Is Long Term Care Broken?

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I really felt compelled to write this story because as

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the general public, what we often see in here is

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the bad side of the nursing home. We don't get to see

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the heroic staff that are showing up every day under these

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very difficult circumstances and challenges to care for

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our loved ones. And so what does that do? That makes us afraid that

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of putting our loved one in a nursing home when they need that care

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and it just doesn't equip us to make change.

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It actually, even as consumers of this health care,

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these services, it actually just makes us

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have this bad attitude and worry and have anxiety,

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maybe instead of learning what we can do to advocate

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and even support our local nursing home.

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Welcome to the nursing home podcast. Your goto

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source for professional insights in the long term care industry.

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Hear from leaders and experts as they share current and practical

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insights to help make the most of your day. I'm the long term care

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financial specialist. What that means is I help people plan for

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the inevitable. Nobody wants to think about getting old, but it's

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possible that someday we might need a little bit of care. Here's your host,

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nursing home administrator turned podcaster Schmuel Septimich.

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Welcome to another live

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recording of the nursing home podcast. The podcast

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which you've become accustomed to getting a different intro

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every single time, but additionally the place where you look

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for real information about the nursing home industry to

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know what's really going on, the things that you cannot Google.

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In today's episode, we are going to carefully

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discuss the concept of some

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of the challenges, specifically related, I think,

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to infection control, but maybe not limited to that that

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exist right now in the nursing home industry. To do that,

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we have introducing today to the podcast Dr.

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Buffy. Lloyd Kriechie, who is

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actively helping prevent infections in nursing homes,

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is author of the book called how

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the Global Pandemic uncovered a Nursing Home System

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Need of Repair and the Heroic Staff Fighting for Change.

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Dr. Buffy. Welcome to the nursing home podcast. Thank you so much for

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having me. Glad to be here and have this great topic of discussion.

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Yeah, we are very glad to have you here as well.

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Before we jump in, if you don't mind sharing with our listeners a little bit

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of your background on how you got to doing what you're doing right now.

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Yeah, well, I'll just say I've been in healthcare for over 30 years

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in different capacities and most

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specifically in the last ten years in epidemiology.

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I've been studying over ten years actually epidemiology and infection prevention and control

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and really since 2016, really a

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targeted focus and mission to supporting nursing

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homes, implement evidencebased practices to

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reduce infections, keep healthcare workers safe, keep residents

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safe. So that's my mission and drive is really

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reducing infections in the nursing homes.

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Amazing. This is definitely always a challenge when you

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take a lot of people who have

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somewhat compromised immune systems and other conditions

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in a fragile state and you put them together and lots of people

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coming in and out, going to the hospital, picking up some

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infections and sharing it with their friends and then going back out

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and continuing that cycle.

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But let's focusing specifically on COVID.

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What has your journey been like? I know that you've been in

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and out of facilities, I guess in

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what professional capacity, and then we'll discuss maybe some of your discoveries.

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Yeah. So I really dove in

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going on the front line supporting nursing homes in June

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of 2020. I worked with the Doctors Without Borders

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first ever USbased mission. They are humanitarian organizations

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that have been around for over 50 years. And they had never

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been in the never had a mission in the United States. So they

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came into the United States, they chose nursing homes,

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among some other areas, in Detroit,

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Michigan, and I was hired as their infection control

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manager. We would go into nursing homes in

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the Detroit region, those that had COVID.

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We'd go in and work with their staff identifying

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gaps in infection control and how we could rapidly

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help them implement best practices

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right away to help prevent the spread of infections. I then went on

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to they had a second mission in Houston, Texas.

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I went to support them there. And to be honest, haven't really

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stopped supported my

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home base is Arizona, supported local and state health

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department, different initiatives

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and going in and out of facilities. All in all, I was

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in hundreds of facilities across the country

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supporting nursing homes with COVID that had

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COVID to help reduce the spread

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as rapidly as we could once it got in and then also provide

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tools for them to try to keep it out as much as possible.

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So really been active and involved in

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the mitigation and the strategy to contain

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this virus. Fascinating.

