ONE OF THOSE OUTBREAKS
ACTUALLY THAT YOU SPOKE OF
THIS ACTUALLY WHEN WE STARTED
TO DO THE PREDICTIVE ANALYTICS
IN CREATING AND URGENT NEEDS
DASHBOARD THAT SERVES AS
OUR HIGH ALERT SYSTEM WHICH
HAS BEEN REALLY HELPFUL AND
EFFECTIVE -- BUT TO ANSWER
YOUR QUESTION ABOUT WHAT ARE
WE THINKING FOR GOING FORWARD
BECAUSE I AM EXPECTING A SECOND
WAVE I'M SEEN EUROPE HAVE A
SECOND WAVE AND SEEN THE EAST
COAST OTHER PARTS OF THE UNITED
STATES -- HAVING THEIR SECOND
WAVE I WOULD MINDFUL THAT WE
HAVE FLU SEASON I'M MINDFUL
THAT WE HAVE MANY HOLIDAYS
WHERE WE KNOW THAT MAYBE NOT
EVERYONE IS GOING TO COMPLY
WITH YOU KNOW JUST IN SEEN IN
MASKING -- AND SO WITH THAT
I AM ONE OF THE INITIATIVES
THAT WE'RE WORKING ON RIGHT
NOW IN CONJUNCTION WITH OUR
HOSPITALS AND OUR SKILLED
NURSING FACILITIES AND OUR
LOCAL PUBLIC HEALTH IS WE ARE
PUTTING TOGETHER WHAT WE WOULD
LIKE TO CALL OUR OUR SEARCH
PLANNING -- AROUND SEARCH
PATIENT THROUGHPUT SYSTEM FOR
YOUR COUNTY AND SO ONE OF THE
THINGS THAT I NOTICED BACK IN
AUGUST WHEN I WAS TRAVELING
-- UP AND DOWN THROUGH THE
CENTRAL VALLEY AND MEETING WITH
COUNTIES IS THAT I FOUND THAT
SOME COUNTIES DID A GREAT JOB
OF MEETING WITH THEIR SKILLED
NURSING FACILITIES AND A GREAT
JOB MARKET MEETING WITH THEIR
HOSPITALS BUT IT WAS VERY RARE
THAT I WOULD SEE COUNTIES THAT
HAD JOINT -- WEEKLY MEETINGS
WITH THEIR ENTIRE WHAT I
WOULD CALL HEALTHCARE DELIVERY
CONTINUE ONE LOOKING AT ALL OF
THE TRANSFER DISCHARGE READMIT
ISSUES THAT CAN HAPPEN -- ON
A DAILY BASIS AND THESE ARE
LONGSTANDING ISSUES THAT YOU
KNOW WE'RE PROBABLY THEIR WAY
BEFORE -- YOU KNOW CALL THAT
THAT OF COURSE EXACERBATED BY
KOPET AND SO WE ARE WORKING
ON ALL FACILITIES LETTER
PROVIDING BEST GUIDANCE AND
LESSONS LEARNED THAT WE HAD
FROM THE FIRST WAVE ON IT
WHAT ARE THE BEST WAYS AND
HAVING SOME CONCRETE GUIDANCE
AROUND TRANSFER AND DISCHARGE
SKILLED NURSING FACILITIES
-- AS THEY ENTER AND RE ENTER
AND GO BACK AND FORTH BETWEEN
-- ACUTE SETTINGS AND SKILLED
NURSING FACILITIES AS WELL
AS READMIT PROCESSES WHEN IS
IT SAFE TO RE ADMIT WHEN IS
IT NOT BE SO -- SAFE -- THE
OTHER THING IS SETTING UP YOUR
ALTERNATIVE CARE SITES WITH
A LOT OF LESSONS LEARNED FROM
WHAT WOULD BE BEST USE OF YOUR
OFFICER ALTERNATIVE CARE SITE
AND AS WELL AS HOW TO BEST USE
YOUR EXISTING SPACE -- WHICH
IS ACTUALLY THE SAFEST SPACE
TO BE ABLE TO BUILD OUT IN
ALLOWS YOU TO FLEX STAFFING
USER STUFF MOST WISELY AND
SO WE HAD A LOT OF LESSONS
LEARNED THAT FIRST WAVE THAT
WE WANT TO BE ABLE TO CODIFY
IN WRITING AND THEN BE ABLE TO
SHARE IT -- I'VE BEEN WORKING
WITH AND -- CAST NCHA THE
CALIFORNIA HOSPITAL ASSOCIATION
SO BRING THE HOSPITALS AND THE
-- SKILLED NURSING FACILITIES
TOGETHER TO COME TO CONSENSUS
ON WHAT THIS IS ALONG WITH
ARCHITECTS DISEASE STOCKS AND
NOW WE'RE AT THE POINT WILL
BE SHARING IT THE NEXT WEEK --
WITH OUR PUBLIC HEALTH OFFICERS
FOR THEIR FEEDBACK AND ONCE
WE HAVE THEIR FEEDBACK ON AND
THEIR INSIGHTS FROM THE COUNTY
LEVEL THEN WE WILL BE ISSUING
OUT THIS GUIDANCE AS WELL AS
THAT DOING A WEAPON ARE -- FOR
BOTH OUR FACILITIES AND OUR OUR
LOCAL HEALTH JURISDICTIONS OKAY
I APPRECIATE I MEAN I I WAS
JUST THINKING THAT IT IS FROM
THAT EXPERIENCE I WAS THINKING
THAT MAYBE A STRIKE TEAM WOULD
BE SENT FIRST AS WE'RE TRYING
TO DEAL WITH A NUMBER OF THINGS
I KNOW THAT WHEN IT NURSING
FACILITY HAS A STAFFING ISSUE
THEY GO TO THE COUNTY THE
COUNTY THEN TRIES TO FIND STAFF
IF THEY CAN'T FIND OUT IF THAT
THERE ARE SOME FACILITY AND
THIS THAT AND THE COUNTY CAN'T
FIND STAFF THEN THEY GO TO YOU
AND THEN ENFORCE I HAVE ALL
THOSE THINGS ARE EXHAUSTED THEN
YOU SENT A STRIKE TEAM I WAS
THINKING THAT MAYBE WE REVERSED
IT AND SENT A STRIKE TEAM
TO STABILIZE EVERYTHING AND
THEN I WORK OUT ALL THE OTHER
ISSUES ESPECIALLY WHEN YOU
KNOW TWENTY FOUR HOURS OR FORTY
HOURS IS OF THE S.
AND WE HAVE DONE THAT EXACTLY
WHAT YOU SAID WE HAVE REVERSED
IT WHEN IT WHEN THE SITUATION
WARRANTED IT SO WITH THAT
URGENT NEEDS DASHBOARD IF
WE CALL WE CONTACTED THE WE
REALIZE WELL THIS ISN'T URGENT
URGENT NEED IT'S NOT ABOUT
CALLING A REGISTRY IT'S NOT
ABOUT GOING TO YOUR MAILBOX
ESTIMATE IANS WE NEED TO SEND
AN APPOINTMENT WE DO SENATE
APPOINTMENT WE HAVE TEAMS OF
EITHER NATIONAL GUARD CAL MATT
AND HEALTH CORE THAT WILL SEND
AND STABILIZE THE SITUATION
-- AND THEN WORK THROUGH --
WHATEVER -- WHATEVER THE ROOT
CAUSE OF WHAT THAT EMERGENCY
SITUATION WAS PERFECT AND THEN
IN TERMS OF -- WHAT TRIGGERS
AN IN PERSON SURVEY ASSESSMENT
IT WHEN YOU TRACK THE NUMBERS
THAT I'M SURE OF AS WE GET
YOU'VE CREATED THIS REAL TIME
-- DATA MANAGEMENT SYSTEM --
DOES THAT WHEN SOMETHING OCCURS
WHEN YOU SEE SOMETHING DOESN'T
AUTOMATICALLY -- SEND YOU OUT
YOU AUTOMATICALLY SEND A TEAM
TO TO DO AN ASSESSMENT OR IS
IT A CASE BY CASE BASIS OR HOW
DOES THAT WORK WHEN HOW DO YOU
DETERMINE WHEN YOU WHEN YOU
SEND SOMEONE NO GREAT QUESTION
SO WE HAVE A DASHBOARD THAT
WE MONITOR AND SEVEN DAYS A
WEEK -- OBVIOUSLY IS REPORTED
TO -- THEY HAVE TO ENTER IN
THEIR DATA IN AZAR DATA COMES
IN REAL TIME IT GETS CORRELATED
WITH OTHER HIGH RISK INDICATOR
DATA THAT WE HAVE COMPILED
WE -- COMPARE IT WITH -- THE
PAST THREE YEARS OF COMPLIANCE
STATUS THAT THEY'VE HAD ANY
INFECTION CONTROL ANY CITATIONS
THE LAST THREE YEARS THAT
GETS PUT IN THE ALGORITHM ANY
OUTBREAKS WITHIN A FIVE MILE
RADIUS ANY WE'RE GOING TO BE
ADDING AS A SAID RECENT FLU
DATA -- WE PUT IN ANYONE THAT
HAS A STAFFING WAIVER THAT'S
CONSIDERED HIGH RISK ANYONE
WHO'S HAVING THEIR VERY FIRST
CASE EVEN IF IT'S JUST ONE
CASE AND IT'S EITHER RESIDENT
OR STAFF THAT TRIGGERS US
TO IMMEDIATELY GO IN AS WELL
BECAUSE WE HAVE FOUND THAT EVEN
THOUGH SOMEONE HAS THE BEST
LAID PLANS AND WE'VE APPROVED
NOT JUST REVIEWED BUT APPROVED
THEIR THEIR MITIGATION PLANS
WE HAVE ALSO ALSO FOUND THAT
IN THAT FIRST TWENTY FOUR HOURS
OF GETTING THAT FIRST CASE --
THEY WILL EITHER -- GO WITH
THEIR PLANS INTO THEIR PLANS
AND EXECUTE THEM PERFECTLY
OR THERE COULD BE A FIGHT OR
FLIGHT SITUATION WHERE YOU KNOW
FEAR OR PEOPLE START TO CALL IN
OR THERE COULD BE OTHER ISSUES
THAT HAPPENED SO -- THAT'S WHY
EVEN JUST HAVING ONE BRAND NEW
CASE THAT WORD SET AN IMMEDIATE
VISIT AND ENTER INTERVENTION
OKAY SO THE OTHER HIGH RISK
IT'S ON OUR WEBSITE WE HAVE
LOTS OF DIFFERENT HIGH RISK
INDICATORS THAT WE'VE ADDED AND
WILL CONTINUE TO ADD IN ONE OF
THE THINGS THAT JUST RECENTLY
HAPPENED AS WE RECENTLY FOUND
THAT THERE WERE SOME CITATIONS
ARE ROOT CAUSES OF FOR EXAMPLE
-- A FACILITY NOT FIT TESTING
THEIR STAFF AND THAT'S A CAL
OSHA REAGAN SO WHAT WE'RE DOING
NOW IS SEEN OKAY WE HAVE ACCESS
TO OUR COMPLIANCE DATA BUT IF
WE CAN PARTNER ACROSS DIFFERENT
DEPARTMENTS TO SEE WHAT OTHER
REGULATORY AGENCIES THAT ARE
ALSO IN THESE FACILITIES IF WE
CAN PARTNER AND SHARE ALL OTHER
COMPLIANCE DATA THAT WOULD ALSO
BE A HIGH RISK INDICATOR TO
BE ABLE TO INTERVENE PERFECT
AND THEN IN TERMS OF MY LAST
QUESTION TO YOU -- AND AND
MAYBE -- AND CRACK AND JUMP
INTO IS A CONCERN ABOUT TESTING
WE CERTAINLY STARTED EARLY
-- AND AS KERN COUNTY WE WE
WENT AND AND USE CARES OUT
-- FUNDING TO TEST -- GET A
BASELINE -- AND THEN OF COURSE
NOW THERE'S A GUIDANCE THAT
EVERY WHAT EVERY WEEK -- STATUS
TESTED AND THEN -- IF THERE'S
NO SIT AT THEIR SITUATION IS
IT AND AND PLEASE CORRECT ME
IF I'M WRONG -- WHAT IS OUR
STATUS OF TESTING KITS FOR --
RESIDENTS AND STAFF I KNOW THAT
WE WERE KIND OF SHORT I MEAN
WE WE KIND OF WERE SHORTAGE
OF TESTING KITS IN THE MIDDLE
THE PANDEMIC AND THEN AND NOW
LOOKS LIKE WE HAVE ENOUGH IS
THAT TRUE DO WE HAVE ENOUGH TO
DO TESTING ON A REGULAR BASIS
TO MEET THE ONE WEEK TWO WEEK
TURNAROUND YEAH WE DO WE RIGHT
NOW WE HAVE WEEKLY TESTING
IN CALIFORNIA -- SO WE ARE I
WOULD SAY VERY AGGRESSIVE IN
CALIFORNIA WITH THEIR TESTING
CMS -- -- DID NOT STATE THAT
TESTING WEEKLY WAS NECESSARY
IN ALL COUNTIES BUT WE FELT
TO BE MORE PREVENTIVE GOING
INTO THE WINTER SEASON WE
REQUIRE THAT EVERYONE TOSSED
OUT WEEKLY BECAUSE WE ALSO HAVE
THE CAPACITY FOR THAT SAID THIS
WEEK ALSO ACTUALLY NOVEMBER
FIRST WE RE OPEN OR WE WILL
BE OPENING OUR FIRST STATE
RUN -- LAB WHICH IS PERKIN
ELMER -- AND THEY WILL START
WITH THE CAPACITY OF FORTY
THOUSAND TESTS A DAY AND BUILD
UP OVER THE NEXT MONTHS UP TO
YOU KNOW UPWARDS TWO HUNDRED
FIFTY THOUSAND TESTS A DAY
-- AND THAT ON TOP OF ALREADY
OUR EXISTING CAPACITY -- SO
THAT WE CAN EXPAND TESTING --
THROUGHOUT THE WINTER MONTHS
AND GREG DO YOU DID DO YOUR
FACILITIES HAVE ACCESS TO
ALL THESE TESTS ARE THEY ARE
THEY COMFORTABLE IN TERMS OF
EVERYTHING THAT'S HAPPENING
THEY THEY ARE DEFINITELY BETTER
OFF THAN THEY WERE AT THE THE
PC ARE AT AND YOU KNOW AS YOU
AS YOU THINK YOU KNOW MISSED
FONG THERE'S THERE'S THE PCR
TEST WHICH IS THE GOLD STANDARD
WHICH IS WHAT CDPH REALLY
WANTS THE THE TURN AROUND
TIME ON THOSE CAST IS IMPROVED
DRAMATICALLY AND AND THEY
ARE ABLE TO GET THOSE IN MUCH
BETTER WAY THERE ARE CHALLENGES
STILL HERE THOUGH I WOULD SAY
FOR EXAMPLE SOME OF THE HELP
SOME HEALTH CARE PROVIDERS
REQUIRED THE THE STAFF TO GO TO
THEIR SITE TO BE TESTED VERSUS
HAVING THE FACILITY TAKE DO
THE TEST AND HOUSE AND SENDING
IT TO THE LAB SO THAT THAT
TAKES TIME OFF OF THE STAFF
TIME TO GET THEMSELVES TESTED
SOME WAYS THE OTHER THING I
WOULD JUST MENTION TO YOU IS
IN A NUMBER OF STATES THEY
ARE ALLOWING THE USE OF THE
ANTIGEN TEST AND YOU KNOW THE
FEDERAL GOVERNMENT SENT ANTIGEN
TEST MACHINES EVERY FACILITY
IN THE COUNTRY AND THOSE ARE
-- THOSE THOSE HAVE VERY RAPID
TURNAROUND BUT THEY DON'T HAVE
THAT THE ACCURACY LEVEL IS
NOT IS NOT AS GOOD AS A GOOD
TURNAROUND IS LIKE FIFTEEN
MINUTES OR LESS ALSO MOST
FACILITIES ARE NOT UTILIZING
WHAT THE FEDERAL GOVERNMENT
HAS HAS PROVIDED THEM IN THAT
AREA ARENA BECAUSE THE YET THE
STANDARD CALIFORNIA'S HIGHER I
WOULD SAY IT'S ARTICLE IT'S ART
I I JUST I THINK THAT THE PCR
TEST IS THE GOLD STANDARD AND
SO IF SOMEONE TEST UNDER THAT
CDPH GUIDANCE IF SOMEONE TESTS
NEGATIVE THEY HAVE TO FOLLOW
UP WITH PCR TEST ANYWAY SO THEY
TEST NEGATIVE WITH THE WITH THE
ANTIGEN TEST THEY STILL HAVE
TO GO GET A PCR TEST SO -- YEAH
THE PCR WOULD BE IS PREFERABLE
BUT IT IS MUCH MORE COSTLY AND
IT IS IT DOES TAKE MORE TIME
AND AND SO I THINK THAT IT IS
IMPROVED BUT IT COULD GO IT
COULD GET BETTER AND IT'S HEIDI
SAID THAT THE PERKIN ELMER LAB
WE WOULD WE WERE HOPING THAT
SKILLED NURSING FACILITIES
WILL BE A PRIORITY FOR THE USE
OF THIS PERKINELMER LAB THAT
THE STATE HAS CONTRACTED WITH
IT'S GOING TO TURN AROUND A
HUNDRED FORTY THOUSAND TEST
DAY I BELIEVE -- AND SO WE'RE
HOPING THAT SKILLED NURSING
FACILITIES AND OTHER CONGREGATE
CARE FACILITIES COULD BE PART
OF THAT IS THE PREFERENCE --
TWO TESTS AT THE FACILITY I
MEAN WHAT A MOBILE UNIT IS
THAT THE YOUR IS THAT THE
YES FROM ME MEMBERS OKAY YES
DEFINITELY BECAUSE IT IS THE I
THINK THAT IT THAT IS SIMPLER
IN SO MANY WAYS TO BE ABLE TO
TEST AT THE FACILITY AB VERSES
THAT STAFF HAVING TO LEAVE THE
FACILITY OR TO GO TO ENOUGH
KAISER FOR EXAMPLE -- TO TAP
THEIR TEST -- IT WOULD BE MUCH
EASIER IF THEY COULD DO THAT
IN HOUSE AT SOME FACILITIES
CAN DO THAT SOME COULD NOT BUT
AS YOU KNOW -- THE STATE IS
REQUIRED TO HEALTH PLANS TO
PAY FOR THE TESTING FOR THEIR
FOR A FOREIGN WORKERS AND AND
SOME OF THE HEALTH PLANS JUST
REQUIRED FOR THAT STAFF TO
REQUIRE THEIR PEOPLE COME TO
THE THEIR FACILITY FOR TESTING
AND JUST LAST I GUESS THE LAST
QUESTION TO THE SENATOR IS IN
TERMS OF THIS HEARING THAT IT
IS IS IS THE PERKINS ELMER LAB
ARE THEY GOING TO PRIORITIZE
SCOOTERS IN THE CITY STAFF OR
RESIDENTS OR BOTH YES WE'RE
GONNA BE PRIORITIZING ALL
CONGREGATE SETTINGS OF BOTH
ONES UNDER AB DEPARTMENT SOCIAL
SERVICES AND DEPARTMENT OF
PUBLIC HEALTH PERFECT THANK
YOU AND MAYBE THIS IS MAYBE
FOR CRACK BUT MISSED A MISSED
AND -- YOU CAN JUMP INTO AYE
MY UNDERSTANDING IS THAT THERE
IS LIKE A FIVE STAR QUALITY
RATING SYSTEM -- FOR NURSING
FACILITIES -- YES IS THERE A
WAY -- UPDATED -- OR MODERNIZE
IT TO MAKE INFORMATION MORE
READILY AVAILABLE CRAIG YOU'D
MENTIONED THAT YOU WOULD LIKE
KIND OF A ONE PORTAL SYSTEM FOR
EVERYONE TO HAVE INFORMATION IS
THAT PART OF THAT DISCUSSION OR
-- HOW WOULD YOU KIND OF BLEND
THAT YOU ARE MAYBE ADDRESS THAT
THAT TRANSPARENCY YEAH THE FIVE
STAR THE FIVE STAR REALLY LOOKS
A QUALITY THAT'S REALLY WHAT
IT'S IT'S FOCUSED ON AND ALL
THE METRICS RELATED QUALITY I
THINK WHAT I WAS REALLY TALKING
ABOUT WAS ONE PLACE FOR -- THAT
EVERYONE CAN UNDERSTAND ALL
THE DIFFERENT GUIDES BECAUSE
WE GET WE HAVE SOMETIMES WE
HAVE FEDERAL GUIDANCE FOR
EXAMPLE IN VISITATION WE HAVE
FEDERAL GUIDANCE ON VISITATION
STATE GUIDELINE VISITATION
STATUS TRIED TO MARRY THAT UP
BUT AS YOU HEARD THE COLON'S
MOTHER SAY THE COUNTIES THAT
WOULD THEN HAVE THEIR OWN
SET OF GUIDANCE SO THERE
THERE'S NO IT'S THERE'S NOT
IT'S NOT THERE'S NO WILL ONE
STOP SHOPPING AND THAT'S JUST
ONE EXAMPLE OF THEIR OTHER
REQUIREMENTS TO WEAR THAT SOME
COUNTIES -- WILL PLACE -- AND
IT MISSION TO BAN ON FACILITIES
-- FOR CERTAIN AMOUNT OF TIME
AND THEN THE STATE OF THE STATE
GUIDES MIGHT BE DIFFERENT ON
THAT SO I THINK LIKE I SAID
FOR PEOPLE TO BE ABLE TO SEE
IN ONE PLACE ALL THE DIFFERENT
GUIDANCE AND REQUIREMENTS
WHETHER THEY'RE FEDERAL
STATE OR LOCAL AT THE FIVE
STAR IS REALLY MORE OF MORE
FOR THE CONSUMER -- TO FIND
INFORMATION ABOUT THE ABOUT
THE AT THE QUALITY OF THE OF
THE FACILITIES MS AKERS AT WILL
AS A WAY TO KIND OF BLEND IT
ALL WHEN YOU GOT THE ONE CITY
GET THE PORTAL RIGHT NOW THE
DASHBOARD THAT HAS THAT WOULD
IT BE ABLE TO WOULD YOU BE ABLE
TO ADD EVERYTHING THAT WAS I
MEAN ALL THIS INFORMATION TO
ONE OR IS THAT IT IS A BETTER
TO KEEP IT SEPARATE I GUESS
I'M NO SO WE HAVE -- AS FAR AS
ALL OF OUR DATA AND INFORMATION
THAT'S ON A ONE STOP PORTAL BUT
AND WHAT CRAIG'S ALLUDING TO IS
WE HAVE OUR ALL OF OUR STATES
GUIDANCE ARE ALL FACILITY
LETTERS FROM DPH THOSE ARE ALL
ON OUR WEBSITE WE CAN ALSO PUT
ALL OF OUR FEDERAL FROM CMS --
ON THERE AS WELL THE TRICK IS
ON HAVING EVERY -- COUNTY AND
EVERY PUBLIC HEALTH OFFICER
THEN -- THE LINKS THERE ARE
HEALTH ORDERS TO OUR WEBSITE
BECAUSE RIGHT NOW YOU KNOW
OBVIOUSLY EVERY COUNTY CAN
HAVE YOU KNOW THEIR OWN HEALTH
ORDER -- AROUND COVE IT IN SO
IT WOULD BE A MATTER OF TRYING
TO -- ASK THAT ALL OF OUR
INDIVIDUAL COUNTIES WOULD THEN
HAVE TO AGREE TO -- POSTING IT
ON A STATE WEBSITE WERE LINKING
IT OR WE CAN MAYBE EVEN LINK
TO ALL OF THE COUNTIES BUT
THAT SOMEONE WOULD STILL HAVE
TO GO THROUGH OUR WEBSITE TO
THEN LOOK AT ALL THE COUNTIES
OF WHAT THEY'RE DOING AND AND
IN TERMS OF THAT SCENARIO --
HOW DOES THAT HOW DO YOU TELL
A CDPH WORK WITH THE COUNTIES
OF THE COUNTIES GO STRICT ARE
HAVE A DIFFERENCE I WANT TO
DO SOMETHING DIFFERENT HOW DO
THEY IS THERE A COLLABORATIVE
PROCESS THERE ARE ARE HOW DO
I KNOW YEAH I KNOW ABSOLUTELY
IT'S A COLLABORATIVE PROCESS
THERE'S BEEN MULTIPLE TIMES
YOU HAVE CALLED A PUBLIC
HEALTH OFFICERS AND SHE WALKS
THROUGH YOU KNOW OUR WHAT OUR
VISITATION GUIDANCE IS WHAT
THEIR VISITATION GUIDES AS
WHAT ARE THE CONCERNS YOU KNOW
-- ARE THERE WAYS FOR US TO
FIND -- SOME MIDDLE GROUND OR
ONLINE -- AND I NORMALLY YOU
KNOW WORKED AGAIN TRYING TO
TAKE IT FROM A SCIENCE APPROACH
OF CAKE YOU KNOW IF SOMEONE
IS SIX FEET APART AND THAT
WEARING A MASK AND THEY'RE IN
THIS LARGE VENTILATED SPACE YOU
KNOW WHAT IS YOU KNOW WHAT IS
THE CONCERN BECAUSE WE BELIEVE
THAT THAT IS SAFE AS PRACTICE
FOR THEM TO BE ABLE TO HAVE
A VISITATION AND SO WE TRY TO
WALK THROUGH WHAT THE ISSUES
ARE BUT THEY ARE DEFINITELY
YOU KNOW MULTI FACTORIAL
DEPENDING ON WHAT IS GOING
ON IN THAT PARTICULAR COUNTY
OKAY CO DISCOURAGE COUNTIES
FROM ACTING SEPARATELY OR DID
YOU HAVE WELL THEY HAVE THE
AUTHORITY ULTIMATE AUTHORITY
TO DO THAT THAT'S THE WAY THAT
OUR OUR LOCAL -- PUBLIC HEALTH
AND GOVERNMENT IS SET UP A WE
DO HAVE DR ERICA PAN -- WHO
IS ARE ACTING STATE HEALTH
OFFICER OF COURSE AND THAT IS
HER ROLE AS WELL TO WORK WITH
THE COUNTIES IN IN GIVING ON
A WORKING WITH THE COUNTIES
AS FAR AS DIRECTION BUT NOW
WE WE WORK COLLABORATIVELY AS
BEST AS WE CAN TO TO GET AS
MUCH ALIGNMENT IS POSSIBLE CAN
YOU RECOMMEND THIS ITEM YEAH
I THINK IT JUST AND JUST ONE
QUICK THING I THINK TO TO SHOW
YOU HOW DIFFICULT SOME OF THIS
CAN BE WHAT IT COUNTY DOES
ON FOR EXAMPLE I'M AWARE ONE
COUNTY IN THE BAY AREA THIS
THAT PARTICULAR ONE PARTICULAR
STANDARD FOR EMISSIONS FROM
HOSPITALS THAT HAS AN EFFECT
OBVIOUSLY AND SNIFFS IN THAT
COUNTY BUT IT HAS AN EFFECT ON
ALL THE SURROUNDING COUNTIES
GIVEN THAT THE BAY AREA FOR
EXAMPLE IS A DYNAMIC REGION
WHERE PEOPLE MOVED COUNTY THE
COUNTY PRETTY PRETTY -- PRETTY
OFTEN SO THAT'S ONE OF THE
REASONS I THINK IT'S IT'S A
CHALLENGE JUST FOR FACILITIES
TO OPERATE IN THAT KIND OF
ENVIRONMENT -- WHERE WHERE AND
WE UNDERSTAND CLEARLY A LOCAL
PUBLIC HEALTH DIRECTORS HAVE
THE ULTIMATE AUTHORITY HERE
BUT JUST JUST GETTING A HANDLE
ON THE WIDE VARIETY HAS BEEN
A CHALLENGE FOR OXFORD FOR
FACILITIES TO OPERATE SO IT'S
GREAT RECOMMENDED THE PUBLIC
OTHER OFFICERS PARKOUR NAY WITH
WITH THAT EVERYBODY I GUESS
AND IN SOME WAYS IT MAY AND
THAT MAY BE PART OF THIS WEEKLY
A BEST PRACTICE OF HAVING A
WEEKLY KIND OF COORDINATING
-- SESSION WHERE EVERYONE CAN
KIND OF SHARE INFORMATION I
GUESS THAT'S THE BEST PRACTICE
THAT'S COME OUT OF IT -- --
THANK YOU VERY MUCH I DO HAVE A
QUESTION FOR MY LAST -- NICOLE
-- DOWN BY MIDNIGHT MR FONG SO
I WAS JUST GONNA SAY I KNOW DR
WASSERMAN WANTED TO JUMP IN AND
IF YOU ARE INTERESTED I'M SORRY
I I I IF ANYONE JUMP WANT TO
JUMP AND I APOLOGIZE I JUST I'M
JUST GONNA MAKE SURE IT'S OKAY
WITH YOU THAT'S ABSOLUTELY DR
THANK YOU SO MUCH IT IT'S
A LITTLE BIT OF A CHALLENGE
FROM THE BEING VIRTUAL SO NOT
I WONDER I WONDER I ACTUALLY
HAD A FEW THINGS I COULD
COMMENT ON -- BUT I WANTED TO
PREFACE IT WITH A WORD I'VE
COME TO UNDERSTAND OVER THE
LAST EIGHT MONTHS WHICH IS THE
WORD STAKEHOLDER AND I I WANT
TO COMMEND CDPH FOR ENGAGING
THE GERIATRICS COUNCIL AND CAL
TCM WE ARE NOT STAKEHOLDERS
WE ARE SUBJECT MATTER EXPERTS
AND I REALLY CONTINUE TO BE
CHALLENGED BY A DISPUTE BYE
BYE HOW THE PROCESS WORKS
WHERE STAKEHOLDERS DO YOU
HAVE THEIR INPUT AND THE
SUBJECT MATTER EXPERTS ARE
NOT INCLUDED IN DISCUSSIONS
THAT DRIVE POLICY THAT MAKE
DECISIONS AND I'LL GIVE YOU
A FEW EXAMPLES WE DIDN'T HAVE
GERIATRICIANS ARE EXPERTS IN
LONG TERM CARE MEDICINE ON THE
TESTING TASK FORCE AND THAT
LED TO SIGNIFICANT DELAYS IN
KNOWLEDGE REGARDING RESPONSE
TO TESTING I'M ALSO I DO WANT
TO COMMENT ON THE OVERALL
MORTALITY AND I DO AGREE
THAT THE STATE HAS DONE AN
INCREDIBLE JOB OF PUTTING INTO
ACTION A NUMBER OF MECHANISMS
AND MITIGATION EFFORTS THAT
HAVE REDUCED MORTALITY BUT
I'M GONNA GIVE YOU A COUPLE
CABBIE ODDS ALMOST MANY OF
THOSE RECOMMENDATIONS WERE
MADE BY THE EXPERTS IN MARCH
AND TOOK TILL JUNE JULY AUGUST
SEPTEMBER OCTOBER BEFORE THEY
WERE IMPLEMENTED LIVES COULD
HAVE BEEN SAVED AND -- I I AND
THE OTHER THING THAT I THINK
A LOT OF FOLKS DON'T REALIZE
AS A GERIATRICIAN LOOKING AT
THE NUMBERS FOR EIGHT MONTHS
IN THE DATA ONE OF THE REASONS
OVERALL MORTALITY HAS GONE DOWN
IS IS BECAUSE WE'RE IMPROVING
IN OUR EFFORTS BUT IT'S ALSO
BECAUSE THE MOST FRAIL MEMBERS
OF OUR NURSING HOMES HAVE
ALREADY DIED SO AND THEY'RE
NOT BEING REPLACED AND SO THE
THE DATA I'M NOT SURPRISED
THAT MORTALITY RATES ARE LOWER
NOW IN THE THE THING THAT
CONCERNS ME AS WELL WE'VE MADE
IMPROVEMENTS VULNERABLE OLDER
ADULTS CONTINUE TO DIE EVERY
WEEK AND AND AND AND I JUST
WANT TO MAKE SURE THAT WE DON'T
LOOK AT THEIR SAYS HEY WE'RE
DOING GREAT WE ARE STILL LOSING
VULNERABLE RESIDENTS WE ARE
STILL LOSING FRONTLINE STAFF
I I ALSO WANTED TO COMMENT
ON THE VA -- I I'VE BEEN IN
TOUCH WITH MY VA COLLEAGUES
FROM THE BEGINNING AND THE VA
IS A GREAT EXAMPLE OF HAVING
GERIATRICIANS INVOLVED HAVING
ENGAGE MEDICAL DIRECTORS
INVOLVED HAVING ENOUGH STAFFING
INVOLVED I DOCTOR TOM YOSHIKAWA
I WAS ACTUALLY ON ONE OF OUR
EXPERT GROUPS HE'S AT THE VA IN
WEST LOS ANGELES -- THAT MADE
RECOMMENDATIONS AROUND TESTING
THAT WE PUBLISHED AT THE END
OF MAY SO I THINK THE VA IS A
GREAT EXAMPLE OF WHAT WORKS AND
I STRONGLY RECOMMEND WE LOOK
AT THAT AS AS AS A POSITIVE
-- THE OTHER THING THAT WAS
THE QUESTION WAS ASKED ABOUT
THE VACCINE PRIORITIZATION
I ACTUALLY HAD THE HONOR OF
SERVING ON THE NATIONAL ACADEMY
OF SCIENCE A COMMITTEE THAT
MADE RECOMMENDATIONS FOR THE
ALLOCATION OF VACCINE AND THERE
IS NO QUESTION THAT FRONTLINE
NURSING HOME STAFF ARE THIS
ARE ONE OF THE MOST IMPORTANT
GROUPS TO GET VACCINATED BUT
WHAT WE'VE ACTUALLY CONVENE
ANOTHER GROUP OF EXPERTS TO
MAKE RECOMMENDATIONS AND GIVE
GUIDANCE AT THE STATE AND
FEDERAL LEVEL BECAUSE WHAT
YOU'VE HEARD TODAY IS THE
TIP OF THE ICEBERG OF THE
CHALLENGES THAT ARE GOING TO
OCCUR WHEN WE START TRYING
TO IMPLEMENT THE VACCINE WITH
THE FRONTLINE STAFF AND AGAIN
THIS IS I KNOW THIS IS NOT
NECESSARILY A FORM FOR HEARING
ALL THOSE DETAILS I AM HAPPY
TO SHARE THAT WITH YOUR STAFF
-- BUT THIS IS NOT GOING TO
BE EASY IN FACT THE WAY THE
FEDERAL GOVERNMENT HAS SET UP
THE PROCESS THEY HAVE BASICALLY
GIVEN RESPONSIBILITY TO CVS AND
WALGREENS TO VACCINATE NURSING
HOME RESIDENTS THEY'VE GIVEN
EACH STATE THE RESPONSIBILITY
TO DECIDE HOW THE NURSING
HOME STAFFER VACCINATED AND
THAT CREATES AND I'VE ACTUALLY
BEEN IN TOUCH WITH SOME OF THE
MAJOR VACCINE MANUFACTURERS
THEY HAVE BEEN GIVEN A LOT
OF GREAT DIRECTION BY THE
FEDS SO THERE'S A LOT MORE
CONFUSION AROUND THIS THING
ANYONE IS TELLING YOU RIGHT
NOW AND I AND I THINK THAT'S
THAT'S REALLY IMPORTANT --
SO THOSE ARE THE THINGS UP
TO THIS POINT THAT I I REALLY
JUST WANTED TO MAKE SURE I I
I I MADE SOME COMMENTS ON AND
I APPRECIATE THE OPPORTUNITY
TO SHARE THEM I KNOW IT'S
A LITTLE BIT DIFFICULT IN
THIS SORT OF SETTING HERE
THANK YOU THANK YOU DOCTOR
BACK TO MR FONG I THINK I
THINK YOU'RE NOT A QUESTION
THANK YOU YES I I I DO DIS
SHARED HIS ADDUCTOR WATCHMAN'S
CONCERNED ABOUT A SENSE OF
URGENCY AND TRYING TO MOVE AS
QUICKLY AS POSSIBLE AND AND
LEARNING A LOT IS THAT SINCE
MY LAST TWO QUESTIONS THAT TO
-- I MISS HOW IS -- I GUESS
THE HAVE WE QUANTIFIED IT --
WHAT THE SHORTAGE IS -- OF OF
LABOR STAFF -- C.