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So this is not an arm share analysis of the nursing homes

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or COVID or anything like that. You don't get more boots on the

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ground than this. And you've been there, you've watched

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copied come in. You've been involved in managing it,

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trying to make sure it doesn't come back in or it doesn't go to other

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places, minimize effect and all of that.

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And that itself could be a whole separate conversation.

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But we've spoken quite a bit

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about COVID in this platform. Let's focus maybe

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more specifically, what are some of the things,

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I guess the keeping holes and systems and other things that you've noticed that

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are broken in the nursing home

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space? And I will say that neither of us are here to bash

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or hurt. No, I'm only saying neither of us because you told

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me beforehand, nursing homes,

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nursing home operators, we understand the struggles. It points

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us to point out some of the areas where some of the weaknesses and then

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hopefully maybe you didn't discuss the sequel to broken.

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Yeah. Now I'm definitely an advocate.

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My passion is to help the nursing homes, to help the workers.

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So many of the things that I've seen and experience

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every day when I talk to nursing home operators and work with the staff

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is they want to do the right thing, they want to deliver good care.

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It's just they're often limited based on

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funding, based on lack of staffing. I mean,

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there's a whole range of challenges that prevent our nursing homes

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to truly be successful. And I'll just say I never plan on

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writing a book. I was pretty busy, so that was not really what I needed

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to do. But I really felt compelled because

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out of the hundreds of facilities that I was in across the country,

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I kept hearing the same story over and over again the

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lack of support, the lack of supplies, the regulatory

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agency coming in and pretty

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much fault finding in the middle of a crisis and

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handing out citations versus support. And it was

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just absolutely devastating to the nursing

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home operators and to the staff. It just

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weaken the morale. And I really felt compelled to write

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this story because as the general public, what we

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often see in here is the bad side of the nursing

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homes. We don't get to see the heroic staff

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that are showing up every day under these very difficult circumstances

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and challenges to care for our loved ones. And so what does that do?

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That makes us afraid that of putting our loved one in

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a nursing home when they need that care and it just

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doesn't equip us to make change. It actually

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even as consumers of this healthcare, these services,

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it actually just makes us have

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this bad attitude and worry and have anxiety

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maybe instead of learning what we can do to

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advocate and even support our local nursing homes.

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Well. So that's very well said. And I will say that I couldn't agree with

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you more. A big push for starting this podcast is because

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I've seen, together with everybody else, the devastation

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that the media does to nursing homes and sometimes

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has very practical effect there. There are nursing homes that have

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been forced to close down and for

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really for no real reason. Taking a report

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from Department of Public health, I'll name that regulatory

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body department of public Health and

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sensationalizing it and making it a big story and something that

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first of all, the heaviest

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regulations and strictest regulations from any industry.

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It's very heavily regulated.

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And unfortunately, like you mentioned before,

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you humbly mentioned that you've been to hundreds of facilities across the country.

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So if you're not credentialed

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to give an opinion, than who is?

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I know personally of cases like this and you share the same thing

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where there's a covert outbreak. So instead of receiving

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the type of support that maybe doctors Without Borders and other

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organizations may be providing, you're literally having surveyors

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walking up and down between sick patients looking for

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citations and pointing out the obvious,

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hey, there's no staff here. We know that people are petrified to come in here.

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Every single person is in here right now. We're literally putting our

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lives at risk for other people. Like, these are from the

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best human beings on the planet. And instead of being heralded

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as heroes for coming in and doing, everyone else is at home

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bunkered up, worried about toilet paper. They're here hands on,

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caring for the people who cannot care for themselves,

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instead of recognizing that or at least allowing it to happen,

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literally getting in the way and showing that you don't have enough

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staff. Really. Would you like to care for this patient? Do you have someone that

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you can send? Do you have supplies that you can

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bring?

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It's so frustrating. Yeah.

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And I've said this on the podcast in the past, but initially

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when I started as an administrator and I easily wanted to

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believe that we're all on the same side of the table and

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the caregivers and the regulators and sometimes that's true,

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and that definitely is sometimes true. And I'm not saying that all regulators

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are bad, but as a whole, it's broken.