N.
A.'S -- INTO AT THE STATE I
LIVE BEING FROM THE CENTRAL
VALLEY IN A RURAL AREA -- YOU
KNOW WE CERTAINLY HAVE EVEN
MORE -- CHALLENGES WHEN IT
COMES TO SHORTAGES OF NURSES
SO I I'M -- IS THERE IS THAT
WE QUANTIFY THAT IN AND I THINK
YOU MENTIONED IN YOUR TESTIMONY
-- THAT THAT THERE WAS A A
BACKLOG OR SOMETHING ISSUE IT
TESTING -- -- ARE ARE GETTING
CERTIFIED THE CERTIFIED TESTING
OUT THAT NOT THE TESTING
KOBE BUT THAT THE TESTING OF
ACTUALLY GETTING THESE -- CNA'S
IN SAID THAT ANSIBLE WORKFORCE
CAN YOU ELABORATE ON THAT
AND WITH THAT I I APPRECIATE
THE CHAIRMAN'S INDULGENCE IN
PATIENTS SO I'M GONNA START
WITH YOUR SECOND QUESTION
FOR THE FIRST TIME ACTUALLY
DEFERRED A CRAG AND HEIDI AT
THE SHORT ANSWER IS THAT YES
THEY HAVE BUT I THINK THE REAL
ANSWER IS MUCH MORE NUANCED SO
IN TERMS OF BACKLOG TESTING AT
THE HEALTHCARE GROUP PATHWAY WE
HAD STUDENTS WHO GRADUATED IN
MAY TESTING CENTERS WERE CLOSED
WHEN THEY RE OPEN TESTING
CENTERS WHICH ARE NOT SUPER
PLENTIFUL IN GENERAL THEY WENT
BACK TO THE EARLIER APPOINTMENT
SO IF YOU GRADUATE IN MAY THE
STUDENTS THAT WE WORK WITH JUST
BEGAN TESTING LAST WEEK AND
THE REMAINDER WILL TAKE THEIR
TEST NEXT WEEK NOW WHY THAT'S
PROBLEMATIC AND WE WERE ALL
LEARNING A NEW NORMAL BUT IT'S
PROBLEMATIC BECAUSE AT THE SAME
TIME WE WERE ISSUING STOPPING
WAIVERS TO FACILITIES AND WE
WERE SAYING YOU COULD HAVE
A A NURSING ASSISTANT WHICH
ESSENTIALLY IS THAT AS YOU
NAMES HALFWAY THROUGH TRAINING
COME WORK WITH YOU THEY GET
PAID LESS THEY CAN'T DO THE
FULL SCOPE OF WORKERS THAT WERE
ISSUED WAIVERS FOR THAT BUT
WE DIDN'T PRIORITIZE HOW WE
FIND OUR WAY THROUGH THIS AND
I THINK THAT SOMETIMES IT'S A
WAY OF THINKING IT'S A WAY OF
PROCESSING IT THAT I THINK THAT
WE NEED TO LOOK AT THE WHOLE
SYSTEM WE WE RELAX REGULATIONS
REALLY ARE AT A RAPID CLIP BUT
I THINK WE DIDN'T ALWAYS LOOK
WHAT'S THE FULL AFFECTED HOW
THAT PLAYS OUT I ALSO THINK
IT'S IMPORTANT TO NOTE THAT
THE STATE AS AS HARDY SAID THAT
THERE ARE -- YOU KNOW THEY'VE
IDENTIFIED FORMER C.
N.
AC WERE CERTIFIED WHO AREN'T
WORKING NOW THE REASON THAT
WORKING AS A LOT IT WAS ONE
OF VERY CHALLENGING WORK IN
SKILLED NURSING FACILITIES BUT
I WOULD ALSO SAY SOMETIMES THE
CULTURE AND VALUE FOR THOSE
FOLKS RUN THE FRONT LINE IS
NOT ALWAYS WHAT IT SHOULD SO
WHEN I HEAR FROM C.
N.
A.'S WHO WENT INTO THE FIELD
AND LEFT PARTLY IT'S THAT THEY
WEREN'T SUCCESSFUL IN CHANGING
THE CULTURE THEY WOMEN DESIRING
TO BE CARE GIVERS BUT THE
SYSTEM WAS SET UP WHERE THEY
HAD TEN ELEVEN TWELVE WE'LL
TO CARE FOR ANY GIVEN PERIOD
OF TIME AND THEY WERE ABLE TO
DO FOR AS EFFECTIVELY AS THEY
WOULD WANT PART OF WHAT OUR
STUDENTS LEARN HOW TO MANAGE
UP WHICH I THINK IS SOMETHING
WE ALL LEARN WHICH IS IT
WHEN THEY'RE IN A COMFORTABLE
SITUATION THE SUPERVISOR WHEN
THEY THINK THERE'S A BETTER
WAY TO CARE FOR RESIDENT HOW
THEY HAVE THAT CONVERSATION
RESPECTFULLY HOW THEY RETAIN
THAT AUTHORITY AND ENGAGE IN
THAT RELATIONSHIP IT'S ALSO
IMPORTANT TO NOTE AND THIS IS
WHAT I THINK THAT YOU SHOULD
REALLY BE AWARE OF IS -- AND
I SAY THIS A LOT YOU KNOW
MY GRAMMAR WITH GRAMMARLY TO
HOTEL MADE SHE DIDN'T FINISH
ELEMENTARY SCHOOL YOU KNOW
THAT THE MAIDS OF YESTER
YEAR OFTEN THE CARE GIVERS UP
TODAY AND WE ARE SO LUCKY TO
HAVE THEM MANY OF THEM ARE AT
THE FIRST IN THEIR FAMILY TO
TO BE IN THIS COUNTRY TO BE
ENGAGING IN THIS KIND OF WORK
AND THEY MAY NOT ALWAYS FEEL
CARE COMFORTABLE CHALLENGING
AN ASSUMPTION RIGHT BECAUSE
THERE'S A POWER DIFFERENCE
THERE WE NEED TO BE MINDFUL
THAT THE REASON PEOPLE ARE NOT
WORKING AS CNA'S ISN'T ONLY
ABOUT THE CONVERSATION BUT IT
IS ABOUT THE COMPENSATION IT'S
ALSO ABOUT THE CULTURE THAT
WE VALUE FOR CARE GIVERS AND
YOUR FIRST QUESTION I'M GONNA
SLIDE AWAY AND LET CREGGAN
HIGHER HEIDI ANSWER THAT HAS
THE TESTING BEFORE THIS THE
TESTING NOT BEEN ADDRESSED OR
AS AS ARE THEY ROOF THAT THEY
STARTED AGAIN OR NO TESTING
HAS RESTARTED YES THANK YOU
VERY VERY QUICKLY MR FOR THIS
FUNKY YOUR QUESTION ABOUT C.
N.
A.'S -- THE LATEST DATA
FROM HOTSPOT I BELIEVE THAT
OVER OVER THE NEXT DECADE
STATE WILL NEED AT LEAST
THIRTY THOUSAND MORE C.
N.
A.'S ALONG IN THE NEXT DECADE
SO THANK YOU VERY MUCH THANK
YOU I THANK YOU CHAIRMAN THINK
THANK YOU MR FONG WE'RE GONNA
GO TO MISTER COOPER NEXT THE
DOCTOR WHAT IT IS FULL OF
MICHAEL IS CONCERNED ABOUT
THE DESTINATIONS OF TWENTY
SEVEN PERCENT OF THE DEATHS
OCCURRING SNFS OBVIOUSLY THAT
SEEMS IMPORTANT AND I HOPE
THE -- SINISA BE PRIORITIZED
-- MY MOM IS CURRENTLY THE
SNIFF RIGHT NOW THAT IT WAS
A SHOCK TO CDPH -- THEY HAVE
A WEBSITE CHALFONT ST YOU CAN
GO LOOK AT ALL THE DIFFERENT
-- SNIFFS IN SEE THE RATINGS
COMPLAINTS AGAINST THEM REALLY
GET A GOOD IDEA ONE OF THEM
WITH A BETTER SNIFFS AROUND SO
WE ACTUALLY GOT A REALLY GOOD
MORNING IN SEPTEMBER THAT WERE
VERY HAPPY WITH SO THANK YOU
THE CTF I'M SORRY C.
PH FOR THAT -- YOU KNOW WE'RE
TALKING ABOUT YOU'LL SEE
AMAZING GETTING ON THIS BIG
ISSUE THE FUNDING IS NOT THERE
WASN'T A FOR DINNER CAL THAT'S
ALWAYS BEEN A BIG ISSUE WITH
IT BEING CUT IN ANYWHERE I
MEAN IT IF YOU PAY PAYS DECENT
PEOPLE COME AND THE PROBLEM
WITH THE RECRUITING RETENTION
IS THE PAY AND IT'S IT'S JUST
-- A PERVASIVE PROBLEM WE HAVE
THERE AND YOU KNOW I GUESS MY
QUESTION TO DH CS IS -- WITH
LABOR COST BEING CAPPED -- WHY
DON'T WE FULLY FUND THE COST
OF LABOR FOR SKILLED FOR SNIFFS
BANGKOK CAPS ARE INCLUDED IT
YOU FIND I'VE TO THAT NINETY
THREE PERCENT UP WE NEED A
CHANGE IN THE MOST RECENT TO
BRING ABOUT COST CAP -- -- AND
THEN ADDITIONALLY WE ARE THREE
THAT THROUGH THE STATUTE WE
ARE LIMITED TO A PERCENTAGE
-- RATE INCREASE ANNUALLY
OKAY BUT IT WAS IT WAS
STILL ISSUE THAT THAT JUST
HAPPENED RECENTLY CORRECT
RECTO THAT WOULD THAT BACK
BUT MY TAX MONEY THAT WAS
PART OF THE CHANGES THAT
THAT HAPPENED DURING THAT THE
LACK BUDGET CYCLE TO CHANGE
HOW WE CALCULATE THOSE --
THAT METHODOLOGY TO INCREASE
THAT TO NINETY FIVE THE
NINETY FIFTH PERCENTILE OKAY
THANK YOU THANK YOU MISTER
-- WITH CHAIR STEPPED OUT BUT
HE GAVE ME THE OPPORTUNITY TO
ASK QUESTIONS AND SINCE I WAS
NEXT SO I'M GONNA GO AHEAD AND
DO THAT -- FIRST WELL THESE ARE
THE FIRST COUPLE QUESTIONS ARE
GOING TO BE FOR MISDIAGNOSIS
-- AND -- WHEN SHE POPPED
BACK ON HERE I GUESS MY FIRST
QUESTION IS YOU KNOW WE HAVE
THE OFFICE OF THESE LETTERS
REQUIRING THAT DEEP FULL TIME
INFECTION PREVENTION IS --
IS THAT HAPPENING IN EVERY --
SKILLED NURSING FACILITY NOW
SINCE
ANYBODY OUT THERE I CAN'T SIX
SORRY I MUST'VE BEEN ON MUTE
OKAY OH SORRY ALSO SORT OF --
-- I DON'T THINK YOU FOR YOUR
QUESTION MARK WHAT -- SO YES WE
DID RECEIVE IN JUNE ALL TWELVE
HUNDRED FACILITIES TURNED IT
THEIR COVERT MITIGATION PLAN --
AND EVEN THOUGH THEY WERE A FEW
THAT NEEDED SOME REITERATIONS
-- BEFORE THEY COULD BE
OFFICIALLY APPROVED ARE THEY
ALL WERE EVENTUALLY APPROVED
AND THEN WE GO OUT EVERY FOUR
TO SIX WEEKS TO THE END VERIFY
THAT THEY ARE IN FACT TO
DOING -- SO AND ONE OF THOSE
PIECES OF THAT MEDICATION PLAN
IS THAT FULL TIME INFECTION
PREVENTION ROLE -- WE HAVE --
FOUND INSTANCES AND -- ENFORCED
WHERE WE DID NOT FIND -- A FULL
TIME INFECTION ROLE AFFECTION
PREVENTION IS ROLL ON THE EONS
BECAUSE WE DO BELIEVE THAT
THAT IS A KEY KEY FACTOR HERE
TO HAVE THAT KIND OF DEDICATED
ROLE NOT SOMEONE WHO IS -- I'M
GOING TO BE THE DIRECTOR OF
NURSING AND TO THE I.
T.
ON THE SIDE -- OR I'M GONNA BE
A FRONTLINE YOU'RE A NURSE AND
THE AND I KEY ON THE SIDE BUT
SOMEONE WHO IS THAT DEDICATED
ROLE OKAY THANK YOU THANK YOU
I'M THE NEW SURVEY MODEL WITH
RESPECT TO THE STATEMENT OF
DEFICIENCIES CAN YOU TELL ME
WHAT THAT'S GONNA LOOK LIKE AND
WILL THE SURVEYORS BE ISSUING
CITATIONS AND FINES AS WELL
SO I'M ASSUMING YOU WERE
TALKING ABOUT THE QUALITY
AND SAFETY SURVEY MODEL THAT
WILL BE IMPLEMENTING A POST
PANDEMIC SO CURRENTLY WE HAVE
OUR COBIT MITIGATION PLANS ON
THAT WE ARE GOING AND LIKE I
SAID EVERY FOUR TO SIX WEEKS
AND WHAT WE STARTED TO THINK
UP WELL HOW COULD WE PREVENT
THIS FROM HAPPENING YOU KNOW
AGAIN EVEN IN A POST PANDEMIC
WORLD BECAUSE PRE PANDEMIC
WE ONLY ENTERED FACILITIES
-- ON THE ANNUAL BASIS AND
SO WE KNOW THAT ANNUAL IS NOT
ENOUGH IF WE LEARNED ANYTHING
ITS FREQUENCY IN THE POWER OF
PRESENCE AND BEING PHYSICALLY
PRESENT IN THESE FACILITIES
MORE OFTEN WHICH GARNERS
BETTER -- COMPLIANCE IN SO --
THE QUALITY AND SAFETY MODEL
YES THEY WOULD BE ISSUING --
ENFORCEMENT ACTIONS ON PENALTY
CITATIONS ALL -- SERVING THE
SAME REGULATOR -- MODEL THAT
THEY -- CURRENTLY PLAY THE
DIFFERENCE IS THE FREQUENCY
AND KEEPING THIS LEVEL OF
-- HEIGHTENS -- FREQUENCY UP
POST PANDEMIC SO AS WE MOVE
INTO THE NEW MODELS HERE
THE THE FAMILY THE RESIDENT
COMPLAINTS -- ARE THEY GOING
TO BE INVESTIGATED THROUGH US A
NEW PROCESS AND AND WHAT'S THE
CURRENT BACKLOG OF CREE COVE
IT INVESTIGATIONS HOW MANY HOW
AND HOW LONG IS IT TAKING TO
-- FOR THOSE INVESTIGATIONS TO
OCCUR GREAT QUESTION SO WHEN
I WAS APPOINTED IN DECEMBER
TWENTY EIGHTEEN -- WE IN
HYATT HERITAGE EIGHTY I THINK
IT WAS AROUND TWENTY FIVE
THOUSAND BACKLOG OF ALL NON
LONG TERM CARE AND LONG TERM
CARE COMBINED TO COMPLAINTS
AND FACILITY REPORTED INCIDENTS
MOST OF THOSE OF WHICH WERE
FACILITY REPORTED INCIDENTS I'M
NOT COMPLAINTS AND I WOULD SAY
IT WAS ABOUT SPLIT FIFTY FIFTY
BETWEEN NON LONG TERM CARE AND
LONG TERM CARE SETTINGS WE PUT
TOGETHER A ROOT CAUSE ANALYSIS
OF HOW THIS BACKLOG EVEN
HAPPENED IN CALIFORNIA -- AND
WERE ABLE TO IDENTIFY SEVERAL
ROOT CAUSES THAT WERE THE MAIN
IMPETUS FOR THIS AND THEN PUT
TOGETHER A COMPREHENSIVE PLAN
TO REDUCE THAT -- EONS WHEN WE
WE INITIATED THAT AND THAT WHAT
WE CALL THE DEBT FREE TWENTY
TWENTY ONE PLAN IN OCTOBER OF
TWENTY NINETEEN AND IN JUST A
FEW SHORT MONTHS PRIOR TO THE
PANDEMIC KIDDING -- WE WERE UP
TO TWENTY FIVE PERCENT OVERALL
TOTAL REDUCTION AND THAT'S NOT
JUST OF -- ALL THE BACK LOT
COMPLAINTS BUT THAT WAS ALSO
INCLUDING THE ENTIRE UNIVERSE
MEANING EVERYTHING COMING IN
AND EVERYTHING THAT WAS BACK
LOCKED BECAUSE IT DOESN'T DO
US ANY GOOD TO JUST WORK OFF
THE BACKLOG AND THEN CONTINUE
TO ACCRUE WHATEVER IS COMING IN
SO THAT WAS THE WHOLE UNIVERSE
-- OVERALL TODAY YOU KNOW IF WE
LOOK AT JUST THE BACKLOG THAT
WAS IT YOU KNOW MAYBE FIFTY
PERCENT ALREADY TAKING CARE
OF -- BUT WHAT MATTERS TO ME
IS THAT THEN WHEN WE HIT THE
PANDEMIC IN MARCH AND APRIL
WELL WE WERE TRYING TO GARNER
ENOUGH PP FOR STAFF WHAT WE
WERE TRYING TO COME UP WITH
NEW INFECTION CONTROL PROCESSES
AS WELL AS DOING INFECTION
CONTROL FEDERAL SURVEYS --
THEN THERE WAS A FEW WEEKS
AFTER WE STOPPED AND THEN
WE FOCUSED OTHER ACTIVITIES
SO UNFORTUNATELY SOME OF OUR
BACKLOG WORK -- HAD TO TAKE
-- AND HAD TO BE PAUSED OR --
AND DEDICATED DURING THE FIRST
OF THOSE INITIAL MONTHS I'M
AND THEN WE WERE ABLE TO --
WE BEGAN THOSE COMPLAIN AFTER
RIGHT -- -- -- INVESTIGATIONS
WE DO THOSE INVESTIGATIONS
IN TANDEM WITH OR IN PARALLEL
WITH OUR -- WITH MEDICATIONS
OR WE GO OUT ONTO A COVERT
MITIGATION SURVEY WE ALSO TAKE
ANY COMPLAINTS OR F.
RIGHTS THAT WE HAVE FOR THAT
FACILITY -- AND THEN THE PLAN
IS ALSO POST PANDEMIC AS WE
ARE CONTINUING THIS LEVEL
OF FREQUENCY TO WORK OFF THE
BACKLOG EVEN MORE QUICKLY
BY BRINGING THESE COMPLAINTS
EVER ARISE WITH US TO THOSE
FACILITIES BECAUSE IN ORDER
TO DO A FEDERAL INVESTIGATION
IT IS REQUIRED THAT YOU GO
ON SITE AND SO WE'RE TRYING
TO REDUCE TRAVEL TIME WHICH
WAS A BIG FACTOR IN OUR
GREAT STATE THAT HAS A LOT OF
GEOGRAPHICAL AND CHALLENGES
WITH YOU KNOW SOME MOUNTAINS
THAT WE CAN'T PASS THROUGH
THE WINTERTIME EXPECTORANT
AND -- A LOT OF RURAL AREAS
THAT ARE HARDER TO GET TO THE
OTHER PIECE WITH THIS IS THAT
WE ARE LOOKING TO RECRUIT
NOW THAT WE HAVE SYSTEMS IN
PLACE TO DO OUR WORK -- AND
AT THAT TELEWORKING WORLD IN
MOVING THINGS FROM PAPER TO
ELECTRONIC WERE ABLE TO ALSO
THEN HAS A FASTER TIME TO TASK
AS FAR AS GETTING INFORMATION
BACK TO THE FACILITY HAVING A
FACILITY ENTER INTO A PORTAL
SYSTEM WHERE THEY CAN ACCESS
THEIR FINDINGS AND BE ABLE TO
ISSUE THEIR PLANS OF CORRECTION
ELECTRONICALLY PRIOR TO THE
PANDEMIC ALL OF THIS WAS DONE
BY SNAIL MAIL AND FAX EVEN IN
TWENTY TWENTY AND SO THIS IS
A BIG HUGE SHIFT AND LEFT THAT
WE ARE MAKING A MOVIE IN OUR
SURVEY PROCESSES ONE SURVEY
IT ONE TYPE OF SURVEY IT AT
A TIME -- ONTO AN ELECTRONIC
PROCESS SO THAT IS THE OTHER
PIECE OF THIS IS THAT THIS
FALL WE ARE NOW WORKING TO
MOVE OUR COMPLAINT AND AFTER
I INVESTIGATION PROCESS INTO
AN ELECTRONIC FORMAT SO THAT
WE CAN BOTH WORK OFF THE
BACKLOG BUT MORE IMPORTANTLY
-- BE ABLE TO DO OUR WORK MORE
EFFICIENTLY AND BE ABLE TO
-- DELIVER THOSE FINDINGS IN
A MORE TIMELY MANNER TO THE
FACILITIES THANK YOU -- NEXT
I'VE GOT A COUPLE QUESTIONS
FOR MISTER CORNET FEASA PUT
AROUND IN THERE THANK YOU
YES SIR YEAH -- COUPLE COUPLE
OF QUESTIONS FOR YOU SO WE
TALKED ABOUT -- THE NEED FOR
MORE MONEY FOR WORK FORCE
-- AND -- THE AND WE'VE GOT
OBVIOUSLY CHALLENGES WITH OUR
MEDICARE RATES AND AND AND SO
ON SO -- NOTE NONPROFIT RUN
FACILITIES VERSUS FOR PROFIT
RUN FACILITIES THEY'RE ALL IN
REIMBURSE THE SAME RATES OR ARE
THEY NOT OR ARE THEY NOT THEY
THERE NOPE NO ONE'S THE INVERSE
THE SAME RATES EVER GET TO FILL
FACILITY SPECIFIC RATE BUT IS
ALSO CONSTRAINED I WOULD ALSO
SAY TO THEY ARE VERY DIFFERENT
PATIENT MIXES IN IN -- FOR
EXAMPLE -- NONPROFIT FACILITIES
OVERALL I HAVE ABOUT HALF
THE LEVEL OF OF OF MEDICARE
PATIENTS THAT FOR PROFIT
FACILITIES DO SO MEDICARE
OFFICER -- FOR PROFITS AT LEAST
TEN DEAD HAVE MUCH MUCH HIGHER
MEDICARE HELP A PATIENT -- --
POPULATIONS OKAY -- IS THAT
PART OF IT IT'S HARD TO IT'S A
LITTLE HARD TO TO DO A DIRECT
COMPARISON THAT BUT EACH WEEK
WE HAVE FACILITY SPECIFIC RATES
BUT I WOULD SAY TO YOU THOUGH
IS IS AND YOU HEARD LINDY'S --
MENTIONED THIS EARLIER THE WAY
THE REIMBURSEMENT STRUCTURE
WORKS IS DE KOSTER CONSTRAINED
SO EVEN THOUGH -- THOUGH THAT
THERE WAS AN INCREASE IN IN THE
-- THE RATES THIS LAST YEAR IF
YOU LOOK AT WHAT THE INCREASE
WAS IT IS STILL FACILITIES
ACROSS THE BOARD ARE STILL PAID
SUBSTANTIALLY LESS THAN WHAT
THE FULL COST ARE THAT THEY
REPORT -- BY BEING ABLE TO DO
A DIRECT PASSED THROUGH FOR
LABOR COST FOR EXAMPLE IF THE
STATE COULD COMPENSATE FOR THE
FULL FULL COST OF LABOR THAT
WOULD MAKE A BIG DIFFERENCE IN
ANY KIND OF FACILITY SO THE TEN
PERCENT BUMP DIDN'T GO TO LABOR
THAN TWO THOUSAND TEN PERCENT
TO TEN PERCENT KOBE BOB IT WENT
TO IT IT HAS TO BE USED FOR
ANYTHING RELATED TO CO THAT IT
IS GOING FOR STAFF BONUSES AND
STAFF -- STAFF INCENTIVE PAY
IS BEING USED FOR OVERTIME IT'S
BEING USED FOR THE ADDITIONAL
COST OF PP FOR TECHNOLOGY ALL
THE THE THE STATUTE REQUIRES --
EIGHTY EIGHTY ONE REQUIRES THAT
THAT TEN PERCENT BUT HAS TO BE
USED FOR COPD RELATED EXPENSES
MANY AND MOST OF THOSE EXPENSES
I SUSPECT ARE ALL GOING TO
MOSTLY BE IN THAT IN THE AREA
OF STAFFING BECAUSE THE STAFF
ACOSTA BEEN SIGNIFICANTLY MORE
-- HIGHER WITH PEOPLE OUT ON
SICK LEAVE FOR EXAMPLE ARE
QUARANTINING -- -- FACILITIES
ARE MAKING USE OF THE NURSE
REGISTRIES THOSE RATES ARE
ABOUT TWICE -- ARE SOMETIMES
THREE TIMES MORE THEY'RE HAVING
TO PAY A LOT MORE OVER TIME AND
THEY'RE PAYING BONUSES AT --
STAFF INCENTIVE -- -- PAY TO
-- KEEP -- STAFF ON THE JOB SO
BUT HE WITHOUT THEIR THEIR LOW
WAGES SO I MEAN COMPARED TO THE
WORK YOU KNOW THE IT'S I THINK
CERTAINLY PEOPLE ON THIS PANEL
BELIEVE THAT YOU KNOW THEY
SHOULD BE HARPER THERE SHOULD
BE HIGHER COMPENSATION SO
YOU'RE PROBABLY BE A FOR PROFIT
ENTITIES ARE STILL MAKING A
PROFIT WELL THE IF YOU LOOK
AT THE DATA THOUGH -- MISTER
WOULD WE CAN PROVIDE SOME
OF THE STATE THE PRODUCT THE
PROFIT MARGINS ARE EXTREMELY
LOW IN THE ROUND THE ONE THAT
NOT EVEN THE I WOULDN'T CALL
THE PROFIT MARGINS BUT IF YOU
LOOK AT THE US BY DATA ON THIS
THERE IN SOMEWHERE AROUND THE
ONE PERCENT RANGE AND I WOULD
TELL YOU THE BEST INDICATOR
OF THIS IS HOW FEW NEW ENTRIES
THERE ARE TO THE MARKET I
MEAN THERE ARE ALMOST NO NEW
SKILLED NURSING FACILITIES IN
CALIFORNIA EACH YOU CAN COUNT
THEM ON ONE HAND -- AND I THINK
THAT'S A PRETTY GOOD INDICATOR
THAT THAT YOU KNOW IF THIS WAS
THAT A BUSINESS WHERE THERE
WAS A LOT OF -- A MONEY TO BE
MADE YOU SEE A LOT MORE PEOPLE
TO MANAGE TO GET INTO THE
BUSINESSES AND THAT'S JUST NOT
THE CASE WELL BUT WE ALSO KNOW
THERE RELATED PARTIES INVOLVED
THAT THAT ARE PART OF THE
TANGLED WEB OF THE WAY NURSING
HOME OPERATORS OPERATE SO IT'S
NOT UNUSUAL FOR MY RECOLLECTION
THAT THAT AN OPERATOR MIGHT
HAVE ITS OWN LAUNDRY SERVICE
AT THE CONTRACT THEY MIGHT
HAVE ANOTHER CORRECTLY THAT
THE BRAND FROM THE SO THERE'S
SO THAT ONE PERCENT DOES IT
REFLECT THE PROFIT OF THE
ENTIRE INDUSTRY BUT THEY'RE NOT
ALLOWED TO MAKE A PROFIT OFF
OF THE RELATED PARTIES THAT'S
THAT'S THAT'S NOT THERE THEY'RE
NOT ALLOWED TO DO THAT AND IF
YOU RECALL THE AUDIT THAT THE
STATE AUDITOR DID LOOK AT THAT
ISSUE TOO AND FOUND NO ISSUES
RELATED TO TO RELATED PARTIES
I TWO YEARS AGO SO OKAY YOU'RE
CORRECT THAT THERE ARE RELATED
PARTIES BUT AGAIN I JUST TO
SAY THAT THEIR DAY THEY'RE NOT
ALLOWED TO MAKE A PROFIT OFF
THAT AND WE WE'RE NOT AWARE
OF ANY AGAIN WITH GIVEN THE
AUDITOR'S REPORT WHEN I WEAR
THAT THAT'S AN ISSUE SO -- JUST
AND THIS WOULD BE A RADICAL
QUESTIONS YOU PROBABLY CAN'T
ANSWER BUT -- I'M GONNA PUT IT
OUT THERE ANYWAY -- IF THERE
WERE INCREASED AN INCREASE IN
THE MEDICARE REIMBURSEMENT RATE
-- DO YOU THINK THE INDUSTRY
WOULD ALLOW FOR THE INCREASE
TO GUARANTEE THAT THAT THAT GO
TO INCREASE WAGES FOR WORKERS
I THINK THAT THE INDUSTRY WITH
VERY LAST PROFESSION WOULD
VERY MUCH LIKE TO PAY WORKERS
MORE I DON'T THINK THERE'S
ANY QUESTION ABOUT THAT WHAT
I SUGGESTED TO YOU IS A DIRECT
PASS THROUGH SO IF THE THAT THE
STATE WOULD FULLY COMPENSATE
WHATEVER THE THE COST ARE
OF OF OF STAFF RIGHT NOW THE
FACILITIES ARE INCENTIVIZED TO
PUT MONEY INTO STAFF THAT THAT
THAT THAT'S THEIR INCENTIVE
NOW BECAUSE THEY THE THE IF
IT THEIR ADMINISTRATIVE COSTS
THEY'RE ONLY REIMBURSED -- AT
THE FIFTIETH PERCENTILE FOR
THE LABOR COSTS REIMBURSED AT
THE NINETY FIFTH PERCENTILE BUT
JUST BECAUSE THEY EVEN IF YOU
GET TO THE HUNDRED A HUNDRED
PERCENT HUNDRED PERCENT I
DIDN'T GET TO A HUNDRED PERCENT
WITHOUT A HIGHER OVERALL RATE
THAT DOESN'T GIVE THEM ANY MORE
MONEY -- SO BECAUSE THE RATES
RIGHT NOW ARE STILL VERY VERY
LOW THEY CAN THEY CAN USE MORE
OF THE RATE INCREASE THEY HAVE
FOR STAFFING THEY COULD DO THAT
-- CURRENTLY BUT THEY DON'T
HAVE ENOUGH MONEY OVERALL IF
THE STATE SIMPLY COMPENSATED
WITH A DIRECT PASSED THROUGH
FOR LABOR THAT WOULD MAKE ALL
THE DIFFERENCE IN THE WORLD
THANK YOU BRIGITTE -- DR
WASSERMAN AND THERE'S WITH MY
LAST SERIES OF QUESTIONS SO
ARE COUPLE QUESTIONS FOR YOU
-- DR WASSERMAN -- THERE --
FIRST OF ALL -- CAN YOU TALK
ABOUT SNIFFS AND AND THIRD THE
THIRD IN OF THE THIRD PARTY
ISSUE -- KIND OF THE NEED FOR
TRANSPARENCY I KNOW ABOUT THE
AUDIT I'M THE ONE WHO INITIATED
THE AUDIT SO -- BUT BUT I'M
CURIOUS AS HOW THIS RELATES TO
THE CARES ACT AND HOW THE MONEY
FROM CARE SECTOR'S BEEN DISTANT
DISSEMINATED IN UTILIZED BY
SKILLED NURSING FACILITIES
YEAH THANK YOU -- CINNAMON --
PRESHEAF THE QUESTION I'M SO I
THINK THE CONCERN THAT SOME OF
US HAVE HAD IS HOW THE MONEY
FROM THE CARES ACT IS ACTUALLY
FOR -- FLOWED TO FACILITIES
AND WHETHER THAT MONEY IS
BEING SPENT A HUNDRED PERCENT
TOWARDS DIRECT PATIENT CARE
WITH WHETHER IT BE HAZARD PAY
WHETHER IT BE PP WHETHER IT BE
TESTING AND I THINK ONE OF THE
CHALLENGES IS THERE'S MULTIPLE
WAYS THAT MONEY CAN FOR LACK
OF A BETTER WORD BE SIPHONED
AWAY -- FOR INSTANCE -- YOU
MENTION RELATED PARTIES -- THE
THE COST REPORT DOESN'T CAPTURE
ALL RELATED PARTIES NUMBER
ONE SO IN ORDER TO REALLY
KNOW SOME OF THESE ANSWERS
WE NEED FULL TRANSPARENCY ON
ALL OF THE RELATED PARTIES
SIMILARLY WE NEED TO GET
INTO A LEVEL OF DETAIL FOR
EXAMPLE WATER FACILITIES
PAYING SAY TO A RELATED PARTY
SUPPLIER FOR THEIR P.
P.
ARE THEY PAYING MARKET RATES
ARE THEY PAYING OVER MARKET
RATES THERE'S A LOT OF WAYS
THAT THE THE THE THE SYSTEM THE
MONEY CAN BE MANIPULATED AND
ALL THE SAME TIME IF IF SOME OF
THAT MONEY IS GOING AWAY FROM
THE FACILITY IT'S NOT BEING
USED TO PAY OUR FRONTLINE STAFF
FOR PUTTING THEIR LIVES AT RISK
AND AND I THINK THAT'S OF GREAT
CONCERN I THINK THERE THE REAL
QUESTION HERE IS WE NEED A FULL
FULL AMOUNT OF TRANSPARENCY OF
ALL THESE ISSUES THANK YOU --
COUPLE THINGS THAT YOU OTHER
THINGS YOU MENTIONED IN YOUR
COMMENTS -- AND RECOMMENDATION
PARTICULAR ONE WAS TWENTY
TO TWENTY TWENTY FOUR HOUR
ARE IN ON DUTY -- I WAS KIND
OF APPALLED TO REALISE AND
KNOW AND UNDERSTAND THAT THE
FACILITY DOES NOT REQUIRE A
TWENTY FOUR HOUR NURSE AND
ARE IN A STE AND OUR AND WE'RE
TALKING ABOUT A MEDICAL DOCTOR
WE'RE NOT TALKING ABOUT NURSE
PRACTITIONERS WE'RE TALKING
ABOUT AND ARE IN SO I'M GOING
TO GUESS THAT SOME POINT
AS THINGS WIND DOWN IN THE
EVENING IT'S IT'S L.
B.
N.
C.
N.
A.'S AND AND YOU KNOW I'M I'M
CONCERNED ABOUT THAT AND I I
I I I WOULD IMAGINE THAT MOST
CONSUMERS ARE AWARE OF IT WE
CERTAINLY WEREN'T AWARE OF IT
AND YOU KNOW I I JUST CAN'T
HELP BUT THINK THAT A CHANGE
IN THAT DIRECTION WOULD BE A
DRAMATIC POTENTIAL IMPROVEMENT
IN THE QUALITY OF CARE AND THE
QUALITY OF THE HEALTH OF THE
RESIDENTS SO THAT SOMETHING
EARLY CAN BE CAUGHT -- AND AND
YOU KNOW THINGS HAPPEN IN THE
MIDDLE OF THE NIGHT YOU KNOW
I MEAN THAT THAT THEY THEY
CLEARLY DO AND AND HOSPITALS
AND WHEREVER I'M JUST SHOCKED
QUITE FRANKLY THAT THERE ISN'T
A REQUIREMENT TO HAVE A NURSE
AT OUR END IN THE BUILDING
TWENTY FOUR HOURS A DAY AT A
MINIMUM -- SO I'D SO YEAH GO
AHEAD YOU AND MY WIFE I WAS
PREPARING FOR THIS AND SHE
HAD THE EXACT SAME REACTION
SHE WAS LIKE WAIT A MINUTE I I
WOULD ASSUME THIS AND KEEP IN
MIND ASIDE FROM THE LEVEL OF
ACUITY OF PATIENTS COMING FROM
THE HOSPITAL THE RESIDENTS IN
OUR FACILITIES HAVE MULTIPLE
MEDICAL ISSUES AND AND AND SO
THERE'S ACTUALLY A COUPLE KEY
POINTS HERE FACILITIES WITH
UNDER NINETY NINE BEDS ARE
NOT REQUIRED TO HAVE A TWENTY
FOUR SEVEN RM AND WE NEED TO
CHANGE THAT BECAUSE AS YOU
SAID IN THE MIDDLE OF THE NIGHT
SOMEONE'S NOT FEELING GOOD WHO
CAN EVALUATE THEM THAT HAS ANY
LICENSED PROFESSIONAL CLINICAL
EXPERTISE AND IT MUST BE A
REGISTERED NURSE NOW WE HAVE
TO GO BEYOND THAT BECAUSE IN
LARGER SIZE BUILDINGS THERE
MAY BE AN RN LOW SURPRISINGLY
EVEN THOUGH IT'S REQUIRED FOR
THERE TO BE TWENTY FOUR SEVEN
ARE IN FOR FACILITIES GREATER
THAN A HUNDRED BADS THAT
DOESN'T ALWAYS HAPPEN AND AND
I THINK THAT IS SOMETHING THAT
REALLY NEEDS TO BE MONITORED
BY THE STATE AS WELL BUT EVEN
EVEN WITH AN TWENTY FOUR HOUR
NURSE AVAILABLE IF THINGS GO
WRONG WITH A FEW PATIENTS AT
THE SAME TIME IF YOU RESIDENTS
AT THE SAME TIME ONE PERSON
IS NOT ENOUGH AND AND THAT'S
WHERE THE POINT SEVEN FIVE
ALL RAN PER TWENTY FOUR HOURS
PER RESIDENT PER DAY COMES IN
THAT DR HARRINGTON SPOKE OF
AND YOU KNOW WE REALLY HAVE TO
REALIZE THAT WE'RE NOT WE'RE
NOT RENTING APARTMENTS HERE
WE'RE RUNNING MANY HOSPITALS
AND AT THE VERY LEAST WE
NEED A REGISTERED NURSE WHO'S
AVAILABLE WHO'S NOT PULLED
IN MULTIPLE DIRECTIONS AND I
HAVE TO TELL YOU THAT MY HEART
BREAKS FOR THE STORIES I HEARD
NICOLE HOW TALL AND AND OTHERS
IN TERMS OF WHAT'S GOING ON IN
UNDERSTAFFED THE SAUDIS RIGHT
NOW THAT WE DON'T KNOW ABOUT
AND DURING CODED THERE'S A
LOT MORE COMPLEXITY THAN WE'VE
EVER HAD IN SO THE NEED FOR
THAT TWENTY FOUR SEVEN POINT
SEVEN FIVE FULL STAFFING IS
ABSOLUTELY ESSENTIAL IF WE'RE
GOING TO PROVIDE EVEN A MODICUM
OF CARE FOR OUR LOVED ONES
THANK YOU -- YOU ALSO TALKED
ABOUT THE CERTIFIED MEDICAL
DIRECTOR SAID AND YOU ALSO
MENTIONED THAT THE COURSE IS
NOT TERRIBLY ONEROUS AND MEET
WITH IS PROBABLY TECHNICALLY
ONEROUS BUT AS FAR AS THE
TIME INVOLVED IT'S A THREE
THREE DAY COURSE HI AND --
YOU KNOW THINKING ABOUT RURAL
COMMUNITIES WHERE WE'RE OFTEN
IT'S REALLY DIFFICULT TO EVEN
FIND A DOCTOR WHO COULD YOU
KNOW WHO WOULD BE WILLING TO BE
ON PAPER THE MEDICAL DIRECTOR
-- HAVE YOU THOUGHT IN JAIL
YOU KNOW ABOUT OTHER POTENTIAL
PROVIDERS WHO C° MIGHT BILL
TO FILL ROLE LIKE THAT I JUST
IN SOME COMMUNITIES YOU KNOW
THERE YOU MAY NOT FIND A DOCTOR
BUT THERE YOU KNOW MAYBE IT'S
A NURSE PRACTITIONER YOU KNOW
YOU KNOW I DON'T KNOW BUT BUT
SOMEBODY WHO COULD BE ON SITE
MORE BECAUSE I MY SENSE IS
THAT A LOT OF THIS IS THERE
ON PAPER MORE THAN THEIR ON
SITE AND AND THAT THAT'S IN
THERE IT DOESN'T SOUND LIKE
FROM YOUR CONVERSATION THAT
THERE REALLY IN INVOLVED IN IN
DECISIONS AROUND THE MEDICAL
TREATMENT OF OF AS FAR AS THE
TREATMENT OF THE OF THE REAR
OF THE RESIDENCE IT SOUNDS
MORE LIKE A AN ADMINISTRATIVE
POSITION -- WHERE THEY KIND
OF COME IN AND YOU KNOW SIGNED
A FEW PAPERS OCCASIONALLY AND
THEN AND THEN THEN THEY'RE
GONNA GET SO -- YEAH IF THE
GOAL IS TO HAVE BETTER CARE
THE CERTIFICATION MAKES A
DIFFERENCE BUT THEY'RE PROBABLY
SETTINGS WHERE IT'S GOING TO BE
REALLY DIFFICULT IT'S DIFFICULT
NOW BUT EXTREMELY DIFFICULT TO
GET GET STAFF -- TO TO DO THIS
JOB KNOW THAT THAT IS A GREAT
QUESTION -- SOME WOMEN AND AND
-- FIRST OFF THAT THE COURSE
HAS ONLINE COURSEWORK AND THEN
IT ENDS WITH A THREE DAY SORT
OF WRAP UP -- THEY USED TO BE
IN PERSON BUT IS NOW VIRTUAL --
BUT YOU KNOW RURAL AREAS HAVE
STRUGGLED REGARDING NURSING
HOMES FOR FOR AS LONG AS I'VE
BEEN A GERIATRICIAN WHICH IS
OVER THIRTY YEARS AND ACTUALLY
BACK WHEN I WAS IN COLORADO WE
WE ACTUALLY HAD A GRANT TO GO
OUT TO RURAL AREAS TO TRY TO
HELP PHYSICIANS DEAL WITH THEIR
OLDER POPULATION AND SO THIS IS
AN ONGOING PROBLEM WHETHER IT'S
ACTUALLY HELPING CLINICIANS
WHO GO TO THE FACILITIES OR
HAVING A MEDICAL DIRECTOR WHO
IS ON SITE AT THE FACILITY --
AND IN RURAL AREAS OFTEN THE
PERSON WHO SEES PATIENTS IS
ALSO GOING TO BE THE MEDICAL
DIRECTOR WHICH HAS SOME OF ITS
OWN CHALLENGES BUT I THINK ONE
OF THE THINGS WE'VE WARM DURING
COLD IT IS THE OPPORTUNITY TO
PROVIDE TELEHEALTH TELEMEDICINE
VIRTUAL AVAILABILITY IN FACT --
THE FACILITY I MEDICAL DIRECTOR
OF -- BECAUSE MY AGENT AND I
HAD ASTHMA AS A KID MY WIFE
HAS SOME IMMUNO COMPROMISED I
HAVEN'T BEEN IN THAT FACILITY
SINCE SINCE THE ONSET OF KOBE
BUT I HAVE CONTINUE TO INTERACT
WITH THE STAFF IN IN AND IN
WITH WITH THE LEADERSHIP OF
THE FACILITY SO THERE ARE MANY
WAYS FOR ANY IN FACT I THINK
ONE OF THE SOLUTIONS HERE FOR
RURAL AREAS IS GOING TO BE
PROVIDING TELEHEALTH TO THE
NURSING HOMES FOR BOTH CLINICAL
CARE AND MEDICAL DIRECTOR
LEADERSHIP AND YOU KNOW TO
YOUR TO YOUR POINT MOST MEDICAL
DIRECTORS UNFORTUNATELY GET
A NICE STIPEND AND FOR THAT
STIPEND THEY GO IN AND THEY
SPEND AN HOUR OR TWO A MONTH
SIGNING PAPERS THAT IS NOT
WHAT THE RAGS MEANT THEM TO
DO THAT'S NOT WHAT THEY'RE
SUPPOSED TO DO THAT'S NOT WHAT
WE NEED THEM TO DO AND ONE OF
THE THINGS THAT REALLY I FEEL
STRONGLY ABOUT YOU KNOW I'M A
PROFESSIONAL YOUR PROFESSIONAL
IF A PHYSICIAN DOESN'T HAVE
THE TOOLS AND THE TRAINING THEN
THEY'RE NOT THEY DON'T HAVE
THEIR OWN EXPECTATION OF WHAT
THEY CAN DO BUT ONCE YOU PUT
IN THEIR HANDS THE TRAINING
THE TOOLS FOR SKILLS NINETY
FIVE PERCENT OF POSITIONS
THAT I KNOW WILL TAKE THAT
RESPONSIBILITY SERIOUSLY AND
ALL OF A SUDDEN YOU WILL HAVE
MEDICAL DIRECTORS WHO ARE
GOING TO GET MORE INVOLVED IN
WHETHER A FACILITY IS UP TO
SPEED STAFFING WISE IN ORDER
TO TAKE COMPLEX RESIDENTS --
IS ONE OF MY COLLEAGUES AND
I SAID EARLY ON IN COALBED
WHEN THE STATE ACTUALLY TRIED
TO SEND CODED PATIENTS INTO
NURSING HOMES MY MY COLLEAGUE
AND I SAID WE'D STAND IN FRONT
OF OUR FACILITY AND KEEP THOSE
RAT THOSE PEOPLE OUT BECAUSE
AS WE ALL KNOW AND THE EXPERTS
NEW IN MARCH THE NURSING
HOME RESIDENTS ON BRINGING
HOPE IT INTO THE FACILITY
IT'S VISITORS ITS STAFF ITS
VENDORS AND AND SO IF YOU HAVE
ENGAGE MEDICAL DIRECTOR WHO'S
ACTIVELY INVOLVED WITH THE
ADMINISTRATOR WITH THE DIRECTOR
OF NURSING AND THEY KNOW THAT
THAT PERSON IS RESPONSIBLE
FOR THE CLINICAL CARE THEN YOU
HAVE AN ADDITIONAL MEANS YOU
HAVE ADDITIONAL ICING YEARS
BEYOND THE STATE SURVEYORS
BEYOND EVERYONE ELSE YOU'VE GOT
PROFESSIONALS WHO ARE GOING TO
BE PART OF THE SOLUTION RATHER
THAN PART OF THE PROBLEM --
ONE FINAL QUESTION FOR YOU IN
THAT SECTOR THANK YOU THANK THE
CHAIR FOR INDULGING ME HERE --
IS THE -- WE TALKED ABOUT THE
LITTLE QUICKLY BACK EARLIER WE
TALKED ABOUT THE TRANSPARENCY
ABOUT THE NEED FOR TRANSPARENCY
AROUND HOW THE CARES ACT MONEY
MAY HAVE BEEN UTILIZED WAS
THERE A FULL ARE YOU WHAT WAS
IT WHAT WAS THE FORMULA FOR --
FOR WHAT YOU KNOW HOW WITH HOW
NURSING HOMES QUALIFIED TO GET
IT AND I BRING THIS UP BECAUSE
YESTERDAY WE FOUND OUT IN OUR
-- OUR HEARING ON HEALTH CARE
AFFORDABILITY THAT HOSPITALS
-- OFTEN THE HOSPITALS THAT
HAD THE BEST BALANCE SHEETS
GOT THE LION'S SHARE OF THE
MONEY BECAUSE OF THEIR MEDICARE
POPULATIONS AND SO ON YET THIS
THE HOSPITALS THAT PROBABLY
NEEDED IT THE MOST I DIDN'T
GET THAT YOU KNOW DIDN'T GET
ANYWHERE CLOSE TO WHAT THEY
NEEDED YET SO IT'S THE YOU KNOW
IT'S THOSE WHO HAVE THE GOAL
GET MORE GOLD THAN THOSE WHO
DON'T DON'T AND SO I'M CURIOUS
IN THIS INDUSTRY -- HOW WAS
THEM HOW WAS IT HOW WAS THE
MONEY DISSEMINATED WHAT WHAT
DID THAT LOOK LIKE -- DID THE
DID THE THE BIGGEST WEALTHIEST
SYSTEMS GET THE MONEY OR WAS
IT WAS IT FAIRLY DISSEMINATED
I FROZE YOU UP APPARENTLY I'M
SORRY I DON'T THINK I DON'T
THINK I HAD THAT POWER BUT
COME BACK
THE MOTIVATIONAL
CLEARLY SOMEBODY DID
LIKE THE QUESTION I AM
THE FOR THE MARKET
OKAY THANK YOU
THE LION KING
YEAH OKAY THAT'S REALLY
WEIRD I THINK THIS IS A LIFE
OKAY THANK
J.
THEY'RE RESTARTING THE
SYSTEM RIGHT NOW YEAH
AND IF THERE IS ANOTHER OKAY I
DON'T DID YOU HEAR MY QUESTION
BEFORE YOU YOU FROZE THERE WAS
SYSTEM SIDE SHOCKING BUT NOW
WE CAN'T HEAR YOU HAVE
ACTUALLY HEARD THE QUESTION
AND THEN IF THEN IF THEN IT
FROZE OKAY ALL RIGHT OOPS
HANG ON WE LOST YOU KNOW IT'S
INTERESTING WHEN WHEN PERHAPS
WE CAN HEAR YOU NOW GO AHEAD
SO WHEN THE CARES ACT CAME
OUT -- THERE REALLY WAS NO IF
THEY JUST GAVE THE MONEY OUT
AND THERE REALLY WASN'T A LOT
OF ATTACHED TO IT -- I THINK
THE LARGER ORGANIZATIONS AS
YOU SAID WITH THE MOST MONEY
THE MOST RESOURCES PROBABLY
WERE BETTER ABLE TO ACCESS
THOSE FUNDS I I ALWAYS WORRY
IN THESE CASES FOR THE NOT FOR
PROFITS THE THE MOM AND POPS
THE SOLE OWNED FACILITIES IN
ORDER WHETHER THEY'RE THEY WERE
ABLE TO PUT IN THEIR REQUEST TO
GET THE MONEY IN TERMS OF FROM
MY UNDERSTANDING FROM TALKING
TO ACTUALLY SEE STAFFERS IN
CONGRESS THERE WASN'T A LOT
ATTACHED TO THIS SO THE MONEY
JUST CAME OUT AND AND I THINK
A LOT OF FOLKS ARE BEGINNING TO
LOOK AT WHAT ACTUALLY HAPPENED
TO IT AND JUST AS YOU JUST AS
YOU ARE ASKING THAT QUESTION
OKAY THANK YOU WELL I GUESS
WE'LL CONTINUE TO LOOK AT THAT
AND SEE SO DO YOU HAVE YOU
HEARD IS THE FEDERAL GOVERNMENT
PLAN TO DO ANY AUDIT ON ON ON
KERR'S ACTED HOW IT WAS SPENT
I'VE ACTUALLY SPOKEN TO
-- STAFF ON THE SO THE I
CONGRATULATE SUBCOMMITTEE
THAT'S THAT'S LOOKING AT THIS
AND -- I IT IS IT IS MY BELIEF
THAT THEY ARE GOING TO BE
LOOKING AT THIS GREAT THANK YOU
THANK YOU
OKAY NOW WE'RE GONNA
GO TO MISTER ZERO
THANK YOU CAN YOU HEAR ME WE
CAN HEAR YOU PERFECT NICE TO
SEE EVERYONE REMOTELY AND THANK
YOU MISTER CHAIR FOR HOLDING
THIS VERY IMPORTANT MEETING
-- SO I'M JUST SORRY THAT I
CAN'T BE THERE IN PERSON BUT
-- HAPPY THAT I CAN JOIN YOU
REMOTELY IDEA MY QUESTIONS ARE
PRIMARILY GOING TO BE -- FOR A
MISTER CORNET -- MISTAKE OR AND
DR WASSERMAN -- BUT BEFORE I
GET INTO IT I I DID WANT TO --
ALSO -- A KNOWLEDGE MISS CARMEN
AS -- AS DID MY A COLLEAGUE
FROM FRESNO -- -- I I FIND IT
INTERESTING THAT SHE -- WAS
INFECTED IN JULY -- AND THEN
HAD THE MISFORTUNE OF CARRYING
THAT TO HER FAMILY AND HER
LOVED ONES AND TO HEAR ABOUT
THE CHALLENGES THAT HER HUSBAND
HAS BEEN DEALING WITH -- IT
WHEN BY JULY WE HAD ALREADY
HAD A COUPLE OF HEARINGS I
BELIEVE AT LEAST ONE IF NOT
TWO AND AND REGARDLESS OF THE
HEARINGS WE WERE WE KNEW THE
ALARMING RATES SO I AM -- I
THINK IT JUST DRIVES HOME THE
FACT THAT EVEN AFTER WE KNEW
WHAT WAS GOING ON THAT WE HAD
STAFFERS -- STRUGGLING AND --
AND I DO APPRECIATE -- MISTER
CHAIR FOR BRINGING ON MISS
CARMEN ALSO TO TO PROVIDE HER
TESTIMONY AND HER STORY IDEA
WANTED TO GET INTO A COUPLE
OF QUESTIONS MISTER WOOD AND
I SEEM TO KIND OF DOCTOR WOULD
AND I SEEM TO KIND OF THINK
ALIKE IN SOME SOME AREAS SAY
PRECIADO HIS QUESTIONS AND
ONE OF THE ANSWERS MISTER
CORNET GAVE WAS THAT -- FOR
THIRD PARTY OR RELATED PARTY
COMPANIES IS THAT -- THERE IS
NO PROFIT INVOLVED AND AND AND
DR WASSERMAN STARTED TOUCHING
ON THAT WHICH WHICH BEFORE
HE WAS EVEN GONNA SAID I WAS
GONNA SAY WELL THERE'S THERE'S
MARKET RATES THAT YOU COULD
BE SETTING AND JUSTIFYING SO
HOW CAN YOU SAY THAT THERE IS
NO PROFIT INVOLVED IT IS THERE
SOMETHING STATUTORILY WRITTEN
YEAH CAN YOU PLEASE ON ME
THANK YOU YES YEAH ALL ALL
FACILITIES THEIR AUDITED AND
THEIR COST THE COST THAT THEY
CAN BE REIMBURSED FOR AUDITED
SO THE AUDITORS EXCLUDE -- WHAT
THEY CONSIDER RE ABOUT -- A
PROFIT ON ON THE THOSE THIRD
PARTY ON THE ISSUE THE WAY
FACILITIES ARE REIMBURSED THEY
REIMBURSE TWO YEARS IN ARREARS
SO IN OTHER WORDS RIGHT NOW
WHAT THEY RECEIVE RIGHT NOW
IS BASED ON WHAT THEY SPENT
TWO YEARS AGO THOSE ARE ALL
AUDITED AND ANY THIRD PARTY
TRANSACTION LIKE THAT THIRD
PARTY -- -- IT AUDITORS WILL
ROUTINELY EXCLUDE CERTAIN COST
THAT BETTER WORK SHOW UP ON
THERE THAT THE COST AND THAT
INCLUDES THE ANY PRODUCT THEY
MAKE ON THIS THIRD THIS THIRD
PARTY BUT BUT YOU'RE FREE TO
PUT WHATEVER RATE FOR THE MONTH
FOR THE STAFF A YOUR YOU'RE
ABLE TO PUT WHATEVER RATE FOR
THE IS THERE A CAP ON THE RATE
FOR MARKET RATE ON THE -- -- UP
RENTAL OR LEASE YEAH I I'M NOT
SURE I CAN GIVE YOU THAT LEVEL
OF DETAIL MISTER NAZARIAN I
GET BACK TO YOU ON THAT I JUST
KNOW THAT IS HOW THE AUDITING
FUNCTION WORKS THOUGH THAT
THAT THERE ARE A LOT OF COSTS
THAT ARE THAT ARE EXCLUDED FROM
WHAT THAT FACILITY YOU KNOW
CAN'T CLAIM -- AND THEN LIKE
I SAY ON TOP OF THAT THEN THEN
EACH OF THOSE COST OF FACTORS
DEPENDING ON THE THE PART OF
THE LINE ITEM IT'S UNDER THEY
WILL BE REIMBURSED AT THE
FIFTIETH PERCENTILE MAYBE THE
NINETIETH PERCENTILE WHATEVER
IT IS AND THEN ON TOP OF THAT
THEN THERE'S A LIMITATION ON
HOW MUCH THEY CAN ACTUALLY GET
BASED ON THE OVERALL IN THE
LIMIT THE OVERALL INCREASE IN
THE MEDIC CAL RATE SO THEY ARE
CONSTRAINED AT MULTIPLE LAYERS
I GET THE CONSTRAINTS THAT YOU
KNOW CONSTRAINTS ARE PUT INTO
PLACE SO THAT WE WE WE TRY TO
YEAH WE TRY TO PROVIDE THE BEST
SERVICE WE CAN BASED ON THE
DOLLARS PROVIDED AND SOMETIMES
THOSE AREN'T ENOUGH BUT THEN
THERE'S ALWAYS -- -- WAYS TO
TO TO TO MOON MANEUVER AROUND
THAT -- NEATLY WE RECENTLY IN
THE LIGHT AND THIS LAST TERM
TOOK STEPS FOR EXAMPLE -- IN
IN THE -- A PUBLIC EDUCATION
CHARTER REALM WHERE WE SAID
IF YOU ARE A OPERATOR OF THE
CHARTER SCHOOL YOU CAN NOT OWN
THE LAND THAT YOU'RE PAYING
LEAST TO SO THAT THAT WAY IT
CUTS POTENTIALLY ANY -- ANY
-- BUT IT BASICALLY TAKES AWAY
ANY POTENTIAL MOTIVES OF MAY
BE PAYING A LITTLE BIT MORE
THAN THE MARKET RATE OR AT THE
HIGHEST LEVEL OF MARKET RATES
FOR LEASE -- ESPECIALLY AT
A TIME LIKE THIS WHEN MARKET
RATES ARE AT ALL TIME HIGH
WE KNOW THERE'S A THAT THE I
COULD NOT WOULD NOT KNOW WE ARE
IN AN ECONOMIC DOWNTURN IT'S
JUST WE HAVEN'T FELT THE FULL
EFFECTS OF IT YET AND SO WE
CAN BE SETTING PRICES RIGHT NOW
YET IN THE IN THE COMING YEARS
THAT RATES MAY NOT BE REALLY
THE RATES THAT SHOULD BE PAID
BECAUSE THE MARKET ISN'T THERE
SO THERE'S A LOT OF THESE GAMES
MANSHIP THAT UNFORTUNATELY CAN
CAN TAKE PLACE -- SO I DON'T
KNOW IF -- MY COLLEAGUE DR
WOULD WAS THINKING ABOUT THIS
BUT BUT I THINK SOMETHING ALONG
THE LINES OF ENSURING THAT --
HOUSING THAT THAT THAT THAT
THAT -- -- OWNER OPERATORS
ARE ALSO THIS INVESTED FROM
OWNERSHIP OF THE PROPERTY --
UP POTENTIALLY HELPS ADDRESS
AT LEAST ONE OF THESE ISSUES
I DON'T KNOW IF YOU WOULD
CARE TO COMMENT MISTER CORNET
ON THAT -- BUT I'D ALSO LIKE
TO I'D LIKE TO HEAR FROM YOU
AS WELL AS FROM DR WASSERMAN
YEAH I I WOULD PROBABLY NEED
TO UNDERSTAND A BIT MORE WHAT
YOU TALK ABOUT I WILL JUST
TELL YOU THIS THOUGH DID MANY
FACILITIES AROUND THE COUNTRY
LESS SO IN CALIFORNIA THAT MANY
FACILITIES AROUND THE COUNTRY
THAT HAVE NOT BEEN ABLE TO
MAKE IT AND HAVE GONE BANKRUPT
OVER THE LAST NUMBER OF YEARS
THE CAUSE OF THAT HAS BEEN THE
READS THE REEDS M.
AND THE OWNERSHIP OF THE AT
THE OF THE LAND THAT HAS BEEN
A MAJOR PROBLEM IN MANY PARTS
OF THE UNITED STATES BECAUSE
AS THE REEDS HAVE INCREASED
THE THE THE LEAST COST --
THAT IS -- SOMETHING THAT THE
POLICE ARE NOT BEEN ABLE TO
MANAGE -- GIVEN THAT SO I SAID
BE CAUTIOUS ABOUT ANYTHING
THAT WE LOOK AT HERE GIVEN THE
EXPERIENCE WE'VE SEEN OTHER
STATES SO YOU'VE YOU'VE YOU'VE
SEEN THAT IN OTHER STATES
BUT IS THAT BEEN THE ISSUE IN
CALIFORNIA THAT HAS BEEN AN
ISSUE IN CALIFORNIA AS WELL
UNDERSTAND I DON'T THINK IT
HAS BEEN AS DRAMATIC IT TURNS
UP AT FORCING FACILITIES INTO
FORECLOSURE AND INTO BANKRUPTCY
AS MUCH BUT IT IS DEFINITELY
AN ISSUE HERE -- BECAUSE WE'VE
SEEN THAT THE THE THE BREEDS
HAVE RUN UP THE COST YOU KNOW
TO THE EXTENT THAT THEY DON'T
THAT IT THERE'S DIFFERENT
MODELS THERE'S DIFFERENT MODELS
OUT THERE SOME FACILITIES --
YOU KNOW ONE OF THEIR IT I JUST
THINK OF ONE LOCAL FACILITY
HERE THAT'S BEEN A FAMILY
OPERATED FACILITY FOR THREE
GENERATIONS THAT THAT FACILITY
OWNER OWNS THE FACILITY AND
ALSO OPERATES THE BUILDING
TO IN MANY CASES SOMEONE ELSE
OWNS THE FACILITY IT OWNS THE
LAND UNDER THE DIRT IF YOU
WILL AND THE FACILITY AND AND
AND THE OPERATOR THAT HAS THAT
OPERATES THE FACILITY AND THEN
A MAJOR PART OF WHAT THEY HAVE
TO PAY THEM THAT'S HAVE TO PAY
THAT THE COST OF THE THE THE
LEASE AND -- AND USUALLY TO
A REPEAT OKAY WELL I I RAISE
THIS BECAUSE I THINK THERE
NEEDS TO BE A CLEAR DISTINCTION
BETWEEN THE PERSON WHO OWNS THE
PROPERTY AND THE PERSON WHO'S
GETTING INTO THE BUSINESS AND
IS GONNA MAKE SURE THAT EVERY
DOLLAR IS INVESTED FOR THE BEST
INTEREST OF THE BEST INTEREST
OF THE HEALTH CARE OUTCOMES --
AND AND THE BEST A PROVIDING
THE BEST SERVICE THROUGH A
MODEL THAT DAY NO WORKS RATHER
THAN MAKING SURE THAT -- -- --
VARIOUS COSTS ARE ARE ADDRESSED
AND THEN THERE ISN'T MUCH LEFT
FOR FOR THE SERVICES THAT NEED
TO BE RENDERED OR PROVIDED IT'S
A VERY CLEAR DISTINCTION FOR ME
AND I I I I I AGAIN THAT'S WHY
WE TOOK STEPS IN THE CHARTER
ARENA -- CHAR AT EDUCATION
ARENA TO MAKE SURE THAT THAT
MOTIVATION WAS NOT NOT THERE
-- AND AND MAYBE THAT'S
SOMETHING THAT WE NEED TO
ALSO I'M CERTAINLY GONNA WANT
TO LOOK AT -- IN THE COMING
YEAR BECAUSE -- BESIDES THAT
WE WE'VE SEEN THIS IN OTHER
SETTINGS IN GROUP HOMES IN
MANY OTHER SETTINGS WHERE THE
STATE WILL PROVIDE A CERTAIN
DOLLARS CERTAIN AMOUNT OF
DOLLARS -- AND AND I WONDER TO
WHAT EXTENT SOME OF THESE FOLKS
WHO CONDUCT THIS BUSINESS ONCE
THEIR PROPERTY HAS PAID OFF
WILL THEN -- BUT QUITE SIMPLY
EVEN EITHER SELL THE BUSINESS
OR ABANDON THE BUSINESS SECTOR
INTERESTED NOW TO KNOW IF
THERE ARE SUCH IF THERE ARE
ANY NUMBERS IN IN THAT -- BUT
-- BUT THIS IS I'M GOING INTO
AREAS THAT I WAS EVEN THINKING
UP BEFORE THIS HEARING SO I
I'D BE VERY CURIOUS TO SEE
-- CURIOUS TO EXPLORE THAT
AS WELL MISTER WASSERMAN DO
YOU DO YOU -- WOULD YOU LIKE
TO COMMENT ON SOME OF THE
QUESTIONS I'M ASKING ABOUT THE
RELATED PARTY -- COMPANIES AND
AND CERTAIN PRACTICES AND AND
AND THE LEVEL OF ENFORCEMENT
SO THERE'S A BIT OF A TIME
DELAY SO I WAS JUST LISTENING
TO THE END OF THE QUESTION
-- I'M ACTUALLY REALLY REALLY
PLEASED THAT MISTER CORNET
BROUGHT UP THE REIT'S I I
COULDN'T AGREE MORE THAT THE
REAL ESTATE PRESSURE ON NURSING
HOMES HAS BEEN A LONG STANDING
ISSUE AND IF YOU ACTUALLY
LOOK AT SOME OF THE LARGE EVEN
PUBLICLY TRADED NURSING HOME
COMPANIES THE READS SIT ON
THE BOARDS OF THOSE COMPANIES
IF YOU THEN LOOK AT OWNERS
OF NURSING HOMES AS WELL
AS OWNING NURSING HOMES AND
OPERATIONS WHEN YOU HAVE THE
SAME PEOPLE OWNING THE LAND
OWNING THE REAL ESTATE AND
OWNING THE PROPERTY AS MISTER
CORNET IS VERY SKILLFUL YOU
KNOW VERY CORRECTLY POINTED
OUT THEY CAN APPLY PRESSURE
TO THE OPERATIONS THAT CAN
IMPACT THEIR ABILITY TO SUCCEED
AND OFTEN END UP LEADING THEM
INTO BANKRUPTCY IF THE THAT
PRESSURE IS TOO GREAT I MEAN
THERE THERE ARE MERELY A NUMBER
OF EXAMPLES OF THIS OVER THE
LAST TWENTY THIRTY YEARS SO I
ACTUALLY THINK A MISCONDUCT HAS
HAS REALLY -- HELPED EXPLAIN
THE FACT THAT THERE ARE NONE
TOWARD PRESSURES FROM REAL
ESTATE ON THE OPERATIONS OF
NURSING HOMES THAT ARE MEANT
TO BE PLACES WHERE WE PROVIDE
CARE FOR VERY VULNERABLE
PEOPLE AND WE REALLY NEED
TO LOOK FOR A WAY OF EITHER
SEPARATING OUT THIS PRESSURE
MAKING CHANGES TO IT -- AND I
THINK THERE'S A NUMBER OF --
IDEAS THAT COULD BE OUT THERE
VERY INTERESTED TO TO DISCUSS
ALL THESE DIFFERENT PRESSURE
POINTS AND SEEING -- HOW WE
CAN START IMPLEMENTING -- ALL
OF THESE DIFFERENT PRESSURE
POINTS INTO SOME KIND OF AN
EXECUTE HERBAL EITHER POLICY
OR LEGISLATION THAT THAT STARTS
STARTS -- UNTANGLING CERTAIN
INFLUENCES FROM BEING ABLE TO
DELIVER THE BEST POSSIBLE CARE
AS WELL I I I THINK I THINK
IT WOULD ACTUALLY HELP ALSO
CALF -- -- -- WITHIN ITS OWN
INSTITUTION TO TO BE ABLE TO --
BABIES MAKE THOSE SEPARATIONS
-- BY THE WAY SINCE SINCE
DOCTORS -- WASSERMAN YOUR SINCE
YOU'RE OUT YOU'RE THERE RIGHT
NOW IS -- YOU STARTED TOUCHING
ON THE -- THE VACCINE TASK
FORCE AND THE IT GERIATRIC
-- MEDICINE BACKGROUND DO
YOU KNOW HOW MANY MEMBERS
THERE ARE ON THE TASK FORCE
SO THE THE GOVERNOR HAS SOME
PUT TOGETHER A WORK GROUP
TO DETERMINE THE SAFETY AND
EFFICACY OF THE VACCINE AND
KEEP IN MIND MOST THE VACCINES
THAT ARE OUT THERE RIGHT THAT
ARE BEING TESTED RIGHT NOW --
ONLY ONE TO MY KNOWLEDGE HAS
EVEN VENTURED INTO NURSING
HOMES TO TO HAVE THEM NURSING
HOME RESIDENTS ENTERED INTO
THOSE CLINICAL TRIALS I EVEN
AMONGST THE OTHER ONES THE
UPPER AGE IS OFTEN SIXTY FIVE
OR SEVENTY FIVE WE DO HAVE
SOME THAT DID GO UP TO EIGHTY
FIVE AND THAT'S ENCOURAGING
SO THAT'S NUMBER ONE FROM A
STARTING POINT SO WHEN WHEN
THIS VACCINE GETS APPROVED WE
REALLY NEED TO EVALUATE IT AND
IN ORDER TO EVALUATE THE SAFETY
AND EFFICACY OF THIS VACCINE
AS IT RELATES TO OLDER ADULTS
WE WILL NEED COLLEAGUES OF MINE
MY SEE FOLKS LIKE MYSELF WHO
I HAVE EXPERTISE IN GERIATRICS
AND LONG TERM CARE MEDICINE AND
THERE IS NOT A SINGLE MEMBER
OF THE VACCINE WORKGROUP WITH
THAT EXPERTISE -- THE MAJORITY
OF THE PHYSICIANS ON THAT WORK
GROUP OF PEDIATRICIANS WHICH
YOU KNOW I UNDERSTAND BECAUSE
PEDIATRICIANS ARE VERY INVOLVED
WHEN IT COMES TO VACCINES BUT
WHEN IT COMES TO OPINING ON
WHETHER THESE VACCINES ARE
GOING TO BE SAFE AND EFFECTIVE
FOR FOR NURSING HOME RESIDENTS
FOR PEOPLE OVER SIXTY FIVE IN
OUR OTHER COMMUNITIES WE NEED
EXPERTS TO BE PART OF THAT
THANK YOU MR WASSERMAN --
ON THE ISSUE OF OF SURVEYORS
-- WE CAN HAVE A MISSED
THEN OCCUR COME BACK
CAN YOU EXPLAIN HOW YOU ARE
HANDLING ENFORCEMENT RIGHT
NOW ABSOLUTELY I'M SO RIGHT
NOW WE ARE IN FOR SEEN BIGGEST
COMPLAINT INVESTIGATIONS
FACILITY WROTE HOARDED INCIDENT
INVESTIGATIONS WERE ALSO DOING
-- COATED NINETEEN MEDICATION
SURVEYS WHICH ARE STATE I'M
SURVEYS WHICH ARE ENFORCEMENT
ACTIVITIES -- -- AND WE ARE
ALSO GOING INTO FACILITIES --
IF THERE ARE A HIGH RISK FOR
URGENT NEEDS ARE OUTBREAKS
IN THAT AND FORESEEN AND
-- BEGINNING EIGHT -- FULL
INVESTIGATION SURVEY -- WHEN
NOT WORDS IT TOO WHEN WE ENTER
INTO AN OUTBREAK SITUATION
OKAY SO WHAT AND WHAT IS THE
END RESULT WHEN SOMEONE IS
NOT COMPLYING OR NOT DOING THE
THINGS THAT YOU NEED YOU YOU
WANT DONE OR YOU HAVE PLACED A
CERTAIN PARAMETERS FOR THEM TO
MEET WHAT DO YOU WHAT STEPS TO
TAKE NEXT SO IF IT IS A A STATE
REGULATION THEN WE WILL DECIDE
FOR A STATE REGULATION IF THERE
IS A SITUATION THAT WARRANTS
A FULL ON INVESTIGATION
THOUGH FOR LIKE A COMPLAINER
FACILITY REPORTED INCIDENT
THEN WE USE OUR FEDERAL
REGULATIONS AND THE FEDERAL
REGULATIONS ARE STRICTER --
AND -- ACCOUNTS I'M A LITTLE
BIT MORE WEIGHT TO THEM THEN
HONESTLY THAT OUR CURRENT STATE
REGULATIONS BECAUSE OF MANY
OF OUR TITLE TWENTY TWO --
REGULATIONS NEED TO BE UPDATED
SO IN THE LAST SIX SEVEN
MONTHS HAVE WE SHUT DOWN
ANY FACILITY YOU DO HAVE THE
AUTHORITY TO DO THAT YEAH WE
SHUT DOWN THE FACILITY HOW MANY
WE HAVE DONE -- WELL I WILL
TELL YOU THERE'S A COUPLE OF
DIFFERENT SITUATIONS SO THERE
IS A REPLICATION PROCESS WHICH
IS ONE WAY THAT WE DO IT AND
WE DID DO A REVOCATION OF A
LICENSE COMPLETELY AND PASADENA
-- BUT WE ALSO -- HAVE DONE
WHAT WE CALL JOINT ON TEMPORARY
EVACUATIONS MEANING THAT WHERE
WE HAVE WORKED ALONGSIDE WITH
THE PUBLIC HEALTH OFFICER
WERE OFTEN THE PUBLIC HEALTH
OFFICER IS DOING THE HEALTH
ORDER AND WE ARE THEY ARE
ON SITE WORKING WITH THEM TO
EITHER DECOMPRESSOR FACILITY
EVACUATED FACILITY -- AND THEN
DEPENDING ON WHETHER OR NOT
-- THEY'RE ABLE TO STABILIZE
THE SITUATION AND THEY MAY
BE ABLE TO RESUME SERVICES
AND THEN ANOTHER ENFORCEMENT
ACTION THAT WE'RE TAKING IS
PUTTING IN TEMPORARY MANAGERS
SO THAT IS A AN INSTANCE WHERE
WE HAVE -- A SITUATION THAT
WE BELIEVE IS UNSAFE TO THE
POINT WHERE WE NEED TO INSTILL
A STATE TEMPORARY MANAGER
AND THAT TEMPORARY MANAGER
THEN TAKES OVER OPERATIONS ON
BEHALF OF THE STATE -- INTEL IN
SOME CASES IT LED TO A ACTUAL
REPLICATION IN OTHER CASES
THEY WERE ABLE TO STABILIZE
THEY HAD THEIR CITATIONS
THEY WENT MOVE THROUGH A DATE
-- CORRECTED THEIR ACTIONS
AND THEN THEY WERE ABLE TO
RESUME -- OPERATING THEIR OWN
FACILITY AND THEN WE REMOVE
OUR TEMPORARY MANAGER SERVICE
BEEN MULTIPLE DIFFERENT TYPES
OF I WOULD SAY ON THE CONTINUUM
OF ENFORCEMENT DO YOU HAVE
NUMBERS GOING BACK TO MY PRE
QUESTION AGAIN BUT HOW MANY
DO YOU HAVE QUAN NUMBERS ON
WHERE YOU ARE WITH THAT THE
THREE OR FOUR LEVELS THAT YOU
JUST DESCRIBED WILL UP HOW MANY
IN EACH CATEGORY YOU HAVE AT
THIS CURRENT STATE SO YOU MEAN
JUST FOR THE PANDEMIC PERIOD
THAT WE'RE TALKING ABOUT SINCE
MARCH OKAY YES YES SO WE HAVE
ONE FACILITY THAT WE HAVE DONE
A FULL REVOCATION AND WE ARE
GOING THROUGH THE COURT PROCESS
-- OF THAT PIECE OF IT AND THEY
DO NOT HAVE OPERATIONS AT THAT
FACILITY WE HAVE ABOUT THREE OR
FOUR DIFFERENT FACILITIES THAT
WE HAVE ENTERED INTO EITHER
A TEMPORARY MANAGER POSITION
WHERE WE HAVE ON HOW TO TAKE
FOR THE -- THE OPERATIONS
TEMPORARILY IT BUT I CAN GET
THAT EXACT NUMBER FOR YOU
-- AND THEN WE HAVE HAD ON A
COUPLE OF I WOULD SAY ONLY A
HANDFUL OF SITUATIONS WHERE WE
HAVE HAD TO I WOULD SAY AGAIN I
THINK IT WAS ONLY TWO OR THREE
TIMES THAT WE ACTUALLY ENTERED
INTO A PARTNERSHIP LET'S SAY
WITH THE PUBLIC HEALTH OFFICER
TO DO AND EVACUATION OR D.
COMPRESSION IN THOSE
SITUATIONS I WAS SKILLED
NURSING FACILITY S.
OR THE NUMBERS SINCE MARCH HAVE
THE NUMBERS OF OF LOCATIONS
THAT YOU'D NEED TO TAKE ANY
STEPS WITH I COMPETING LEADING
LEADING UP TO POTENTIAL
REPLICATION -- HAS THIS HAS
HAS IT BEEN THE SAME THIS YEAR
AS IN ANY OTHER YEAR OR HAS
THERE BEEN A INCREASE IN THE
NUMBER OF SO THAT IS THAT'S AN
INCREASE IT'S IT'S UNUSUAL THAT
YOU WOULD ACTUALLY HAVE TO GET
TO THE POINT OF REPLICATING IT
LICENSE IN FACT I DON'T THINK
IT HAS BEEN DONE WHEN I ASKED
MY TEAM WHEN IS THE LAST TIME
THAT THIS KIND OF STANCE HAD
BEEN DONE IT HADN'T BEEN DONE
IN YEARS NOT EVEN FROM I THINK
MY PREDECESSOR BUT MAYBE THE
PERSON BEFORE THAT -- SO IT
WAS A VERY UNUSUALLY -- I GUESS
STRICT COURSE OF ACTION THAT
WE TOOK BUT I STAND BY THAT IT
WAS THE SAFEST COURSE OF ACTION
AND IT WAS ONE THAT WE ALSO
WERE ABLE TO MAKE SURE THAT
WE'RE ABLE TO TRANSFER THOSE
RESIDENTS SAFELY OVER A PERIOD
OF TIME -- AND -- SO WE WILL GO
THROUGH THAT THAT ENFORCEMENT
PROCESS AND AND SEE THIRD SEE
THAT THROUGH THE ENTIRE -- A
COURT PROCESS THAT THAT TAKES
WAIT WAIT DO THE CLIENTS OF
A REVOKED PLACE OR SHUT DOWN
PLACE END UP GOING THEY ARE
TRANSFERRED IT TO LOCAL --
FACILITIES -- AND WE WORK WITH
THE LOCAL PUBLIC HEALTH OFFICER
TO MAKE SURE THAT WE HAVE
SAFE SPACES PARTICULARLY WITH
COPE IT'S EVEN MORE DIFFICULT
RIGHT BECAUSE YOU WANT TO MAKE
SURE THAT IF YOU HAVE CALL
THE POSITIVES THAT YOU WERE
TRANSFERRED TO A LOCATION THAT
ALREADY HAS A COVERT POSITIVE
WING OR WHAT COLOR RED ZONE
ALREADY ENACTED IN CO CORK IT
APPROPRIATELY -- AND THEN IT
YOU'RE MAKING SURE THAT YOU
CAST INTO MEDICAL EVALUATIONS
TO SEE IF THERE'S ANYONE THAT
NEEDS TO BE TRANSFERRED TO
A LOCAL GENERAL ACUTE CARE
HOSPITAL AND THEN YOU'RE ALSO
DOING EVALUATIONS IN TESTING
TO SEE IF FOR THOSE WHO ARE
COPING -- NEGATIVES I HAVE
NO EXPOSURES CAN THAT BE --
APPROPRIATELY TRANSFERRED --
AND IF YOU REALLY HAVE TO I
MEAN OF COURSE OUR OUR FIRST
COURSE OF ACTION IS ALWAYS TO
TRY TO -- WHAT WE CALLED YOU
KNOW ENFORCE AND ENSURE THAT
THERE IS IT THERE IS SAFETY AT
THE LOCATION -- BUT IF IT IS
SO UNSAFE WE MUST BE ABLE TO
HAVE TO GO THROUGH A TRANSFER
PLAN -- WITH A LOCAL OFFICER
BUT HOW DO YOU DEAL WITH
THAT CAPACITY ISSUES IF THE
OTHER FACILITIES IN THE AREA
ARE ALREADY AT CAPACITY HOW
WOULD YOU BE ABLE TO INTRODUCE
NEW INDIVIDUALS -- IN IN IN
INTO INTO INTO THE CARE OF
THE ADJOINING FACILITIES SO
LUCKILY WE HAVE NOT HAD THAT
ISSUE THERE IS CAPACITY AND
THERE HAS BEEN CAPACITY IN ALL
OF THESE SITUATIONS -- AND IN
FACT WITH THE CASE OF PASADENA
-- THEY HAVE I'VE ALSO WORKED
WITH THE LOCAL PUBLIC HEALTH
THERE ARE PASADENA MULTIPLE
TIMES -- AND DOCTOR AND GO
HAS EXPRESSED THAT THEY HAVE
THEY HAVE ENOUGH CAPACITY TO
WHERE THEY DO NOT NEED THIS
PARTICULAR FACILITY TO COME
ONLINE AGAIN AND IT WAS IN A
STATE I THINK EVEN JUST THE
PHYSICAL -- AGE OF THE FACILITY
AND THE -- -- HOW IT WAS SET
UP IS NOT SOMETHING THAT WE
WOULD ENTERTAIN HAVING -- A NEW
OPERATIONS AND AT THIS TIME IN
THE EXACT THE WAY THAT THEY GOT
ACTUAL FACILITY SET UP TODAY
ISRAEL IS THE TO THE PASADENA
LOCATION NOW SHUT DOWN OR OF
WHILE THEY'RE GOING THROUGH THE
COURT PROCESS CAN THEY STILL
OPERATE YEAH IT'S COMPLETELY
SHUT DOWN AND ALL OF THAT
RESIDENTS ARE AT OTHER NEARBY
FACILITIES WITHIN PASADENA OKAY
I I I AT LEAST SINCE THAT'S
THE PASADENA IS IN AND URBAN
DENSE AREA I I SUSPECT THAT THE
FAMILIES AND LOVED ONES WERE
WORKING WITH WITH MAYBE THE
STATE TO MAKE SURE THAT THEIR
LOVED ONES ARE GETTING TO A
NEARBY LOCATION SO THEY ALWAYS
DID IT JUST RAISES A LOT OF
OTHER ISSUES -- WHAT ARE THE
CURRENT TESTING PROTOCOLS FOR
INDIVIDUALS WHO ARE LEAVING
SKILLED NURSING SO LEAVING TO
GO HOME OR YES SO IF A PATIENT
HAS THE RIGHT OR RESIDENT HAS
THE RIGHT TO BE ABLE TO JUST
CHARGE -- AND SO WE DO NOT HAVE
YOU KNOW SPECIFIC RULES ABOUT
I AM TESTING IF THEY WANT TO
DISCHARGED TO GO HOME YOU MEAN
MEANING THAT THEY'RE GOING TO
ACTUALLY STAY HOME NOT TAKE A
PASCO HOME FOR A TIME PERIOD
AND THEN COME BACK BUT WELL
IN I WAS THINKING IN JUST AND
GOING HOME PERMANENTLY BUT BUT
BEING DISCHARGED BUT IN EITHER
CIRCUMSTANCE I JUST I'M I'M
WONDERING IS THERE SOME KIND
OF A -- WHETHER AN INTRODUCTION
OR EXIT OUT OF THE BILL OUT OF
THE CONTAINMENT OF THE BUILDING
IS THERE IS THERE TESTING THAT
GETS DONE TO MAKE SURE THAT WE
KNOW WHAT STATE THE INDIVIDUAL
IS LEAVING IN SOME MOST COMMON
EXAMPLE THAT WE HAVE WHERE IT
RESIDENT IS LEAVING TEMPORARILY
IN COMING BACK IS USUALLY WHEN
THEY'RE GOING TO A GENERAL
ACUTE CARE HOSPITAL FOR -- AN
ACUTE EPISODE OF SOME SORT OF
ISSUE AND THEN THE RE ADMITTED
BACK INTO THEIR SKILLED NURSING
FACILITY WHICH IS OFTEN THEIR
HOME SO TO SPEAK -- AND SO
FOR THAT WE DO NOT REQUIRE TWO
SETS OF TESTS WE WOULD JUST
REQUIRE ONE TEST SO THAT THEY
WILL HAVE THE RESULTS SO THAT
THEY KNOW WHERE TO CALL COURTS
THAT INDIVIDUAL SO IF THEIR
TEST POSITIVE THEN THEY CAN
GO INTO THE COVERT POSITIVE
COMPORTED WING OF THE FACILITY
IF THEY ARE -- CONSIDERED A
EXPOSURE FOR SOME REASON FOR
IT THAT THEY CAN GO INTO THE
YELLOW AND TALKING ABOUT A
QUARANTINE TYPE WHEN THEY'RE
INTO THE FACILITY -- AND THEN
IF IT WAS -- TESTED NEGATIVE
-- THEN THERE'S POTENTIAL THAT
THEY COULD GO INTO THE COOK
THE GREENS OUT OF THE FACILITY
ARE YOU FAMILIAR WITH ANY
CIRCUMSTANCE WHERE SOMEONE A
RESIDENT WAS LEAVING AND GOING
HOME -- AND AND POTENTIALLY
BENT AND MAY HAVE BEEN INFECTED
AND IT WAS FOUND OUT LATER NOT
IN A SKILLED NURSING FACILITY
NOW I KNOW THAT WE SEE A LOT
OF THAT AND I'VE HEARD SOME
OF THOSE ISSUES MORE SO IN ON
DEPARTMENT OF SOCIAL SERVICES
-- BUILDINGS WHICH ARE RESIDENT
CARE FOR THE ELDERLY ARSIA FEES
AS WELL AS ASSISTED LIVING IN
ASSISTED LIVING FACILITIES YOU
OFTEN SEE MORE PEOPLE -- OF
COURSE AND HAVING THE FREEDOM
TO KIND OF GO IN AND OUT ON
ITS LAST SO THAT YOU WOULD
SEE THAT IN A SKILLED NURSING
FACILITY BUT THE RESIDENTS
ARE ARE MORE IN THE ACUTE
RANGE OF -- OF ILLNESS AND
AND USUALLY NOT -- YOU KNOW
LEAVING OR GOING HOME BUT TO
THAT POINT AS WE ARE GEARING UP
AND PREPARING FOR AND HOLIDAY
SEASON AND A SEASON WHERE WE
DO TEND TO SEE -- POTENTIAL
-- PASSES OR FOR AND SKILLED
NURSING FACILITY RESIDENTS TO
GO HOME FOR A CERTAIN AMOUNT
OF TIME A WE WILL BE AN ISSUE
IN ALL FACILITIES LETTER IN
THE NEXT FEW WEEKS THAT WE'VE
BEEN DRAFTING PRESENTLY WITH
OUR INFECTIOUS DISEASE TALKS
ABOUT WHAT ARE SOME BEST
PRACTICES ABOUT WHAT COULD BE
A POTENTIAL WHEN THEY COME HOME
OR IF THEY COME BACK TO THE
SKILLED NURSING FACILITY IF
THEY HAVE A SOME SORT OF PASS
THAT GO IT THEY GO OFF ON HOW
TO BEST AND MAKE SURE THAT THEY
ARE LIMITING THAT EXPOSURE TO
OTHERS IN THE RESIDENTS K.
CHANGING CHANGING DIRECTION
LITTLE BIT BACK TO THE
STAFFING ISSUE -- ARE YOU
CONTINUING TO OFFER STAFFING
WAIVERS FOR A FOR ONE YEAR
SO RIGHT NOW WE HAVE A MERCHANT
SEE STAFFING WAIVERS -- THAT
ARE NINETY DAYS AND EACH
NINETY DAYS AND EVEN DURING
THAT NINETY DAY PERIOD WE HAVE
THE ABILITY TO REASSESS OR
REVOKE -- IF WE STILL LIKE THE
SITUATION WAS ABUSED OR NOT
-- -- THAT THERE WAS -- EVA
UNSAFE SITUATION IN A FACILITY
AND SO WE DO HAVE THAT PROCESS
RIGHT NOW WE DO POST ONLINE ON
OUR WEBSITE ALL THE FACILITIES
THAT HAVE THOSE WAIVERS AND WE
ARE PROCESSING THOSE AS THEY
COME IN -- AND -- WE HAVE ABOUT
-- ABOUT FOUR HUNDRED OF THE
TWELVE HUNDRED SKILLED NURSING
FACILITIES WHO REQUESTED AN
EMERGENCY STAFFING WAIVER IN
THE LAST NINETY DAYS AND I
KNOW THAT WE HAD APPROVED --
ALREADY I THINK IT'S SOMEWHERE
AROUND A HUNDRED AND FIFTY OF
THOSE -- AND THEN THERE ARE
OTHERS THAT WE'RE REQUESTING
MORE DOCUMENTATION AND --
THERE ARE OTHERS THAT WE WILL
BE TO NINE -- BASED OFF OF
THEIR PERFORMANCE -- IN THE
LAST NINETY DAYS OKAY SO IT'S
AT NINETY DAYS AND HOW MANY
TIMES CAN CAN A WAIVER BE
RECEIVED BY THE SAME COMPANY
THERE'S NOT A LIMIT ON THESE
EMERGENCY WAIVERS -- BUT AGAIN
THAT WE AS THE DAYS GO ON THE
QUESTION THEN BECOMES WHAT
DID YOU DO IN THE LAST NINETY
DAYS WHAT STAFFING -- YOU KNOW
BUT AGENCIES WHO DID YOU WORK
WITH WHY WHY DO YOU STILL NOT
HAVE STAFFING EVEN NINETY DAYS
LATER -- PARTICULARLY WHEN
WE KNOW AS A STATE RAN AT THE
STATE DOES CAN LEVERAGE YOU
KNOW -- THE ABILITY TO HAVE
-- LARGER CONTRACTS TO BE
ABLE TO DRAW STAFF FROM OUT
OF STATE WHEREAS -- MAYBE A
SMALL MOM AND POP -- -- SKILLED
NURSING FACILITY IN A RURAL
AREA MAY HAVE MORE DIFFICULTY
LEVERAGING OR FINDING -- STATE
I MEAN FINDING -- CONTACTS
OR FINDING NEW STAFF THOSE
ARE THE THE PEOPLE THAT WE'RE
LOOKING AT FOR YOU KNOW STATE
WHAT STAFFING WAIVERS BUT
OTHER FACILITY SHOULD BE ABLE
TO COME UP WITH THE STAFFING
PLAN IN THOSE NINETY DAYS
TO BE ABLE TO RESOLVE THE
SITUATION ON THEIR OWN CHAU DUE
TO THE COMPANIES THAT ARE ARE
DO YOU DO THE COMPANIES THAT
ARE ASKING FOR THESE WAIVERS
DO THEY HAVE YOU NOTICED A
CERTAIN TREND ARE THEY THE
ONE DO THEY OFFER HAZARD PAY
IN ORDER TO MAYBE ENTICE OR
ATTRACT EMPLOYEES ARE THEY TRY
OFFERING INCREASED A ANY TYPE
OF MOTIVATION OR INCENTIVES
ARE YOU NOTICING ANY TRENDS
ARE YOU ASK IS THAT ONE OF THE
FACTORS IN THE QUESTIONS THAT
YOU ASK TO SEE IF THEY'RE ALSO
TAKING THE CERTAIN APPROPRIATE
STEPS IN ORDER TO MAKE SURE
THAT THEY'RE MAINTAINING A
CERTAIN LEVEL OF OF -- OF OF
CARE THAT WE'RE ESTABLISHING
STANDARDS FOR WE DO ASK FOR
THEM TO ROVIRA NARRATIVE AND
EXPLAIN EXPLANATION OF WHAT
METHODS -- THEY HAVE ALREADY
TRIED ON WHETHER THAT IS WHAT
KIND OF MARKETING A RECRUITMENT
HAVE THEY DONE -- WHAT IS THERE
YOU KNOW CURRENT GAP THEIR PAY
STRUCTURE YOU KNOW SO THAT WE
CAN KIND OF GET A SENSE IS THAT
BELOW MARKET IS THAT OUT MARKET
IS ABOVE MARKET -- AND WE ASK
FOR YOU KNOW WHAT OTHER TYPES
OF AGENCIES HAVE THEY TRIED
IT THEY TRIED OUTSIDE OF THEIR
REGION -- IF THEY'RE RURAL AREA
-- AND WE ASK FOR THAT IN THAT
PROCESS WE ALSO ASK IF THERE
HAD BEEN ANY RECENT LAYOFFS
-- AND ANYTHING -- THAT MIGHT
WARRANTS THAT THERE WAS SOME
INDICATIVE REASON THAT THEY
THEY COULD HAVE HAD MORE STAFF
HAVE YOU NOTICED IF -- IF A
FACILITY IS PAYING HAZARD PAY
OR INCREASED PAY -- DO THEY
FALL INTO THE CATEGORY OF
COMING TO YOU FOR WAIVERS YEAH
THAT'S A GOOD QUESTION I MEAN
THAT'S SOMETHING THAT MAYBE
WE COULD SEE IF WE COULD GET
DATA ON THE DATA FRONT IT --
INDUSTRY TO FIGURE OUT WHO IS
DOING THE -- THE HAZARD PAY
BECAUSE THAT I DON'T HAVE A
WHOLE SONG TO BE ABLE TO IT
OR EVEN A WAY TO GATHER THAT
DATA BUT WE CAN SEE IF WE CAN
TAKE THAT BACK BECAUSE I THINK
THAT WOULD BE AN INTERESTING
CORRELATION TO SEE IF IT'S IF
THAT IS A TRUE FACTOR THAT'S
ACTUALLY BEING HELPFUL OKAY
WELL I I'D LOVE TO HEAR THIS
FROM IF MISTER CORNET AND MR
WASSERMAN ONE OFFERED THEIR
THOUGHTS ON ON THESE QUESTIONS
ABOUT HAS YOUR PAD LOVE TO
HEAR FROM THEM AS WELL YEAH
MISTER NAZARIAN VIRTUALLY
EVERY FACILITY I'M AWARE OF IN
THIS AGAIN THIS TWELVE HUNDRED
TWENTY FOUR FACILITIES IN THE
STATE I MEAN SO IT'S IT'S HARD
TO KIND OF SAY THIS UNIFORMLY
BUT VIRTUALLY EVERY FACILITY
-- EVERY MULTI -- COMPANY
FACILITY THAT I'M AWARE OF IS
PAYING SOME KIND OF HAZARD PAY
THEY'VE THEY'RE DOING IT IN
DIFFERENT WAYS THEY MAY HAVE
DIFFERENT THAT WAY OF DOING IN
SOME CASES PAYING A FEW EXTRA
YOU KNOW OF A FEW EXTRA HOURLY
DOLLARS IN SOME CASES DOING
LUMP SUM PAYMENTS THEY'RE ALL
CUT ALL OVER THE BOARD BUT
I'M TO MINE ALMOST EVERYONE
I KNOW I'M AWARE OF THEY'RE
PAYING WHAT THEY'RE THEY'RE
PAYING WHAT IS REQUIRED IN THE
MARKET AND THE MARKET IS IS
OBVIOUSLY TIGHT ALREADY AND
IT'S NOW IT'S GOTTEN TIGHTER
AND THEY'RE TRYING DESPERATELY
TO KEEP PEOPLE ON THE JOB SO
RIGHT BUT BUT THE PAIN WHAT'S
THAT THAT'S A VERY RELATIVE
RESPONSE THOUGH MISTER CORNET
RIGHT WHAT YOU'RE PAYING
WHEN YOU SAY YOU'RE PAYING IN
THE MARKET IT COULD BE COULD
VERY GIVEN ESPECIALLY THE THE
GEOGRAPHY AND THE DEMANDS OF
THE STATE SO THE QUESTION NO
NOTHING ELSE YEAH GIVEN THAT
GIVEN THAT RELATIVITY BUT
WHAT'S YOU KNOW I I'M STILL
INTERESTED TO KNOW NUMBER
WISE WHAT IF THERE'S A DO I'M
INTERESTED TO SEE IF THERE'S A
CORRELATION BETWEEN COMPANIES
THAT ARE GETTING WAIVERS AS
AND AND AND COMPANIES WHICH
COMPANIES ARE UP PROVIDING
THE HAZARD PAY AND IF THERE
IS A YEAH WHAT WHAT THE NEXUS
OF THAT IS BECAUSE BECAUSE I
SUSPECT -- A LOT OF FOLKS WHO
ARE GOING TO BE GETTING PAID
THE HAZARD PANDIAN FURTHER
TO CONTINUE STAYING OR WILL
EVEN MIGRATE BETWEEN FACILITIES
BUT I I'M I'M INTERESTED TO
HEAR FROM YOU AND TO SOME
EXTENT CDPH TO TO VERIFY THAT
THAT I WILL TELL YOU THOUGH I
WOULD SAY THOUGH IT IT MIGHT
SURPRISE YOU BECAUSE I'M AWARE
AT THE CITIES FOR EXAMPLE
THEY'VE SAID THEY'VE THEY'VE
INDICATED THAT THEY PAYING
SUBSTANTIALLY THEY'RE PAYING
MUCH HIGHER WAGES THE PAYING
THEIR ALSO PAYING HAZARD PAY
AND THEY WILL GET US SOME DAYS
THEY WILL JUST GET A NUMBER OF
UP UP STAFF WILL JUST CALL IN
AND NOT COMMAND NOT BE ABLE TO
COME IN FOR IT FOR DIFFERENT
REASONS THAT PART OF THAT IS
THINGS THAT ARE DIFFICULT FOR
THE STAFF TO DEAL WITH TO --
YOU KNOW EVERYBODY'S KIDS ARE
DOING REMOTE SCHOOLING I MEAN
IF THEY HAVE FAMILY KNOWS ALL
THOSE THINGS ARE ARE DIFFICULT
ISSUES UNDER ANY CIRCUMSTANCE
AND WITH THE SHORTAGE WE HAVE
IN WORKFORCE GENERALLY THIS IS
JUST DOUBLE DOWN ON THE PROBLEM
I HAVE TO ASK FOR A HALL
PASS FOR MY WIFE ON MANY
OCCASIONS I I THAT I UNDERSTAND
I I -- WOULD THAT WOULD
THE DOCTORS HERRINGTON AND
WASSERMAN WANT TO OFFER
SOME THOUGHTS ON ON THIS
GOOD YEAH I I DEFINITELY AM YOU
KNOW THIS GOES TO THE ISSUE OF
HOW HOW WE KEEP AND MAINTAIN C.
N.
A.'S IN OUR NURSING HOMES
AND THERE'S A BIT OF A FALSE
NARRATIVE OUT THERE THAT IT'S
HARD TO GET GOOD PEOPLE IT'S
HARD TO KEEP THEM OKAY BEEN
DOING THIS FOR THIRTY YEARS
IF YOU FIND REALLY TOP NOTCH
FACILITIES FIVE STAR FACILITIES
-- VERY SUCCESSFUL FACILITIES
YOU OFTEN FIND C.
N.
A.'S WHO HAVE BEEN WORKING
THERE TWENTY OR THIRTY YEARS
SO HERE'S THE DEAL IT'S IT'S
ABOUT IT'S ABOUT LEADERSHIP
IT'S ABOUT RESPECT SO IF YOU
HAVE THE RIGHT CULTURE IN YOUR
FACILITY AND YOUR C.
N.
A.'S FEEL RESPECTED AND
ACKNOWLEDGED AND CARED FOR AND
THEN THE OTHER SIDE OF THAT
IS YOU'VE GOT TO PAY THEM A
LIVING WAGE IF IF THEY HAVE TO
WORK TWO JOBS IT'S GOING TO BE
REALLY HARD FOR THEM TO BE THAT
COMMITTED TO YOUR FACILITY SO
I THINK IT'S A COMBINATION OF
ADEQUATE WAGES AS WELL AS --
RESPECT AND STRONG LEADERSHIP
FROM THE FACILITY IN TERMS
OF ABSOLUTELY RESPECTING AND
APPRECIATING THE CNA'S SO I
I THINK YOU KNOW PART OF THE
FEMALE HERE WHEN IT COMES TO C.
N.
A.'S IS WE HAVE A LOT OF WORK
TO DO THIS IS NOT SOMEWHERE
WHERE WE JUST SAY OKAY LET'S
GIVEN HAZARD PAY AND NOW
THEY'RE GONNA COME AND IF
THEY'RE NOT TREATED WELL THEN
THEY'RE NOT GOING TO COME AND
AND AGAIN I'M NOT SAYING THAT
THAT THERE IS ANY NECESSARY --
ACROSS THE BOARD GENERALIZATION
OF SHE AND IS NOT BEING TREATED
WELL WHAT I AM SAYING IS THIS
IS SOMETHING THE INDUSTRY
REALLY NEEDS TO LOOK AT AND I
WOULD INDUSTRY TO DOUBLE DOWN
ON EVERYTHING NICOLE HOW SAID
ABOUT HOW WE TRAIN THESE FOLKS
AND THEN HOW AS FACILITIES WE
TREAT THESE FRONTLINE HEROES --
THAT WE NEED SO SO DESPERATELY
AND AND I THINK IF WE IF WE
TREAT THEM WELL AND PAY THEM
WELL I THINK WE WILL NOT HAVE
THE STAFFING ISSUES THAT WE'RE
TALKING ABOUT HERE AND ONE
LAST COMMENT ON THE WAIVERS
I'M TO ME I I GET THE WAIVERS
FROM A BUSINESS PERSPECTIVE
I DON'T GET THE WAIVERS AS A
CLINICIAN WHEN YOU'RE BASICALLY
SAYING WE CANNOT PROVIDE AN
ADEQUATE LEVEL OF CARE FOR OUR
RESIDENTS BUT WE'RE GIVING A
WAIVER BECAUSE THE FACILITY
HAS TROUBLE GETTING THEM I
I I AS A CLINICIAN I ATE I
JUST DON'T UNDERSTAND THAT
RIGHT GET YOUR ANSWER
THANK YOU AND AND MISSED THANK
YOU FOR INDULGING ME I REALLY
APPRECIATE -- YOU GIVING ME THE
OPPORTUNITY I'LL ONLY HAVE ONE
MORE QUESTION BUT WE SEEMS LIKE
A I MEANT TO TALK TO HER YEAH
YES HE YES OF COULD YOU REPEAT
THE QUESTION IT'S VERY HARD
TO HEAR ON THIS REMOTE SYSTEM
THE QUESTION THE QUESTION
GENERALLY WAS AROUND THE
ISSUE OF -- OF THE --
-- YOU TO SHORTAGES IN STAFFING
AND AND AND OFFERING WAIVERS
-- AND WHETHER OR NOT WHEN
YOU HEY MAKE HAZARD PAYS --
AND OR INCENTIVIZE GREATER
PAYS ALL RIGHT IN FACILITIES
WHERE THERE ARE HAS OUR PAYS
OR INCREASED PAYS TO STAFF ARE
THOSE ALSO THE FACILITIES THAT
THEN DO NOT REQUEST WAIVERS
MY WANTED TO SEE IF THERE
WAS SOME KIND OF THE INTER
RELATION -- THAT WE'VE BEEN
ABLE TO NOTICE OR OR TRENDS
FROM THE RELATIONSHIP THAT WE
CAN NOTICE AND AND START SEEING
WHO'S ASKING FOR WAIVERS AND
IF THEY'RE ASKING FOR WAIVERS
HAVE THE EXHAUSTED EVERY AVENUE
WHICH IS ALSO INCENTIVIZING
EMPLOYEES TO GET PAID MORE
SO THAT THEY DO COME TO WORK
AND -- SO THAT THAT WAS THE
GIST OF IT THAT WAS THE IDEA
SELECT SHOWTIME AND ASSIST ON
-- YES I HAD SOME DIFFICULTY
UNDERSTANDING THE QUESTION
BECAUSE OF THE REMOTE -- BUT
GENERALLY I WANTED TO SAY THAT
OF THE SHORTAGE OF WORKERS IS
A FUNCTION OF TWO THINGS IN
ADDITION TO SOME OF THE THINGS
THAT HAVE BEEN MENTIONED IT'S
IT'S A FUNCTION OF PAY OUT
BECAUSE IF YOU CAN MAKE MORE
MONEY AS A JANITOR OR IN IN
A FAST FOOD COMPANY WITH LESS
STRESS AND LESS -- DANGER OF
THEN THERE'S NO INCENTIVE TO
GO TO WORK FOR NURSING HOME AND
SECONDLY IS THE WORKLOADS OF
WE KNOW FROM OUR RESEARCH THAT
NURSING ASSISTANT SHOULD ONLY
HAVE A SEVEN RESIDENTS AT A
MAXIMUM ON THE DAY AND EVENING
SHIFT AND MAYBE TWELVE OR
FIFTEEN AT NIGHT AND YET MOST
NURSING HOMES AND MANY OF THEM
ARE ASKING A NURSING ASSISTANTS
TO HAVE TWELVE OR EVEN FIFTEEN
RESIDENTS TO TAKE CARE OF SO
THEY SIMPLY CAN'T GET THE WORK
DONE SO IT'S IT'S EXTREMELY
FRUSTRATING AND WITH THE LOW
PAY OF IT IT MEANS SAID THAT'S
THAT'S BASICALLY WHAT CAUSES
THE SHORTAGE AND THEN WHEN
YOU GIVE A WAIVER IT CREATES
A SPIRAL DOWN SO THESE WAIVERS
HAVE BEEN COUNTERPRODUCTIVE
AND A GOOD EXAMPLE OF THAT IS
OF AND ON OCTOBER NINTH AT THE
WATSONVILLE POST-ACUTE CENTER
-- THAT WAS OF A VERY HIGH
RISK OF FACILITY AND THEY ENDED
UP HAVING SIXTY ONE RESIDENTS
THAT GOT INFECTED AND NINE
DEATHS AND -- THAT FACILITY
ONLY HAD THREE POINT FOUR HOURS
PER RESIDENT DAY SO IT WAS
BELOW THE STATE MINIMUM AND
OF FIFTEEN MINUTES OF OUR IN
TIME PER RESIDENT PER DAY AND
THEY WERE GIVEN A WAIVER AND SO
THEY USE SPIRAL DOWN ON THEIR
STAFFING AND ENDED UP HAVING TO
HAVE THE NATIONAL GUARD COME IN
SO WE THANK YOU KNOW THERE HAS
TO BE A WAY TO GET THE WAGES
INCREASED WITH PASS THROUGH
ARRANGEMENTS AND TO GET THE
WORKLOAD DOWN I EVEN IF THAT
HAS TO BE PHASED IN OVER TIME
OF HAZARD PAY WOULD MAKE A HUGE
DIFFERENCE ESPECIALLY YOU KNOW
IN THIS CURRENT ENVIRONMENT
AND WE KNOW THAT MANY NURSING
HOMES HAVE A GIVEN OUT HAZARD
PAY AND THAT HAS RENAMED IT HAS
MADE A DIFFERENCE ALTHOUGH WE
DON'T HAVE ANY RESEARCH DATA
ON IT BUT JUST ANECDOTALLY
SO -- -- THIS IS IS IT'S
A FUNDAMENTAL OF A PROBLEM
HERE AND I THINK OF I WANT TO
JUST SAY THAT I THINK A LOT
OF THE DALLAS THAT WE'VE HAD
THE OVER FOUR THOUSAND DEATHS
COULD HAVE BEEN PREVENTED IF
WE HAD ASKED NURSING HOMES TO
INCREASE THERE ARE IN STAFFING
AND THERE'S TOTAL STAFFING
DURING THE PANDEMIC AND ASKED
THEM TO REALLY INCREASE THE
HAZARD PAY AND THEY OVER AT
LEAST THREE DOLLARS AN HOUR
MORE ON OVERALL PAY IT WOULD
HAVE MADE A BIG DIFFERENCE
IN THE INSTANCE THAT ARE
YOU SAID THE NATIONAL
GUARD CAME IN TO A FACILITY
WHO COVER THEIR COST
I I DON'T KNOW THE ANSWER TO
WHO COVER THEIR COSTS BUT I
MEAN IT'S JUST A SYMPTOM OF
WHAT HAPPENS WHEN YOU HAVE
LOW STAFFING AND PUT THIS
OTHER NURSES IN AN UNTENABLE
POSITION AND THEN -- WHEN THEY
GET SICK OR THEY'RE EXPOSED
TO THE COLD BED THEY'RE NOT
GOING TO BE ABLE TO WORK OR
THEY'RE GOING TO LEAVE WORK
AND LEAVING THE FACILITY
WITH NO OTHER ALTERNATIVE
BUT BRINGING IN THE NATIONAL
GUARD AND I AM NOT SURE WHO
PAID FOR THEM BUT I STE I
DOUBT IF THAT WAS THE FACILITY
WELL IT WAS SILLY YEAH THE
FACILITY IS BUILT ANY TIME THAT
WE DEPLOY EMERGENCY STAFFING
WHETHER THAT'S HEALTH CORE
A MERCHANT SEE -- STAFFING
THROUGH OUR NATIONAL GUARD
OR THROUGH ACCOUNT THAT
TEAMS ALL OF OUR DEPLOYMENTS
FOR EMERGENCY STAFFING THE
FACILITIES ARE BILLED --
THAT STAFFING AND IS THAT
BUILDING AT THE SAME RATE
AS THE STAFF WOULD HAVE BEEN
GETTING PAID OR IS THERE A
DIFFERENCE GREAT QUESTION SO
WE BILL AT THE STATE RATE THAT
WE GET THOSE STATE CONTRACTS
FOR AND WE PASSED THROUGH
THAT COSTS DIRECTLY -- ENSUE
I'M OFTENTIMES THE STATE
CONTRACTS ARE VERY PRICEY
THEY'RE EXPENSIVE -- AND SO
IT IS DEFINITELY NOT -- IN A
FACILITIES INTEREST TO -- HAVE
EMERGENCY STAFFING AND AND THAT
KIND OF BILL MISTER IS THERE
CAN I JUST CONNECT MUCH SAY ONE
OTHER THING JUST FOR CONTEXT
BECAUSE I THINK THERE'S BEEN
A LOT OF GOOD TESTIMONY A LOT
OF GOOD POINTS HERE I WANT TO
MENTION TO THE EXTENT WE HAVE
MORE STAFF IN FACILITIES COULD
IT COULD WELL BE A GOOD THING
THAT I DON'T WANT TO QUESTION
THAT AT ALL BUT I DO WANT
TO POINT OUT IF YOU LOOK AT
THE HISTORY OF THIS PANDEMIC
IF YOU HAVE MORE STAFF AND
THEY DON'T HAVE P.
P.
E.
AND THEY DON'T HAVE TESTING
THAT YOU PROBABLY STILL GOING
TO HAVE PROBLEMS AND THAT
BECAUSE AND THAT'S WHAT WE SAW
IF YOU THINK ABOUT THE PANDEMIC
WE'VE HAD FACILITIES THAT
HAD VERY HIGH STAFFING LEVELS
WERE ABLE TO MAINTAIN HIGH
STAFFING LEVELS AND STILL HAD
SPREAD BECAUSE THEY DIDN'T HAVE
PP THEY DIDN'T HAVE TESTING
AND THEY DID NOT KNOW BASED
ON THE EARLY GUIDANCE EARLY
GUIDANCE SAID THAT YOU HAD TO
BE SYMPTOMATIC WHERE YOU PER
SPREADING THAT WAS WRONG AND
WE FOUND THAT OUT THAT THAT
HAPPENED LATER ON IN ADDITION
WHEN WE HAD -- EMISSIONS FROM
HOSPITALS OF OF -- FOLKS WHO
WERE ALREADY POSITIVE RESIDENTS
ALREADY POSITIVE -- THAT WERE
THERE WE WERE A SYMPTOMATIC
THEY WERE SPREADING SO TO THE
EXTENT WE HAVE MORE STAFF YEAH
THAT THAT'S THAT THAT THAT
COULD BE AN ADVANTAGE ON THE
ONE HAND ON THE OTHER HAND WITH
THE FUNDAMENTALS WE'VE SEEN
IN THIS PANDEMIC ESPECIALLY
THE FIRST NUMBER OF MONTHS
THAT WOULD PROBABLY NOT MADE
ANY DIFFERENCE UNFORTUNATELY
THANKFULLY WE'RE IN A BETTER
SPOT THANK WROTE IN A MUCH
BETTER SPOT ON PP WE KNOW
MORE ABOUT THAT EVERYBODY
KNOWS MORE ABOUT THE VIRUS
BUT THIS IS BEEN A STATEWIDE
PROBLEM FOR THE ENTIRE HEALTH
CARE ANYWAY CRAIG CRAIG ALL
DUE RESPECT YOUR YOUR YOUR
SEEING THINGS THAT RAISES A LOT
OF OTHER QUESTIONS AND AND SO
AGAIN I WANT TO BE RESPECTFUL
OF OF MY CHAIRS TIME -- YOU
KNOW EITHER BECAUSE I I HAVE
JUST ONE MORE QUESTION BUT THIS
IS LEADING TO A CERTAIN OTHER
AREAS AS WELL I MEAN IT YOU
WHAT YOU'RE BASICALLY SAYING
IS THAT IF YOU KNOW WE DON'T
DO ONE SET OF THINGS THEN WE
WON'T HAVE TO WORRY ABOUT SOME
OTHER THINGS THAT'S WHAT I
HEARD AT LEAST THAT'S WHAT I
HEARD I DON'T KNOW COMMITTEE
MEMBERS HEARD THAT AS WELL BUT
BUT YOU KNOW WE WERE HAVING
STRUGGLES AS WE'VE HAD MULTIPLE
OF THESE HEARINGS IN ORDER TO
ADDRESS THE SHORTCOMINGS OF
OF THE DEPARTMENT OF PUBLIC
HEALTH AND WHY WE'RE NOT
GETTING CERTAIN STANDARDS INTO
PLACE YOU KNOW IT OUT ONCE IF
WE CAN MEET THOSE WHICH WHICH
THEY HAVEN'T BEEN MET YET BUT
AS WE'RE MAKING HEADWAY INTO
MEETING SOME OF THOSE YOU
KNOW -- I THERE'S A PART THAT
THE INDUSTRY NEEDS TO PLAY
AS WELL AND MAKE SURE THAT
IT'S MEETING THESE CHALLENGES
AS WELL SO HELP ME OUT HERE
BECAUSE BECAUSE THAT ANSWER IT
RAISED MORE QUESTIONS THAN THAN
WHAT I CANCER WELL I THINK YOU
HEARD THE STATISTICS AT THE
BEGINNING AS TO HOW MUCH BETTER
WE ARE DOING RIGHT NOW HOW MUCH
BETTER WE'RE DOING RELATIVE
IN TIME BUT HOW MUCH BETTER
WE'RE DOING THAN OTHER STATES
AND HAVE A THAT DOESN'T THAT
DOESN'T NECESSARILY ADDRESS
THE QUESTION WELL IT IT DOES
I UNDERSTAND THAT AND I THINK
WE DON'T HAVE THOSE VULNERABLE
PEOPLE PASSED AWAY ALREADY WELL
WE'VE ALREADY WE'VE ALREADY
WITH THERE'S ALREADY BEEN A
DISSERVICE AND AND I DID AGAIN
WE WE MOURN ALL THE EVERYONE
HAS PASSED AWAY IN ANY FACILITY
AND AGAIN AS I TRIED TO SAY
AT THE BEGINNING WE CELEBRATE
THE CARE GIVERS WE HAVE HERE
AND UNFORTUNATELY THAT HAS NOT
HAPPENED ENOUGH EITHER THAT
IS THERE'S BEEN AN AWFUL LOT
OF FOCUS ON THE HOSPITAL CARE
GIVERS AND NOT NEARLY ENOUGH
FOCUS ON THAT THE CARE GIVERS
AND OUR LONG TERM CARE SETTINGS
AS FAR AS WE'RE CONCERNED BUT
I JUST WANT TO EMPHASIZE AGAIN
THOUGH IN THIS PANDEMIC SOME
OF THE THE THINGS WE'RE TALKING
ABOUT GIVEN WHAT WE WHAT WE'VE
LEARNED SINCE THEN WE WE WERE
PET THIS WAS A A PERFECT STORM
FORCE FRANKLY WE HAD A PANDEMIC
WE DIDN'T KNOW IT BUT NO ONE
KNEW ANYTHING ABOUT THE WAS
AFFECTING THE HEALTH CARE
STRUCTURE ACROSS THE BOARD WE
HAD NO PETE NOBODY HAD ANY P.
P.
ET AND WE DIDN'T HAVE ANY
TESTING THOSE THINGS WERE ALL
A REAL PROBLEM AND PUT EVERYONE
BACK ON THEIR HEELS VERY VERY
BADLY FOR QUITE A NUMBER OF
MONTHS OUT THANKFULLY THINGS
ARE MUCH BETTER ON THOSE FRONTS
THAN THEY WERE A PARTICULAR
IN THE TESTING OF THE PD IS
YOU'VE HEARD ALREADY SO WHAT
YOU'RE SAYING AND IT'S BETTER
TO AN INCORRECT I I THINK I
MUST TAKE EXCEPTION TO WHAT
YOU'RE SAYING BECAUSE PART
OF IT IS WE'RE ALSO COMING
OFF OF A WHAT ONE OF THE BEST
ECONOMIC PERFORMING PERIODS
OF TIME WE'VE HAD CONTINUOUS
GROWTH IN THE ECONOMY SO WHEN
WE'RE SEEING UP THERE WAS A
PERFECT STORM YES THERE WAS A
PERFECT STORM BUT THE REALITY
IS THAT THE PERFECT STORM WAS
PRECEDED BY NINE YEARS IF NOT
MORE OF ECONOMIC GROWTH AND
BENEFIT AND SO THAT'S THE TIME
WHEN WE MAKE THE APPROPRIATE
PRECAUTIONS AND INVESTMENTS
TO MAKE SURE THAT WE'RE READY
FOR INSTANCES LIKE WHAT WE'VE
BEEN DEALING WITH FOR THE LAST
SEVEN MONTHS SO THAT THAT'S
THAT'S WHERE I'M HAVING A BIT
OF A CHALLENGE ACCEPTING THAT
RESPONSE HI I COULDN'T AGREE
MORE I COULDN'T AGREE MORE
AND WE WERE VERY WE WERE VERY
PLEASED WITH WHAT HAPPENED IN
EIGHTY EIGHTY ONE THIS YEAR
TO GIVE US A RATE GIVE OUR
FACILITIES RATE INCREASES THEY
DIDN'T COME NEARLY THEY WERE
NOT NEARLY ENOUGH TO COVER
THE COST SO EVEN WITH THE GOOD
TIMES THE STATE HAD WE ARE
PERSONALLY DID NOT SEE THAT AND
AS AGAIN AS I SAY WE'RE BEING
REIMBURSED RIGHT OUR FACILITIES
BEING REIMBURSED BASED ON WHAT
THEY HAD TO PAY TWO YEARS PRIOR
TO TO TODAY -- AND GIVEN WHAT'S
HAPPENED ON ALL COST AND THE
LAST TWO YEARS THEY'RE STILL
VERY FAR BEHIND SO I BUT I
COULD HURT SIXTEEN KERR WITH SO
I'LL JUST ASK MY LAST QUESTION
AND MR CHERRY THANK YOU SO
MUCH FOR GIVING ME A THE TIME
THAT YOU HAVE -- HOW ARE WE
ENSURING THAT OVERSIGHT ISN'T
SIMPLY LOOKING AT INFECTION
PROTOCOLS -- BUT IT'S ALSO
ADDRESSING THE QUALITY OF LIFE
INSIDE THE SKILLED NURSING
FACILITY SO AND AND AND I
WELCOME RESPONSES FROM MISS
THEN OCCUR MET MISTER CORNET AS
WELL AS -- DR WASSERMAN AS WELL
WELL OFTEN WHEN WE ARE IN A
FACILITIES TO WORK REQUIRED
-- ASK CONTRACTORS OF CMS
AND BY OUR DUTIES -- OR STATE
SURVEYORS IS THAT EVEN IF WE'RE
IN A FACILITY INVESTIGATING
WHETHER OR NOT THERE WAS A
FLY IN THE SOUP IF WE SEE
SOMETHING WHILE WE'RE IN THAT
FACILITY THAT WARRANTS CONCERN
THAT HAS NOTHING TO DO WITH
WHY WE ENTERED THE FACILITY
IN THE FIRST PLACE WE HAVE
THE RIGHT AND THE DUTY TO
EXPLORE THAT AND TO DO A AN
INVESTIGATION ON THAT SO EVEN
IF WE'RE IN A FACILITY THAT
IS ABOUT SOMETHING ELSE SO AN
INFECTION PREVENTION IT COULD
BE A COMPLAIN TO COULD BE
ANYTHING WHEN WE'RE IN THERE IF
WE SEE SOMETHING THEN WE MUST
FIGHT AND GO FOR IT AND I'VE
HAVE IT MANY EXAMPLES OF TIMES
UNFORTUNATELY WHERE WE HAVE
BEEN INFORMED INFECTION CONTROL
SURVEY AND WE WITNESS AND SEE
BECAUSE A LOT OF THE SURVEYORS
THEY KNOW THESE FACILITIES
THEY'VE BEEN IN THERE MULTIPLE
TIMES THROUGHOUT THE YEARS AND
THEY SEE A RESIDENT WHO LOOKS
LIKE THEY'VE LOST WEIGHT AND
THEN THAT'S THE FIRST THING
AN INDICATION IF THEY START TO
DO A FULLER INVESTIGATION OF
NUTRITION AND TO SEE IF THERE'S
A QUALITY OF CARE ISSUE TO SEE
IF THERE ARE MORE -- -- DEEPER
ISSUES GOING ON THE FACILITY
INFECTION -- -- THAT SITE --
INFECTION I'M A SURVEYS THEY
HAVE SOMETIMES LANDED WITH
WHAT WE CALL IMMEDIATE JEOPARDY
SITUATIONS OR AND I J.
AS WHAT WE CALL THEM WHERE WE
ARE ISSUE IN IMMEDIATE JEOPARDY
SITUATION THAT HAS NOTHING
TO DO WITH THE PANDEMIC BUT
EVERYTHING TO DO WITH POOR
LEADERSHIP AND POOR QUALITY OF
CARE AND SAY THAT'S JUST YOU
KNOW ONE WAY THAT WE'RE ABLE
TO SEE IT BUT THE OTHER WAY
IS ACTUALLY PARTNERING WITH
THE CALIFORNIA DEPARTMENT OF
AGING AND WE ACTUALLY REACHED
OUT TO THE OMBUDSMAN PROGRAM
AND ASK WHAT OTHER FACILITIES
ARE CONCERNED WITH WHAT OTHER
FACILITIES FOR YOU HAVE HAD
ISSUES WITH IN THE PAST SO
THAT WE COULD THEN TARGET
AND PRIORITIZE VISITS THOSE
FACILITIES AS WELL -- AND I
THINK THE MORE THAT WE CAN
COMMUNICATE WITH THE BEIJING
OUR OMBUDSMAN PROGRAM EVEN
FURTHER -- WE CAN BE ABLE
TO DO A LOT MORE ON BECAUSE
THEY WILL SEE SOMETHING IN
A DIFFERENT WAY AS WELL AND
SINCE -- AND WE'RE PROVIDING
AS MUCH TECHNICAL ASSISTANCE
TO GET OUR OUR PARTNERS ARE
ARE INVESTMENT BACK INTO THESE
FACILITIES I'M SO THAT THEY
CAN -- BE EYES AND EARS AS WELL
MR GERRY MCGEE TO HOLD OFF ON
ONE THING -- WE HAVE TO CLOSE
DOWN THE WIFI OR THE -- PUBLIC
COMMENT AT SAN FRANCISCO AT
FIVE PM SO THERE'S ONE PERSON
IN SAN FRANCISCO WHO HAS COME
TO GIVE PUBLIC COMMENT IF YOU
COULD HOLD ON FROM HER IN THE
LAST QUESTION LET'S LET THAT
PERSON GIVE PUBLIC COMMENT
THANK YOU YOUR ONE MINUTE
GOOD AFTERNOON MISTER CHAIR
AND MEMBERS OF THE COMMITTEE
THANK YOU FOR THE OPPORTUNITY
TO COMMENT MY NAME IS FELICIA
BARBATO AND I'VE BEEN WORKING
WITH THE CALIFORNIA DEPARTMENT
OF PUBLIC HEALTH FOR EIGHT
AND A HALF YEARS AS A HEALTH
FACILITIES EVALUATOR NURSE MY
JOB IS TO ENSURE THE RESIDENTS
OF CALIFORNIA ARE SAFE WITHIN
THE SKILLED NURSING FACILITIES
I AM ALSO A PROUD MEMBER OF
SEIU LOCAL ONE THOUSAND I
WOULD LIKE TO BRIEFLY DESCRIBE
WHAT IT HAS BEEN LIKE TO
WORK DURING THE WHOLE OF IT
I HAVE BEEN WELL AWARE OF
THE POOR INFECTION CONTROL
PRACTICES AND QUALITY OF CARE
IN MANY OF OUR NURSING HOMES
PRIOR TO THE PANDEMIC THE
HIGH RATES OF DEATH IN THESE
FACILITIES DURING THE PANDEMIC
UNFORTUNATELY COMES AS NO
SURPRISE WHEN I SAW WHAT WAS
HAPPENING IN WASHINGTON STATE
IN FEBRUARY I KNEW WHAT WAS
HEADED OUR WAY SOME CO WORKERS
AND I REQUESTED AT THAT TIME
THAT WE BE FIT TESTED WITH N.
NINETY FIVE MASKS SO THAT WE
COULD BE PREPARED TO ENTER
NURSING HOMES TO ENSURE SAFETY
HOWEVER IN MARCH WE WERE TOLD
TO STAY OUT OF THE FACILITIES
BECAUSE THEY WERE NOT SAFE
FIT TESTING BEGAN FOR US IN
AUGUST SIX MONTHS LATER WE
ARE THE POINT OF CONTACT FOR
THE STATE TO ENSURE THE SAFETY
OF NURSING HOME RESIDENTS BUT
BECAUSE OF THE LACK OF PLANNING
AND PROPER EQUIPMENT WE WERE
NOT ABLE TO GO IN EARLY IN
THIS PANDEMIC TO PROTECT OUR
MOST VULNERABLE I BELIEVE MANY
LIVES COULD HAVE BEEN SAVED
IF WE HAD BEEN ABLE TO DO SO
WE HAVE TO BE HONEST ABOUT
WHAT HAS HAPPENED AND CORRECT
IT NOW THANK YOU THANK YOU
THANK YOU FOR YOUR PATIENCE --
ANY OF THE PUBLIC TESTIMONY
IN SAN FRANCISCO BEFORE
WE HAVE TO I GUESS
SHUT DOWN THERE
LET ME ALSO JUST THANK DR
HARRINGTON FOR PARTICIPATING
IN THE HEARING I I HAD A
QUESTION FOR HER AS WELL
BUT I'LL WAIT TO ALLOW
JUST CONTACT HER DIRECTLY
BACK TO YOU MISTER NAZARIAN
THANK YOU MISTER CHAIR
AT THAT THAT WAS MY LAST
QUESTION WHICH WAS BASICALLY
YOU KNOW INSURING -- I WE'RE
INSURANCE OVERSIGHT -- AND
IT'S NOT SIMPLY JUST LOOKING
AT INFECTION PROTOCOLS BUT
BUT ALSO LOOKING AT ADDRESSING
QUALITY OF LIFE AND I WANTED
-- -- MISS THEN OCCUR MISTER
CORNET AND MID DR WASSERMAN
TO ALL HAVE AN OPPORTUNITY TO
RESPOND WE OUGHT WE ALREADY
HEARD FROM MISS US THAT OCCUR
SO IF -- MISTER CORNET AND
DR WASSERMAN WANNA CHIME IN I
THANK WELCOME IT AND THANK YOU
I
DIDN'T KNOW WHO IS
GOING TO GO FIRST --
I'M TRYING TO GET MY
THE QUESTION REMIND
REMIND ME THE TOPIC
I DEFER TO DOCTOR LAST NIGHT IF
YOU HAVE ANY OTHER QUESTIONS ON
THAT AND THE MISSIONS AND JUST
LIKE I SAID JUST TO LET YOU
KNOW THE THE THE SURVEYORS ARE
IN THE BUILDINGS AT LEAST EVERY
SIX WEEKS NOW AND SOME CASES
MORE CHECK ON THE MITIGATION
PLANS -- AND AND SEE HOW SILLY
TO DO IT AND SO IT JUST IN
TERMS OF OVERSIGHT I'M NOT SURE
THAT ANSWERS YOUR QUESTION BUT
OKAY YEAH I KNOW I'M I'M GOOD
I I I I WAS THINKING ABOUT WHAT
THAT OUR BRAVE SOUL WAS WAS
SHARING WITH US I'M YOU KNOW
I I WOULD LIKE TO SAY THAT --
AS OF LATE MY ORGANIZATION HAS
BEEN WORKING CLOSELY WITH CDPH
WE'VE ACTUALLY BEGUN TO DEVELOP
SOME EDUCATION TRAINING FOR
SURVEYORS AROUND WORKING WITH
-- OR ASKING QUESTIONS OF AND
-- -- INTERVIEWING THE MEDICAL
DIRECTORS THE CONSULTANT
PHARMACISTS -- AND SO WE
ACTUALLY REALLY APPRECIATE
THOSE EFFORTS AND WE THINK --
TWO MR CHRIS POINT THAT ONE OF
THE CHALLENGES OF THE SURVEY
PROCESS IS HOW YOU IMPACT FOR
LEADERSHIP IN A FACILITY AND
AND I THINK YOU BEGIN TO IMPACT
OUT BY ASKING MORE QUESTIONS OF
ALL THE LEADERS IN THE FACILITY
ADMINISTRATOR THE DIRECTOR
OF NURSING THE THE MEDICAL
DIRECTOR OF THE CONSULTANT
PHARMACIST AND SUCH SO OKAY
I THINK THERE'S A LOT THAT WE
CAN LEARN FROM WHAT'S HAPPENED
OVER THE LAST EIGHT MONTHS I
I THINK THERE'S BEEN POSITIVE
MOVEMENT IN TERMS OF LOOKING
AT HOW WE APPROACH THESE
PROCESSES I ABSOLUTELY AGREE
THAT -- WE NEED TO CONTINUE
DOWN THAT PATH AND YOU KNOW WE
CAN WE CAN FIND FAULT IN WHAT
WE'VE DONE WRONG BUT I THINK
WHAT WE NEED TO DO IS START
FIGURING OUT WHAT WE WHAT'S
NEXT IN AND I I I WILL SURE --
CAL TCM IS ACTUALLY SUBMITTED
A GRANT PROPOSAL THROUGH THE
CMP FUNDS TO PROVIDE LEADERSHIP
AND MANAGEMENT TRAINING TO A
FACILITY LEADERSHIP TEAM SO
AND I I FEEL VERY STRONGLY
THAT DURING A CRISIS LEADERSHIP
IS ABSOLUTELY ESSENTIAL AND
I I I DON'T THINK THERE'S ANY
SPACE AMONGST ALL OF US TO
RECOGNIZE THAT IF YOU DON'T
HAVE STRONG SOLID LEADERSHIP
IN A NURSING FACILITY
ESPECIALLY DURING A PANDEMIC
YOU'RE GONNA HAVE PROBLEMS
AND YOU'RE GONNA HAVE POOR
OUTCOMES SO I I THINK THAT'S
REALLY ONE OF THE KEY AREAS
FOR ALL OF US TO BE LOOKING AT
THIS IS VERY ARE YOU WANNA DO
THAT SERVICE SENATE FOR YOU
ARE YOU DON'T I'M I'M DONE
WITH THE QUESTIONS THANK YOU
MISTER CHAIR THANK YOU HI I
WANT TO JUST HAVE A COUPLE
QUESTIONS I WANTED TO GO TO
MISS HOLLAND INTO DR WASSERMAN
-- AN UNFORTUNATE DR HARRINGTON
NOW WE HAVE TO SHUT DOWN SAN
FRANCISCO BUT YOU ALL ADVOCATED
FOR -- YOU KNOW MORE NURSING
COVERAGE NURSING ASSISTANT
COVERAGE INCREASE IN WAGES I
THINK YOU'VE HEARD THE RESPONSE
FROM MR JOYCE CORNET IN TERMS
OF THE CHALLENGES AND THE
DIFFICULTY AND THE SHORTAGE
OF -- PEOPLE TO GO HIGHER I
GUESS HOW -- YOU SEE HOW THIS
RECOMMENDATION HOW WOULD YOU
ADVISE US TO -- IMPLEMENT
THIS AND WHAT IS STOPPING
THIS FROM BEING REALITY
-- I WOULD START BY SAYING
TODD BENEFITS SO YOU I KNOW OF
THAT DID TO PAY HAZARD PAY WHEN
THEY HAVE A VERY SIGNIFICANT
PANDEMIC THAT RESULTED IN
DOZENS OF DEATHS AND THEY
THEY PAID THEIR CNA'S MORE
WHILE THEY WERE AN OUTBREAK
AND AS SOON AS THE OUTBREAK
WAS OVER THEY LOWERED THEIR
PAY AND I THINK THAT SPEAKS
THE WAY THAT SO MANY CNA'S
ARE TREATED SO I THINK IT'S
A MULTI PRONGED APPROACH ONE
WE NEED TO IMMEDIATELY CHANGE
THE COMPENSATION STRUCTURE AND
WHILE SOME OF IT CERTAINLY CAN
BE PASSED THROUGH AS I ALSO
SUPPORT WHAT HAS BEEN -- TALKED
ABOUT AROUND REALLY UNDERSTAND
THE THE COMPENSATION STRUCTURE
AT SKILLED NURSING FACILITY
WHERE THE FUNDS ARE REALLY
GOING BECAUSE LET'S REMEMBER
HOW THEY'RE BEING PAID IT'S THE
PEOPLE'S MONEY IT'S OUR MONEY
SO I THINK IT'S ABOUT TALK
ABOUT RIGHT BUT REVITALIZING
AND REVOLUTIONIZING HOW CNA'S
ARE TRAINED FOR THEIR EXISTING
JOBS I THINK IT'S ALSO ABOUT
BUILDING STACKABLE PATHWAYS
FOR CNA'S TOO BUT ENTER OTHER
FIELDS LIKE LEN R.
N.
-- SURGICAL TECHNOLOGIST OTHER
FIELDING TO REALLY LOOK AT
WHAT THAT WHAT THAT LOOKS LIKE
AND MAKE SURE WE'RE NOT HAVING
THESE REDUNDANT PATHWAYS MAKING
IT POSSIBLE FOR PEOPLE I ALSO
THINK WE THINK WE NEED TO
LOOK AT WHAT SKILLED NURSING
FACILITIES LOOK LIKE AS A
WORKPLACE WHICH IS WHAT EXACTLY
WHAT DR HARRINGTON WAS TALKING
ABOUT WHICH IS THAT TWELVE TO
FIFTEEN CNA'S ON NIGHT SHIFT IS
MUCH MORE AKIN TO WHAT C.
N.
A.'S ARE CARING FOR ON DAY
SHIFT WHEN THERE IS THE
HIGHEST LEVEL OF NEEDS WE
NEED TO LOOK AT HOW FOLKS ARE
ACTUALLY ABLE TO DO THEIR WORK
IT'S BACKBREAKING INTIMATE
AND IMPORTANT WORK AND FOR
MAKING IT POSSIBLE THEM OF
COURSE PEOPLE DON'T STAY I
ALSO SUGGEST SURVEYING THE --
CNA'S WHOSE THEY WERE LICENSE
WHO ARE NO LONGER WILLING TO
WORK IN THE FIELD LET'S NOT
SIMPLY SAY OH IT'S BECAUSE
OF KIDS ARE ALWAYS BECAUSE OF
THAT THAT'S ACTUALLY ACCESS
THEM WHAT WAS HARD ABOUT THIS
WORK AND WHAT WOULD IT TAKE TO
GET THEM BACK INTO THE FIELD
SO COULD YOU COMMENT ON JUST
BEFORE THE THE SUBJECT ON
THE THE SHORTAGE OF YOU HEARD
MISTER CORNET TALK ABOUT A
THIRTY THOUSAND PERSON --
SHORTAGE IN THE WORKPLACE
AND -- I ME I UNDERSTAND I
UNDERSTAND -- YOUR -- YOUR
FEELING CUENTA STORAGE DEVICE
ABOUT HOW TO RESHAPE THE
WORKPLACE BUT -- LET'S SAY
WE COULD DO THAT HOW WOULD
WE GET MORE PEOPLE INTO THAT
WORK IN INTO THIS FIELD YEAH
I THINK IT'S ALSO PARTLY ABOUT
WE COULD LOOK TO SOME OF OUR
OUR SCHOOLS WE HAVE A MEDICAL
TECHNOLOGY HIGH SCHOOLS AND WE
FUNNEL YOUNG PEOPLE INTO THAT
FIELD WELL YOU CAN START WITH
ANATOMY IN YOUR FIRST YEAR
AND BY YOUR SENIOR YEAR YOU
COULD BE WORKING ON YOUR CNA
PROGRAM CREDENTIALS SO THAT YOU
LEAVE OUT WITH ENTRANCE INTO
COMMUNITY COLLEGE AND YOU'RE
ALREADY SEEING A AND YOU HAVE
A JOB AN EXISTING JOB IT ALSO
WOULD BE THAT THE CD TRAINING
CAN TAKE TIME IF YOU'RE DOING
IT WELL IT'S AN EXTENDED PERIOD
OF TIME THERE ARE MANY PROGRAMS
ARE ONLY A FEW WEEKS AND I HOLD
THAT THEY ARE NOT APPROPRIATE
OR NOT TRAINING -- I THINK IT'S
ABOUT LOOKING AT THAT LIKE GOSH
CAN WE DO PAID INTERNSHIPS FOR
PEOPLE WHILE THEY'RE TRAINING
TO BE A SENIOR I THINK IT'S
ALSO EXPANDING THE NUMBER OF
PROGRAMS THAT ARE AVAILABLE AS
YOU POINTED OUT IN SOME RURAL
AREAS IT'S VERY HARD TO BECOME
A CNA BECAUSE THERE'S NOT
AND ACCESSIBLE SCHOOL I THINK
IT'S A MULTI PRONGED APPROACH
I DON'T JUST THINK IT'S ONE
THING BUT I THINK PART OF THE
PROBLEM IS THAT YOU KNOW WE
HEAR YOU KNOW THE C.
N.
A.'S ARE MANY REPORTERS AND
SO OFTEN THEY REPORT TO US
ANONYMOUSLY BECAUSE THEY'VE
MADE OTHER COMPLAINTS THEY'VE
ATTEMPTED TO ADDRESS ISSUES
OF CARE THAT THEY KNOW ARE
WRONG THAT AREN'T REALLY TAKEN
SERIOUSLY THE LICENSING LEVEL
AND SO I THINK IT'S REALLY
ABOUT SAYING THAT THE CNA YOU
KNOW YOU HAVE THE RESIDENT
AND THEN RIGHT OUTSIDE THAT
YOU HAVE THE CNA IN TERMS
OF LOCUSTS OF CARE AND WE
NEED TO VALUE THOSE THINGS
SIMULTANEOUSLY AND HELP THEM
HELP US TO RESHAPE THE INDUSTRY
I KNOW THAT THAT'S A BIT OF
A SORT OF A SOFT ANSWER FOR
YOU BUT I THINK THAT'S WHAT
WE HAVE TO START IS THAT --
YOU KNOW UNFORTUNATELY ALL
THE THE NUMBERS THE DATA WE
DON'T HAVE THAT MUCH OF AN
INSIGHT INTO WHAT C.
N.
A.'S LIVES LOOK LIKE I ALSO
WOULD SAY IF WE'RE SERIOUS
ABOUT CONTROLLING THE DISEASE
OF CODE IN LONG TERM CARE WE
HAVE TO GET SERIOUS ABOUT THE
LIVES OF WHAT OUR SENIORS ARE
DOING OUTSIDE OF WORK WHICH IS
THAT MANY OF THEM THEMSELVES
ARE LIVING IN SORT OF A HIGHLY
PACKED HOUSING WITH OTHER
FAMILY MEMBERS WERE ALSO CARE
GIVERS THEY'RE ALSO STILL
DOING ALL OF THE THINGS THAT
WE HAVE TO DO LIKE GROCERY
SHOPPING LIKES KIDS LIKE IF
WE WANNA GET SERIOUS ABOUT
CONTROLLING DISEASE IT'S NOT
JUST ABOUT THE WORKPLACE IT'S
WHAT WE'RE EXPECTING THAT
PERSON TO DO OUTSIDE OF WORK
I FULLY UNDERSTAND THAT BUT
I THINK WE WE AS LEGISLATORS
HAVE TO FIGURE OUT -- WHAT
PROCEDURES OR POLICIES WE CAN
IMPLEMENT TO REALLY SCALE --
-- YOUR TO BE ABLE TO SCALE
TO SOLVE THIS PROBLEM THIS
IS NOT JUST AT IT THIS IS NOT
JUST AN ISSUE WITH A FACILITY
OR TEN PERCENT THE FACILITIES
THIS IS A SYSTEMIC ISSUE ISSUE
WITH IN THE INDUSTRY -- AND IN
WE'VE HEARD AND WE HEARD FROM
MISTER CORNET TALKING ABOUT
THE YOU KNOW THERE'S ALWAYS THE
CONSTANT DRUMBEAT OF MEDICARE
REIMBURSEMENTS AND IF I HAVE
A NICKEL FOR EVERY HEALTH
PROFESSIONAL THE COMPLAINTS
ABOUT MEDICAL REIMBURSEMENTS
LIKE A CLOSE THE FIFTY FOUR
BILLION DOLLAR BUDGET GAP SO
-- HE GIVE US WISDOM WE WERE
YOU KNOW WE'RE WE'RE VERY
SYMPATHETIC AND I THINK YOU ARE
YOUR POINTS ARE EXTRAORDINARILY
WELL TAKEN BEEN ON I'M TRYING
TO GET SOMETHING THAT WE CAN
GO DO RIGHT SO I THINK THAT'S
THAT'S THAT'S OUR CHALLENGE
BECAUSE I I MEAN I I TOTALLY
AGREE WITH YOU I THINK WHAT
YOU SAY MAKES SENSE BUT HOW
DO WE HOW WE SCALE THAT HOW DO
WE GROW THAT DISTANCE VERSES
JUST YOU KNOW HAVING HAVING
A GREAT STORY AND HAVING YOU
KNOW THIRTY -- YOU KNOW THIRTY
PEOPLE BEING IMPACTED WHICH
I'M NOT SAYING IT'S NOT A PORT
IT IS VERY PARK THAT'S HOW YOU
DO THINGS BUT YOU KNOW WHEN
YOU HAVE HIM TWELVE HUNDRED
FACILITIES AND HAVE A SHORTFALL
THAT EACH OF THOSE AND THIS
FUNDING ALL ACROSS THE STATE
HOW DO HOW DO WE TALK ABOUT
SO SIR I WOULD SAY I HAVE A
PLAN FOR THAT LIKE I WE HAVE
A PROGRAM THAT IS REPLICABLE
ACROSS THE STATE TO ALLOW MORE
QUALIFIED CNA'S TO ENTER THE
FIELD IT REQUIRES A FINANCIAL
INVESTMENT OF TRAINING IT
REQUIRES WRAPAROUND SUPPORT
SERVICES FOR THESE INDIVIDUALS
AND THEIR CHOIRS US LOOKING
OUR REGULATORY EDUCATION SYSTEM
TO KNOCK DOWN SOME ARTIFICIAL
BARRIERS IN ITS PLACE SO WHAT
I WOULD SAY IS THE WAY I'D
FOLLOW UP IS I'D LIKE TO SHARE
THE CURRICULUM THAT I HAVE
WITH YOU AND SHARE OUR OUTCOMES
ACTUALLY EVALUATED BY A FIRM
AND TALK ABOUT WHAT THAT LOOKS
LIKE SO I THINK IT'S MULTI
PRONGED BUT I THINK IT'S A
CONTINUING CONVERSATION OF IF
I HAVE PERMISSION TO REACH OUT
TO YOUR STAFF TO SHARE THIS
WITH THEM AND TO CONTINUE THIS
CONVERSATION OF HOW IT CAN BE
REPLICATED ACROSS THE STATE
YOU YOU'RE MORE THE COMMISSION
WOULD WELCOME IT AND HOW MUCH
WOULD IT COST SO I CAN TELL
YOU WHAT IT COSTS ON A LOCAL
LEVEL AND THAT'S ENTIRELY NEW
ONES BASED ON WHAT THE ADULT
EDUCATION STAFF ARE PAID --
AND ALSO THIS TO WHAT WE ALSO
ARE SUPPORTED BY A JOHN MUIR
COMMITTEE HEALTH FUND FOR THE
SHORT TERM AT THE STATE LEVEL
I HAVE TO LOOK AT THAT I WOULD
SAY I DON'T THINK IT'S ACTUALLY
MORE EXPENSIVE THAT WERE
ALREADY PROVIDING FOR PEOPLE
IN TWO WAYS FIRST OF ALL IN
TERMS OF THERE'S ALREADY WE OWE
IT DOLLARS BEING ALLOCATED TO
ADULT EDUCATION AND -- SUPPORT
OF EDUCATION SERVICES I THINK
IT'S ABOUT SPECIFICALLY YOU'RE
MARKING THOSE FOR ENTRY INTO
A LIGHT HOMEOWNERS WITH THIS
IS THIS IS BUDGET COMMITTEE
WHATEVER PEOPLE GIVE ME WORDS
LAST FOR A NUMBER I JUST NEED
A NUMBER WITH THE NUMBER NOT
BECAUSE IT'S BECAUSE WHEN YOU
PUT WORDS INTO A BUDGET THAT
MEANS YOU GOT ZERO MONEY SO
YOU COULD GET THAT IF YOU WANT
TO WITH HOW MUCH MONEY ARE WE
TALKING I DON'T KNOW I HAVE
TO GO BACK AND LOOK AT THAT
I CAN MAKE UP A NUMBER BUT
IT'S A HUNDRED PERCENT MADE
UP AT THIS POINT WELL THAT'S
NOT BOCANEGRA NUMBER TWO SO
OKAY I WILL GIVE A SENSE OF
HOW MUCH IT IS PER PERSON IT
ALSO JUST JUST SO YOU KNOW
YOU MENTIONED SORT OF ADULT ED
JUST REALIZE THAT WE'VE WE'VE
WE'VE IN MANY WAYS STARTED
TRANSITIONING ADULT AT INTO
COMMUNITY COLLEGES BECAUSE
WE HAD THAT DEBATE VERSES --
ADULT ED IN EITHER K.
THROUGH TWELVE DISTRICTS ARE
HIGH SCHOOL DISTRICTS IN OUR L.
AND THAT YOU KNOW KIDS ARE
TAUGHT DISTRICTS AND ADULT
AND COMMUNITY COLLEGES AND
THE REASON WE TRANSITIONED
AND AND I THINK YOUR POINT'S
WELL TAKEN BUT THE REASON WE
TRANSITION IS DURING THE LAST
RECESSION WHEN K.
THROUGH TWELVE DISTRICTS
HOW TO MAKE A CHOICE
BETWEEN CUTTING K.
THROUGH TWELVE PER ADULT THAT
THEY UNIFORMLY ACROSS THE BOARD
CUT ADULT THAT SO THAT'S WHY
WE DECIDED TO KIND OF KEEP IT
WITH COMMUNITY COLLEGES SINCE
THEY SERVE ADULTS ARE MORE SO
I KNOW I WOULD CHANGE IS YOUR
OPINION OF TIME WELL I WOULD
SAY DURING THE THE SCHOOL
WE WORK WITH DURING THE LAST
RECESSION WHAT THEY ACTUALLY
SAW PEOPLE FLOCKING TO SEE
IN A PER TRAINING PROGRAMS
BECAUSE THOSE WERE JOBS THAT
IT WERE HAD OPENINGS AND THAT
COULD BE FILLED AND PEOPLE
WHO DONE OTHER JOBS INCLUDING
PROFESSIONAL YOU KNOW A
MANAGEMENT LEVEL REALLY NEEDED
TO WORK SO IN TERMS OF STUDENT
COSTS IT'S BETWEEN EIGHTEEN
HUNDRED AND TWENTY FIVE HUNDRED
PER STUDENT DEPENDING ON A
COUPLE VARIABLES BUT THAT
COVERS FOOD COMPREHENSIVE
SUPPORT SERVICES AT TRAINING --
SO I HEAR YOUR POINT AROUND THE
ALIGNMENT BUT I ALSO THINK WE
NEED TO LOOK AT BOTH COMMITTEE
COLLEGE AND ADULT EDUCATION
THOSE FUND -- BUT IN THE BUDGET
BUT I INVITE YOU TO TALK TALK
TO MISTER CORNET WHO'S RIGHT
NEXT TO YOU BESIDES BEING THE
YOU KNOW CO THE THEIR HEALTH
FACILITIES HE'S ALSO A BUDGET
GROW SO HE CAN HE CAN HELP YOU
WITH THAT PARTICULAR YOU JUST
YOU JUST HEARD IS A THIRTY
THOUSAND PERSON SHORTAGE AND
YOU HAVE A PLAN TO SCALE THAT
I THINK IT IS AN OPPORTUNITY --
THERE ARE OTHER FIELDS WE HAVE
PLENTY OF INDUSTRIES WHERE WE
DON'T HAVE A SHORTAGE ROUGHLY
DOING WHAT WE CALL IT THIS
YEAR THIS MAGICAL TRANSITION SO
THIS IS NOT WHAT WE'RE HEARING
IN THIS HEARING AND I REALLY
WOULD URGE YOU KNOW THE TWO
OF YOU TO TALK ALSO FOR OUR
MARKET FOR YOU TO TALK WITH
OUR COMMITTEE WOULD BE MORE
THAN HAPPY TO UNDERSTAND HOW
TO YOU KNOW HOW TO THINK ABOUT
THIS I'M NOT A DOCTOR ONCE
AGAIN JUST GOING BACK TO YOU
YOU JUST THE SAME SAME KIND
OF QUESTION YOU MENTIONED YOU
KNOW MORE MORE ARE IN COVERAGE
MORE COVERAGE MORE RESOURCES
HOW DO WE HOW HOW DO WE DO IT
I ASSUME IF THE THE FACILITIES
HAD THE MONEY TO DO THE STATE
ALREADY BE DOING IT SO HOW
DOES THIS BECOME A REALITY OKAY
OKAY -- CAN YOU HEAR ME OK
WE CAN HEAR YOU GREAT HAVING
A LITTLE FEEDBACK HERE WE
GET OKAY SO ACTUALLY I WANNA
FRAME THIS TWO WAYS FIRST THE
NURSING HOME INDUSTRY IS AT AN
INFLECTION POINT RIGHT NOW AND
WE HAVE TO DO SOMETHING AND AND
ONE OF THE BEST EXAMPLES I'LL
GIVE YOU -- IS WHAT ASSEMBLY
MAN WHAT DID WITH HIS BILL WE
RECOMMENDED THE SECOND WEEK
OF MARCH THAT EVERY NURSING
HOME IN THE STATE HAVE A FULL
TIME INFECTION PREVENTION NEST
AND I WILL TELL YOU WHAT WE
HEARD FROM VARIOUS FOLKS WAS
WE CAN'T AFFORD THAT AND MY
RESPONSE WAS YOU CAN'T AFFORD
NOT TO THERE IS SOMETHING
CALLED INVESTING IN QUALITY
SHOW THAT YOU HAVE BETTER
OUTCOMES IN YOU SAVE MONEY AND
SO ON I I QUESTION THE PREMISE
THAT CERTAIN INVESTMENTS IN
STAFFING NECESSARILY ARE GOING
TO LEAD TO A NET LOSS OF MONEY
AND YOU KNOW WE HAVE NOT FOR
PROFITS THAT DO DO FINE AND SO
I HONESTLY THINK THE INDUSTRY
NEEDS TO LOOK IN THE MIRROR
AND DECIDE AS AS BOTH MISTER
NAZARIAN WOULD MENTIONED WHERE
DOES THE REAL ESTATE FLOW
WHERE THE FUNDS FLOW I SAID I
SAID IN THE ASSEMBLY HEARING
TO THE HEALTH COMMITTEES BACK
IN JUNE THE LARGE NURSING ON
CHANGE IN THIS STATEMENT CROSS
THE COUNTRY COULD EASILY HAVE
LEVERAGED THEIR ASSETS TO
ACQUIRE ABUNDANT P.
P.
E.
N.
TESTING IN MARCH AND APRIL WHEN
THE EXPERTS WERE SAYING THAT'S
WHAT WE NEEDED THEY HAD NO
FIDUCIARY RESPONSIBILITY TO DO
THAT AND THEY DIDN'T ACTUALLY
I ONLY TAKE A STEP ON THE FLOOR
THERE ARE SOME DARK OPERATORS
DR ONE DID SORRY ARE YOU JUST
SAYING THEY THEY COULD THEY
COULD BRING IN MORE PEOPLE NOW
THEY'RE JUST CHOOSING NOT TO
BECAUSE OF PROFIT BECAUSE WE
HAVEN'T SEEN THE SAME AMOUNT OF
CONSTRUCTION RATES ARE PROBLEMS
IN THE NONPROFIT SECTOR THAT
IN ESSENCE MAY BE DEALING
WITH EVEN UP FOR CLIENTELE
SO THAT IS THAT WHAT YOU'RE
SAYING WE COULD DO IT RIGHT
NOW IS JUST THE PROFIT MOTIVES
GETTING IN THE WAY DISTRICT
UNDERSTAND WHAT YOU'RE SAYING
THAT'S A GREAT QUESTION AND
ACTUALLY THE DATA THERE IS
DATA SHOWING -- FEWER OUTBREAKS
FEWER DEATHS IN NOT FOR
PROFITS VERSUS FOR PROFIT AND
LOOK I'M AN ENTREPRENEUR I I
BELIEVE IN THE PROFIT MOTIVE
-- AT THE SAME TIME WE CAN'T
ABUSE THAT PRIVILEGE AND I
I THINK THE INDUSTRY REALLY
HAS TO TAKE A HARD LOOK AT
HOW MUCH MONEY IT WANTS TO
MAKE AND WHERE IT WANTS TO
MAKE IT AND THAT'S WHERE ALL
THE OTHER TRANSPARENCY ISSUES
COME IN AYE I DON'T THINK THE
STATE SHOULD HAVE TO SPEND
EXTRA MONEY IN IN IN FACT THE
REASON WE RECOMMENDED THAT
FULL TIME INFECTION PREVENTION
IS BACK IN MARCH WAS IT THAT
WOULDN'T COST THE STATE A
CENT AND IN FACT IT WOULD TAKE
PEOPLE THAT THE NURSING HOMES
ALREADY HACKED BECAUSE EVERY
NURSING HOME ALREADY HAS AN
INFECTION PREVENTION NEST IT'S
JUST THAT THEY'RE TYPICALLY
PULLED IN TWELVE DIFFERENT
ELECTION DIRECTIONS AND NOT
ALLOWED TO DO THEIR JOB AND
TO BE TO BE VERY HONEST IN
A LOT OF WAYS THERE WAS JUST
RESISTANCE BECAUSE FOLKS DON'T
UNDERSTAND THAT YOU HAVE TO
INVEST IN DOING THE RIGHT
THING AND PROVIDING QUALITY
CARE IN ORDER TO BE PROFITABLE
THAT IS WHAT I BELIEVE AND I
I THINK THAT IS THAT IS SORT
OF A MANTRA I BELIEVE IN AND
I TOO WOULD BE HAPPY TO SPEND
TIME WITH YOUR STAFF TO IN
TERMS OF I LOVE NUMBERS --
SO I AND I I DO BELIEVE THAT
THIS INDUSTRY CAN SURVIVE BUT
THEY'RE GONNA HAVE TO MAKE A
HUGE DECISION IN TERMS OF HOW
MUCH PROFIT AND WE'RE THAT
PROFITS GOING TO BE IF THEY
DO WANT TO SURVIVE THANK YOU
DR OSMAN JUST FOR ONE SECOND I
DON'T HAVE MORE QUESTIONS BUT
WE'VE HAD SOME VERY PATIENT
MEMBERS OF THE PUBLIC WHO HAVE
TO LEAVE -- SO I AM GOING TO GO
OUT OF ORDER AND ALLOW PEOPLE
FOR PUBLIC COMMENT TO COME
ON UP IN THE ROOM AND FORTY
TWO OR TWO ONE LOOKING AT THE
PUBLIC IN PEOPLE WON'T COME
UP COME UP COME TO THE MIKE
IT WILL GIVE YOU WILL GIVE
ME A MINUTE AND I'LL CONTINUE
MY QUESTIONS GO GO AHEAD SIR
FIND NJ AND PROFESSOR -- AND
SOMEONE CHIANG AND THEN THE
REST OF THE COMMITTEE AND
MY NAME IS PATRICK BANKER
AND THE OTHER IN SACRAMENTO
I AM I SHOULD SAY FUNDED YOUNG
PERHAPS YOUR GRANDMA HAD YOU
PAINT A STROKES AND PLACE
LITTLE GIVES IN THE LAKES
THREE TO FIND IN THE BACKYARD
PERHAPS YOUR GRANDMOTHER WAS
AS BEAUTIFUL AS MINE PERHAPS
HE HE SHARED FOOD AND SANG
TOGETHER MY GRANDMOTHER PASSED
AWAY BEFORE I EXPERIENCED SOME
HARDSHIPS ON IT'S EMBARRASSING
TO SAVOR BASICALLY I WAS
TORTURED FOR ELEVEN MONTHS
STRAIGHT TWENTY FOUR SEVEN SIX
MONSTER TWENTY FOUR SEVEN CABLE
BROKE INTO MY APARTMENT PUT
SERVICES ON THE GROUND FOR THE
TOP OF A DRUG ON MY DOORKNOB
WHICH BASICALLY TORTURED ME
WITH SOME KIND OF THE BRAIN
VIRUS I DON'T KNOWS DIFFICULT
IS MORE DIFFICULT THAN I CAN
EVEN DESCRIBE ON BUT I JUST
WANT TO KNOW THAT ON -- I'M NOT
SURE ABOUT A GIVEN A MEDICATION
ARE THE VACCINES TO THE ELDERLY
BECAUSE I'M NOT I'M JUST I
FEEL LIKE MAYBE WE SHOULD MAYBE
CONTENT AND BETTER UNDERSTAND
ABOUT WHAT'S ALL IN IT BECAUSE
I THINK THERE MIGHT BE SOME
KIND OF BIO TECHNOLOGIST MAYBE
AND I NOT TRYING TO BLAME
ANYBODY I'M NOT MAD AT ANYONE
I KNOW THE DOCTORS ARE PERFECT
THE WAY GOD MADE HIM I THINK
ALL PER THE WAY GOD MADE YET
I THINK WE ALL ARE ON I JUST
THINK PARTY IN TURKEY'S PART
OF MAYBE MAKE MISTAKES BECAUSE
SOMETIMES WE GO THROUGH LIFE
AND PEOPLE CAN TELL US WHEN I
GET ENOUGH BECAUSE WE'RE NOT
GOOD LOOKING ENOUGH THAT'S ME
OR RICH ENOUGH THAT'S MAYOR
SMART NOTHING I DON'T YA OTHER
THAN THAT BUT I KNOW THAT'S
ME AND I THINK IF YOU IF YOU
COULD WRAP UP PLEASE I THINK
ROCK ENOUGH TO MAKE ON MADE US
AND ON AND ON AND TO THE PERSON
TO THE PEOPLE RESPONSIBLE
FOR HAVING GONE THROUGH I
WOULD JUST LIKE TO SAY ON
MAYBE WE CANNOT WORK ON
BUILDING A CULTURE WHERE
ALL PEOPLE CAN CAN BE THEIR
BEST AND I THINK ALL OF YOU
WHO WHOEVER IS RESPONSIBLE I
THINK YOU'RE TRYING TO BASK
IN WHAT YOU DO IN YOUR PRIMARY
CREATED TO AND LIKELY TO
DELIVER YOUR FEEDBACK CALMLY
RESPECTIVELY AND IN PERSON --
AND IT'S NOT I'M NOT WILLING
TO LISTEN THANK YOU VERY MUCH
I THINK APPARENTLY GOTTEN
ANYTHING WE THANK YOU CHRISTIAN
ANY OTHER PUBLIC COMMENT
A MINUTE THAT'S WHAT I GET AND
I APPRECIATE THE FLEXIBILITY
AND I JUST WANNA MAKE SURE I
CAN BE HEARD AND THAT I CAN BE
SEEN THERE I AM I I FREQUENT
THIS ROOM WELCOME TO DAY TWO
HUNDRED AND THIRTY EIGHT OF
FLATTENING THE CURVE IT IS
EVIDENT YOU HAVE CONTINUED ON
THIS PATH TO ENSURE RECEIPT OF
CARES AND OTHER GRANT FUNDING
I'M HERE TO TELL YOU THAT WE
ARE NOT INTERESTED IN KERR'S
MONEY BECAUSE CARE IS MONEY
IS BLOOD MONEY IT IS THE BLOOD
MONEY OF OUR SMALL BUSINESS IS
DYING AND THE FORCED ISOLATION
OF OUR MOST VULNERABLE THE
ELDERLY AND OTHER POPULATIONS
IN SKILLED NURSING FACILITIES
NO AMOUNT OF MONEY IS WORTH
THE SACRIFICE THE NATIONAL
CENTER FOR HEALTH STATISTICS
EMPHASIZED THAT MOST DEATHS
ARE NOT BICYCLE THAT BUT WITH
COLD IT THE STATE HAS COMBINED
THE DATA SETTING THE RATES
BY COLD IT ARTIFICIALLY HIGH
ONLY SIX PERCENT OF THOSE
DEATHS HAD NO COAL MORBIDITY
ON THEIR DEATH CERTIFICATES IN
ADDITION THE PCR TEST FURTHER
INFLATES THE POSITIVITY RATES
DUE TO FALSE POSITIVES WE ARE
ISOLATING PEOPLE TO THE POINT
WHERE THEY ACTUALLY WANT TO DIE
HOW CAN YOU POSSIBLY WILL BE
OKAY WITH THIS CASES ARE NOT
ILLNESSES THIS IS THE FIRST
TIME IN HISTORY WE HAVE TESTED
HEALTHY INDIVIDUALS FOR TRACES
OF THE VIRUS AND USE THESE
TESTS AS RATIONALE TO DECIMATE
OUR ECONOMY AND PREVENT PEOPLE
FROM EXPERIENCING LOVE JOY
AND CONNECTION FRANKLY I'M
HORRIFIED BY THE LANGUAGE I'M
HEARING ABOUT PEOPLE NEEDING
TO SUBMIT TO THE FLU SHOT
AND THE COVERT SHOT MANDATED
MEDICINE IS A DISGRACE NOW
AND FOREVER WE KNOW THIS
FROM HISTORY AND THIS IS WHY
WE HAVE SIGNED TREATY AFTER
TREATY EDIFYING THE IMPORTANCE
OF INFORMED CONSENT THERE IS
NO MORE BASIC LIBERTY LIBERTY
THEN THE FREEDOM TO DECIDE
WHAT GOES INTO OUR BODIES THE
UNIVERSAL DECLARATION OF HUMAN
RIGHTS WAS ADOPTED IN NINETEEN
FORTY EIGHT AFTER WORLD WAR
TWO IN RESPONSE TO ITS MEDICAL
AND ETHICAL HORRORS SIMILARLY
THE NUREMBERG CODE IN TWO
THOUSAND AND FIVE ON BEHALF
OF GLOBAL CONSENSUS YOU COULD
RUN WHICH INVOLVES ONE HUNDRED
AND NINETY THREE COUNTRIES
INCLUDING THE UNITED STATES
-- NASCO ADOPTED THE UNIVERSAL
DECLARATION ON BIOETHICS
AND HUMAN RIGHTS ARTICLE
SIX ONE CONSENT DECLARES
ANY PREVENTATIVE DIAGNOSTIC
AND THERAPEUTIC MEDICAL
INTERVENTION IS ONLY TO BE
CARRIED OUT WITH THE PRIOR FOR
AND YOU MIGHT YOU MIGHT
WE GAVE YOU MORE THAN YOUR
TIME THANK YOU WE ALSO ALLOWED
YOU TO GO OUT OF ORDER SO
THANK YOU IN AGAIN THE PUBLIC
COMMENT WE'RE ASKING FOR IS ON
THE BUDGET COMMITTEE HEARING
THERE IS HAPPY TODAY WHICH IS A
HEATED OVERSIGHT HEARING AROUND
SKILLED NURSING FACILITIES
THANK YOU NEXT PERSON GOOD
AFTERNOON I'M LISA COLEMAN
WITH THE CALIFORNIA LONG TERM
CARE OMBUDSMAN ASSOCIATION AND
I THINK THE LEGISLATORS FOR
BRINGING AND KEEPING THEIR EYES
ON WHAT'S GOING ON IN LONG TERM
CARE FACILITIES THIS CONTINUES
TO BE MY PASSION AND AND I'M
GLAD IT'S YOURS NOW TO I DID
WANT TO SPEAK TO US ASSEMBLY
MEMBER TANG IN A SPECIFIC
QUESTION ON NUMBERS SO WE'RE
EARLIER WE'RE TALKING ABOUT
THE VA HOT -- VA FACILITIES AND
HOW THEY HAVE A VERY LOW RATE
OF CODE IN THEIR FACILITIES
THEY ALSO HAVE A VERY LOW
RATE OF SEEN A TURNOVER THEY
HAVE A VERY -- LONGEVITY OF
THEIR STAFF THEY'RE PAID STATE
WORKERS AND WITH STATE WORKERS
THEY GET BENEFITS AND SO WE'RE
WE'RE MAKING THAT CONNECTION
AND I DON'T THINK ANYBODY HERE
WOULD ARGUE THAT A VA HOSPITAL
GETS RICHLY PAID ON A PER DIEM
ON A DAILY BASIS SO SO THERE'S
DOLLARS TO COMPARE WHERE DOES
THIS NEED FOR THIRTY THOUSAND
CNA'S COME FROM TWO YEARS AGO
WHEN THE WHOLE WAIVER PROGRAM
FOR STAFF SHORTAGES WAS FIRST
BROUGHT UP THE NUMBER WAS
FOURTEEN THOUSAND WE ONLY HAVE
TWELVE HUNDRED SKILLED NURSING
FACILITIES WHERE DOES THIS HUGE
NUMBER COME FROM SO I DO THINK
THAT THE CALL HOUSE PROGRAM
IS AMAZING I'VE TALKED WITH
THOSE FOLKS ONE OF THE THINGS
IN THE BUDGET COMMITTEE I KNOW
IT'S VERY DIFFICULT FOR YOU
IN GENERAL IS WE SPEND MONEY
OVER HERE BUT WE DO NOT SEE HOW
WE'RE SAVING MONEY OVER HERE
I HAVE MET WITH MANY OF HER --
PARTICIPANTS IN THOSE PROGRAMS
IF THEY WEREN'T IN THIS PROGRAM
LEARNING A SKILL WE WOULD BE
PAYING FOR THEM ON WELFARE WE
WOULD BE PAYING FOR THEM IN
OTHER WAYS INCARCERATIONS AND
IN OTHER -- SOCIAL SERVICES
THERE IS PRIDE IN DOING A JOB
WELL DONE AND I THINK THIS
IS A PROGRAM THAT SHOULD BE
INVESTED IN ACROSS THE STATE
THANK YOU NEXT BE REPLACED
GOOD AFTERNOON CHAIR MEMBERS
THANK YOU UP FOR CONVENING THIS
REALLY IMPORTANT HEARING -- MY
NAME IS ALEXANDRA SMITH DAVIS
I'M WITH LEADING AGE CALIFORNIA
-- WE REPRESENT A CONTINUUM OF
SENIOR CARE PROVIDERS INCLUDING
SKILLED NURSING FACILITIES
I'LL BE BRIEF BECAUSE I THINK
THE PANELIST A GOOD JOB OF
DESCRIBING ALL OF THE ISSUES
THAT WE'RE FACING -- AND I'D
LIKE TO HIGHLIGHT IT WOULD
WORK FORCES WE'VE TALKED
ABOUT ALL DAY ALL AFTERNOON
-- WE ARE ALSO FEEL THAT WE
NEED TO INVEST IN OUR WORK
FORCE THE LTSS -- CENTER IN
BOSTON DID RECENTLY RELEASED
REPORT EXPLAINING ALL THE
BENEFITS OF INCREASING WAGES
FOR OUR -- DIRECT CARE STAFF
WE ECHO THOSE -- BENEFITS
INCLUDING US LOWER TURNOVER
OF INCREASED -- HAPPINESS
IN THEIR IN THEIR -- JOBS
AND IN ADDITION TO WORKFORCE
I'D REALLY LIKE TO THINK I'M
HEIDI FOR HER LEADERSHIP AT
CDPH IN THE LAST EIGHT TO TEN
MONTHS AND WORKING WITH --
OUR FACILITIES AND CREATING
AN ENVIRONMENT WHERE WE CAN
ASK QUESTIONS AND CONVENE --
WEEKLY MEETINGS INCLUDING THE
ONE -- DOCTOR OSTERMAN SCRIPT
HELPS -- CONVENE AGAIN THANK
YOU SO MUCH THANK YOU ANY OTHER
SPEAKERS FROM THE PUBLIC KAMADA
HI CAN I HAVE THE ATTENTION
GUYS FOR JUST ONE SECOND I
WILL BE QUICK I ACTUALLY DON'T
HAVE TOO MUCH TO SAY TODAY
BECAUSE SO MUCH HAS BEEN SAID
ALREADY IT'S FOUR HOURS I MEAN
YOU GUYS HAVE BEEN TALKING FOR
LITERALLY HOURS BUT I DO HAVE
TO KNOW WHICH WOULD BE THINGS
THAT ARE WORTH MENTIONING ONE
IT IS SO COLD IN HERE I HAVE
BEEN FREEZING THE ENTIRE TIME
AND I THINK SOMEONE SOMEWHERE
SHOULD DO SOMETHING ABOUT
IT NUMBER TWO FRANKLY WE ARE
NOT GOING TO HAVE TOO MANY
MORE LIVING MEMBERS OF THE
BLOOMERS THE EX WHAT THE SILENT
GENERATION IF YOU DO NOT STOP
THIS I DON'T HAVE A BETTER WAY
TO DESCRIBE THIS OTHER THAN
STOP THE LINES THE MEDIA
MANIPULATION THE IMMENSE
CORPORATE THE CATASTROPHE
DESTRUCTION THAT A VACCINE
IS GOING TO MAGICALLY ON DUTY
FOR THE FACT THAT OUR GOVERNOR
TARGETED NURSING HOMES TO
MURDER SO MANY VULNERABLE
RESIDENTS BY STUFFING COBIT
CONTAMINATED PEOPLE IN
WITH THE ELDERLY THANK YOU
ANY OTHER COMMENTS
FROM THE PUBLIC
OKAY SEEING NONE CLICK TO
GO BACK TO MY QUESTIONS
WAS IT WAS I'M SORRY AS
WITH ANY OTHER MEMBERS OF
THE PUBLIC IN THE OTHER
FACILITIES AROUND THE STATE
SAME THING NINE I'M GOING TO
GO BACK TO -- DOES MY QUESTION
SO -- -- -- YOU MISTER CORNET
ARTS DISCORDANT STILL THERE
THANK YOU FOR YOUR PATIENCE
SO AS I THINK YOU YOU HEARD
SOME OF THE YOU KNOW WE WE
HEARD ABOUT THE THE SHORTAGE
I DON'T KNOW IF YOU WANT TO
TALK ABOUT WHERE THAT THIRTY
THOUSAND -- NUMBER CAME FROM
BUT THEN ALSO JUST THE FEEDBACK
IN TERMS OF -- THE INDUSTRY
IN TERMS OF TREATING WORKFORCE
BETTER -- YOU KNOW BETTER WAGES
THAT THE QUESTION IS IS ON THE
WAGES LOWER THAN THAT THEN THEY
THEN THEY SHOULD BE BECAUSE
THAT YOU KNOW THE INDUSTRY
THE FOR PROFIT INDUSTRY VERSUS
THE NONPROFIT INDUSTRY IF YOU
COULD ADDRESS SOME OF THOSE
ISSUES SURE SURE YEAH THE THAT
THAT NUMBER'S REALLY FROM AUST
POD -- SO YOU KNOW THE DYNAMIC
NUMBER BUT THAT'S FROM FROM
YOU KNOW THE STATE AGENCY THE
STATE WHAT THE THAT COLLECTS
THAT DATA DOES THOSE ANALYSES
SO YOU KNOW BUT THAT THAT'S
NUMBER ONE BY THE WAY ON MISS
HEALTH PROGRAM I'M AWARE OF
THAT PROGRAM AND WE HAVE A WE
HAVE MEMBERS OF OUR ASSOCIATION
AND CONTRA COSTA COUNTY THAT
PARTICIPATE SHE MENTIONED SOME
-- -- ON THAT -- JUST EARLIER
IN AND THINK IT'S A IT'S A
IT'S A GREAT OPPORTUNITY TO TRY
TO BRING MORE PEOPLE INTO THE
FACILITY AND EVERYTHING I'VE
HEARD ABOUT FROM OUR MEMBERS
IT'S IT'S IT'S A IT'S A GREAT
PROGRAM I WOULD JUST SAY TO YOU
THAT DID TO CHEAT TO GET THE
WORK FORCE WE NEED IT'S GOING
TO REQUIRE A LOT OF DIFFERENT
ARROWS IN THE QUIVER I THERE'S
NOT GONNA BE ONE WAY TO DO
THIS BUT IT'S GOING TO REQUIRE
A LOT OF DIFFERENT THINGS
SALARY AT AND PROGRAMS LIKE
MISS HOW MENTIONED AND OTHER
OTHER PROGRAMS THAT THE STATE
COULD PROMOTE TO THE COMMUNITY
COLLEGES WERE WORKING WITH
COMMUNITY COLLEGES CONSTANTLY
TO TRY TO GET MORE OF THAT
WORKFORCE TRAINING PROGRAMS FOR
PARTICULAR FOR C.
N.
A.'S BUT ALSO FOR LPNS AND
OUR ENDS AS WELL OF THE BOOT
THERE'S NO QUESTION THIS IS
GOING TO TAKE OUT A MULTI
PRONGED APPROACH GOING FORWARD
CERTAINLY AND I WOULD SAY SIX
CERTAINLY A NON SALARIES ARE
AN ISSUE I JUST WANT TO BUT
LET ME LET ME JUST EMPHASIZE
AGAIN ON THIS ISSUE ABOUT THE
PROFITS AND AND AND AND SO
FORTH -- I MEAN RIGHT NOW AND
THAT THIS CAME UP EARLIER FOR
MR THE SYRIAN ABOUT THE READ
THE PROFITS I WANT TO MAKE
SURE THAT YOU AWARE OF THIS
THE MEDIC CAL REIMBURSEMENT
SYSTEM FOR CAPITAL COST THEY'RE
THEY'RE BASED ON WHAT'S CALLED
A FAIR RENTAL SYSTEM THAT'S
CALCULATED BY THE STATE AND
IT DOES NOT TAKE INTO ACCOUNT
ACTUAL LEASES MORTGAGES AND
THAT KIND OF THING SO THAT'S
ALL EXCLUDED ALREADY TO THE
MEDIC HOUSE I SAID DOESN'T
PAY FOR THAT RELATED ANY
RELATED PARTY PROFIT EITHER --
THAT'S ALL REMOVED THROUGH THE
THROUGH THE AUDIT PROCESS AND
ULTIMATELY THOUGH -- AT AFTER
YOU MAKE ALL THOSE ADJUSTMENTS
THE AMOUNT OF MONEY THAT THAT
IS LEFT IS EVEN CONSTRAINT
EVEN MORE RIGHT NOW BECAUSE
REFER TO SELL THESE ALL REPORT
THEIR ACTUAL COST AND THE RATE
IS BASED ON THEIR ACTUAL COST
AGAIN AUDITED A LOT OF COST
EXCLUDED PROFIT EXCLUDED SO
FORTH FROM IT FROM THE -- FROM
THE THIRD PARTY -- PARTIES AND
SO FORTH AND THEN AFTER THAT
HAPPENS THEN THEIR RATES ARE
REDUCED EVEN MORE BY AT LEAST
SIX PERCENT RIGHT NOW BECAUSE
OF THE MEDIC CAL RATES IF
MEDIC CAL WASN'T CUTTING THAT
BACK YOU BE BE ABLE TO FULLY
REIMBURSE FACILITIES FOR THEIR
COSTS THEIR THEIR COST WOULD
STILL BE YOU KNOW CONSTRAINED
TO SOME DEGREE BUT THEY WOULD
HAVE MORE MONEY THAT I WOULD
SAY TO BE ABLE TO PASS ALONG
IN IN SALARIES THAT THE BEST
WAY TO DEAL WITH THIS IN OUR
VIEW IS FOR THE STATE TO TO
PAY DIRECTLY THE LABOR COSTS
THE DIRECT AND INDIRECT LABOR
OUTSIDE THE BUDGETARY CAP THAT
WOULD MEAN THE DH CS COULD
FULLY REIMBURSED FACILITIES
FOR THEIR ACTUAL LABOR COST
WHICH WOULD ALLOW FACILITIES
TO INCREASE THEIR WAGES AND YOU
KNOW RETAIN WORKERS -- PROVIDE
HIGHER AND HIGHER QUALITY
CARE IN GENERAL SO I THINK WE
THINK THAT'S THE THAT'S THE
NUMBER ONE THING I WOULD SAY
THAT WE COULD HAVE THE BIGGEST
IMPACT THANK YOU INDEED YOU HAD
MENTIONED EARLIER P.
P.
AND TESTING HAS THAT ISSUE BEEN
RESOLVED IN TERMS OF ADEQUATE
PPE ADEQUATE TESTING I WOULD
SAY IT IS MUCH BETTER I DON'T
WANT TO SAY IT'S RESOLVED
BECAUSE YOU KNOW WE WE WE STILL
SEE SHORTAGES EVERY ONCE IN
AWHILE IT SOMETIMES -- -- FOR
-- FOR A WHILE IT WAS DOWN TO
THAN IT WAS A MASK THEN IT WAS
GLOVES AND IT'S GONE BACK AND
FORTH AND I THINK THE OTHER
SUPPLY CHAINS INTO THE UNITED
TO THE SUMMIT TO THIS PP IS
MANUFACTURED OUTSIDE THE UNITED
STATES WE'VE HAD THEY'VE BEEN
USED BY CHAIN ISSUES SO I WOULD
SAY THE SITUATION IS BETTER
BUT IT'S STILL NOT NOT TOTALLY
PERFECT AS YOU KNOW THOUGH SB
TWO SEVENTY FIVE IS GOING TO
REQUIRE THE STATE TO TO BUILD
A MUCH BIGGER STOCKPILE OF UP
TP -- YOU KNOW GOING FORWARD
AND I THINK THAT'LL HELP IN THE
FUTURE OF THE TESTING TESTING
IS CERTAINLY IMPROVED BUT AGAIN
YOU KNOW TEST RESULTS ARE MOST
VALUABLE IF THEY IF THE RESULTS
CAN COME BACK IN TWENTY FOUR
HOURS OR LESS I'M SO THERE
ARE STILL SOME CHALLENGES IN
THAT ARENA IT THERE CERTAINLY
BETTER THAT THE TURN AROUND
TIME IS CERTAINLY BETTER AS I
MENTIONED EARLIER THOUGH THERE
ARE LOGISTICAL ISSUES WITH THE
TESTING THOUGH IN SOME CASES
FOR THE STAFF TESTING THEY HAVE
TO LEAVE THE BUILDING -- GO
TO THEIR HEALTHCARE PROVIDER
SOME FACILITIES ARE ABLE TO
DO THE TESTING AND HOW IT
TAKE THE TEST IN HOUSE SEND
IT OFF TO THE LAB -- HOPEFULLY
IT COMES BACK IN LESS THAN
TWENTY FOUR HOURS SO I I I
WOULD JUST EIGHTY IT'S IT'S
IMPROVED I DON'T THINK IT'S
TOTALLY THERE AT ALL -- BUT I
DID MENTION THE PERKIN ELMER
LAB AND HEIDI MENTIONED THAT
TO THAT MAY HELP GOING FORWARD
YEAH THAT'S WE HOPE TO SUPPORT
THE TESTING LEVEL HELP AND
HOPEFULLY YOU SEEN IMPROVEMENTS
WITH PP SINCE WE IT WENT INTO
A VARIETY OF CONTRACTS WITH
DIFFERENT SUPPLIERS FOR THAT
THAT'S RIGHT SO THEN JUST ARM
GOING TO MISS A STARTER OR
MISS HARRINGTON YOU YOU HEARD
MR QUARTETS COMMENTS ABOUT THE
MEDICAL REIMBURSEMENTS RESTORED
THE SHORTAGE OF THAT -- THAT
BEING A MAJOR ISSUE HOW HOW
WOULD YOU ADDRESS THAT ISSUE
ASSEMBLY MEMBER WENDY
HARRINGTON WITH A PARTNER
HEALTHCARE SERVICE THAT I
MEAN I THINK AGAIN I THINK YOU
YOU HAVE TO CONSIDER IT IN A
BROADER SCOPE AND WE HAVE TO BE
VERY RESPONSIBLE SO YOU DO NEED
TO LOOK AT AND AGAIN WE WE HAVE
IN THE CALCULATION AT THE NIGHT
THE NINETY FIFTH PERCENTILE
EVERYTHING THAT DOES DO --
YOU KNOW REALLY INCENTIVIZES
DAY UTILIZATION AND AND AND
THAT INVESTMENT IN Q.
AND LABOR ADDITIONALLY IF WE
LOOK AT YOU KNOW THE WE DO
CALCULATIONS AND RIGHT NOW
WE REIMBURSED APPROXIMATELY
NINETY SIX PERCENT -- THAT
CLOCKED FOR MEDIC HOW AND WE
DO SOMETHING CALLED THE UPPER
PAYMENT LIMIT CALCULATION THAT
WE HAVE TO PROVIDE COULD BE A
MASCULINE SURE THAT OUR RATES
ARE NOT ABOUT -- THE UPPER
PAYMENT LIMIT AND A PART OF
THAT CALCULATION WE LOOK AT
-- I HAVE A WHOLE GROUP AND
BASED ON THAT VEHICLE YOU'RE
EIGHTEEN NINETEEN CALCULATION I
WE WERE REIMBURSING FOR MATTER
HOW ONLY APPROXIMATELY NINETY
SIX PERCENT OF THE TOTAL COST
OKAY AND THEN THE BIGGEST
THE DO YOU HAVE THE FACILITY
SAYING THAT STILL STILL NOT
ENOUGH WHAT WAS THAT AGAIN
JUST MISSED MISTAKES -- SERVES
KOURNIKOVA PLEASE MHM FIRST
OF ALL IT DOES BACK TO TWO
THOUSAND EIGHTEEN NINETEEN
THAT THAT GET AWAY DOZENS AT
TO WHERE THEY'VE CHANGED A LOT
BUT THAT'S ALSO BASED ON THAT
THE REPORTED COSTS BUT WHAT
I'M SUGGESTING IS IF WE WANT
TO GET MORE MONEY INTO SALARIES
AND WAGES THIS IS THE WAY TO
DO IT BECAUSE RIGHT NOW -- AND
IS MISS AMERICA THINK DESCRIBED
ACCURATELY THEY THE THERE IS
A CONSTRAINT ON ON ALL OF THIS
THAT THEY CAN PAY UP TO NINETY
FIVE PERCENT BUT THAT DOESN'T
MEAN THEY HAVE MORE MONEY IN
THEIR BASED HEY IT JUST MEANS
THAT THEY THAT THAT THAT'S AN
ELIGIBLE AREA WHERE THEY CAN
REIMBURSE THAT AREA VERSUS
ADMINISTRATION ADMINISTRATION
THEY CAN ONLY PAY UP TO THE
FIFTIETH PERCENTILE SO EVEN
EVEN BEING DOING EVEN DOING
THAT DOESN'T GET THE MANY
MORE MONEY TO PAY ITS THE REAL
BUDGETARY CONSTRAINT IS WHAT
THE ANNUAL INCREASE IS ANNUAL
PERCENTAGE INCREASE IN IN THE
RATES OF THE RATES ARE GOT IT
AND THEN JUST COME BACK TO MISS
MISTER GRIMACES MS HARRINGTON
YOU -- BUT MY UNDERSTANDING
IS NONPROFIT TO ABOUT TEN
PERCENT OF THE TWELVE HUNDRED
-- SKILLED NURSING FACILITIES
A DAY OVER ALL HAVE PERFORMED
BETTER THAT'S MY UNDERSTANDING
PLEASE CORRECT ME IF I'M WRONG
DO YOU HAVE ANY FEEDBACK AS TO
WHY THAT MAY BE THE CASE IS THE
POPULATION IS AT THE RESOURCES
WORK WORKED -- IF ANYTHING DO
YOU THINK IS IS THE DIFFERENCE
SO SOME OF THE LEAST FROM THE
RESEARCH I'VE SEEN SOME OF
THE POOREST PERFORMING -- OF
FACILITIES IN THE FOR PROFIT
-- WORLD ARE ACTUALLY ARE
SMALLER -- FACILITIES NOT ARE
LARGE CORPORATIONS AND -- WE
BELIEVE FIVE BEST GUESS FROM
WHAT WE'VE BEEN LOOKING AT
EARLY RESEARCH IS THAT THERE
THEY'D LACKS THE ABILITY TO --
IF YOU'RE A SMALL MOM AND POP
SMALL BUSINESS -- BUT WHO WAS
IMPACTED BY COPA PARTICULARLY
IF YOU'RE IN A RURAL AREA I'M
YOU MAY LACK -- EVEN RESOURCES
WITHIN YOUR COUNTY OR YOUR
REGION OR YOU MAY LACKS THE
STAFFING THAT CAN ACTUALLY BE
ABLE TO GO OUT AND LEVERAGE
AND TRY TO FIND AN ADDITIONAL
-- STAFFING CONTRACTS THAT ARE
OUTSIDE OF YOUR AREAS BUT AT
LEAST THAT'S FROM WHAT I'VE
SEEN FROM FROM THE RESEARCH
FROM WHAT I'VE BEEN LOOKING AT
SO FAR I'M I DO WANT TO MAKE
A COMMENT ABOUT STAFFING IN
GENERAL SINCE IT'S BEEN SUCH
A HUGE TOPIC IT IS SUCH A ROOT
CAUSE -- OF QUALITY AND SAFETY
IN A FACILITY AND THAT'S THAT
I AGREE WITH THE COLE HOW ON
AND SOME OTHER PANELISTS HERE
THAT THIS IS REALLY A MULTI
PRONG -- MULTI SECTORAL ISSUE
IT'S BOTH CULTURAL IT'S NOT
JUST I MEAN YES WAGES RF AND
MAJOR MAJOR FACTOR BUT I THINK
THE ISSUES RUN DEEPER THAN THAT
AND SEE THEIR FOR THE SOLUTIONS
NEED TO BE BROADER THAN THAT
AND AS I SAID BEFORE BREAKING
IT DEPARTMENT OF EDUCATION
AND I REALLY LIKE THE WHOLE
HOUSE YOU KNOW -- COMMENTS
ABOUT YOU KNOW EVEN STARTING AS
YOUNG AS IN THREE U.
K.
THROUGH TWELVE EDUCATION HAVING
FOLK AND PROGRAMS AND AND
THINGS OF THAT NATURE PRIOR TO
MY POSITION HERE IN CALIFORNIA
I WAS WORKING ABROAD IN EUROPE
WHERE I HAD THE OPPORTUNITY TO
SEE A VARIETY OF DIFFERENT WAYS
THAT THE ADDRESS -- A CULTURAL
AND GENERATIONS AND MIXING THEM
TOGETHER HAVING KINDERGARTEN
NEXT TO SKILLED NURSING
FACILITIES HAVING -- COLLEGE
STUDENTS HAVE FREE ROOM AND
BOARD IF THEY WORK IN A SKILLED
NURSING FACILITY JUST A VARIETY
OF DIFFERENT APPROACHES THAT
WE CAN LEARN FROM -- BOTH -- IN
OUR STATE AND INTERNATIONALLY
OF SOMEBODY'S PRACTICES
THANK THANK YOU FOR THAT OKAY
-- I AM DONE WITH MY QUESTIONS
I'M SEEING IF ANYONE ELSE
THIS THIS IS ACTUALLY BEEN ARE
REALLY APPRECIATE EVERYONE'S
PATIENCE AND THOROUGHNESS ON
THIS HEARING THE FACT THAT
IS NOT ME BY MYSELF FOR ME IN
MISTER ABILITY BY OURSELVES
APPRECIATE ALL THE GOVERNMENT
LOOKS FOR STICKING AROUND
AND ALL THE MEMBERS WHO
PARTICIPATED REMOTELY AND VERY
MUCH APPRECIATE ALL THE PEOPLE
WHO SAT FROM THE ADMINISTRATION
AS WELL AS ALL ARE SORT OF
EXPERT WITNESSES VERY MUCH
APPRECIATE ALL THE TESTIMONY
IT JUST DEMONSTRATES I THINK
THE IMPORTANCE OF THE ISSUE AND
HOW STRONGLY WE FEEL ABOUT THE
ISSUE WE DO APPRECIATE ONE ALL
THE WORK THAT HAS BEEN DONE TO
REDUCE IMPROVE THE SITUATION
AND SKILLED NURSING FACILITIES
BUT ALSO I THINK MISTER CORNET
BROUGHT IT UP MOST IMPORTANT
TO ALL THE ALL THE PEOPLE
WHO ARE WORKING ON THE FRONT
LINES IN THE FACILITIES EACH
AND EVERY SINGLE DAY WE VERY
MUCH APPRECIATE THAT WE KNOW
HOW DIFFICULT IT IS AND HOW
DIFFICULT THESE CIRCUMSTANCES
ARE -- SO AGAIN WITHOUT
SEEING ANY OTHER PUBLIC
COMMENT OR ANY OTHER FURTHER
QUESTIONS WE'RE GOING TO
ADJOURN THANK YOU VERY MUCH