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I mean, like, really broken. And I think everybody can agree

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that it's important to have people driving on the highway and it's important

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to have people enforcing that the rules to have rules, and someone

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has to enforce that they're followed who does what. Everyone will go

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to where they naturally gravitate. And that applies to nursing

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homes, as it does to fast food chains and nuclear power plants

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and hospitals and hotels and anything else that shouldn't maybe not hotels,

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but that should be regulated. But it should be

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in a supportive way. The way that it sounded

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like that's such an obvious blatant deviation

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from a mission, if there is one. Why use handing

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out citations? There was a call. I'm going to let you talk in a minute.

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You just get me worked up a little bit. I love it.

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There was a call with a bunch of operators of a certain state, which will

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remain nameless for now, but I know people who are on that call with the

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governor of the state during COVID when many of them had outbreaks

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in their buildings discussing the new staffing regulations that were going

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into place. And everyone's just like, listening and

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hanging their head and like, okay, so a new set of citations

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is going to come out, and it may or may not be financial penalties,

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but then someone had the guts to speak up. Mr. Governor, where do

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you expect us to get these people from?

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We have governor building. People don't want to work here. They're risking

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their lives. We can't tell them that they're going to be safe.

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Administrators died. The ons died. Nurses died.

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CNAs died from COVID that they got from their patients. These are

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facts. Everybody knows that. And it's a big risk?

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Yes, of course, with proper infection control, prevention all that

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they can mitigate the risks, but people don't want to come.

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And then the same government that's regulating heavily regulating

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or unreasonably regulating the industry is also giving

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out. Not anymore, but at that point, untold amounts

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of money when they literally make you more money staying home than

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coming. So you could stay home, make a lot of money, or risk a

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life and work crazy hours in

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a nursing home. So which one will you choose? And now that you cannot convince

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those people to make the completely unreasonable decision to come

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in, and now you get penalized for that. Alright, I feel better.

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Thank you for listening. Well, I just want to add to this scenario.

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I love the talk about people drive.

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And so we have police officers

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that we regulate the speed. Now imagine

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if there's a category five hurricane

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barreling in on your city and you're told to evacuate,

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so you're told to evacuate. However,

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at the same time, the number of police officers has

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gone up maybe seven times to make sure they're pulling people over

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and giving them a ticket at their speeding right now,

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what part of that would make any sense at all?

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Right, you're in the middle of a crisis. You need to get to safety,

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but we're going to pull you over and give you a speeding ticket.

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That's essentially what has happened during COVID

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where all CMS surveys were

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suspended. Hospitals outpatient nursing

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homes, every one of them was suspended. But nursing

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homes were actually, the surveyors were

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funded $80 million to do targeted infection

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control surveys for nursing homes only when

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they had an outbreak. So, just as you described,

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during their darkest hour when they have no PPE,

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half their staff have quit or they're sick,

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state surveyors walk in the door, not to help, not to

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say, let us help you, but to literally stay on site

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for days, watching every single thing your

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staff do and citing them for

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any mistakes. Citing them

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for not disinfecting a pen when they're

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sharing it between nurses, stuff that

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wasn't significant. And when you have $80

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million that is towards a process,

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how are you going to prove that you're actually using

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those dollars appropriately? Well, the more

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citations you have, this shows you're doing your job. And that's

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literally, that's what the expectation was. I talk

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in my book, I have several examples in my book that describe

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the devastating effects of this process for

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the nursing homes when they were doing everything they could

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to keep our residents alive, to provide care.

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And from the very beginning, this was the

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federal response for our nursing homes from the very first outbreak in

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Washington. This is really what set

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the stage. So not only were we under prepared,

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the whole nation was under prepared. Every healthcare setting

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was under prepared. Longterm care, I would say,

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was even more unprepared because our infection control practices weren't

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quite as robust as what we have in hospitals and other healthcare settings.

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It was very difficult to get PPE if we weren't part of a large hospital

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system. And so we really were kind of

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pushed. And then we were required to take patients

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with cobid whether we wanted to or not, we were forced to.

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And so whether we were prepared or not, whether we had the

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staff or not, we were forced to. And then we had a survey

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process that came in and pretty much pounced on us more.

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This truly was the greatest pain that

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I experienced and heard from operators and staff

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all over the country. It wasn't so much COVID because,

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you know, in long term care, we rally,

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we are scrappy, we make do, we get things done.

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But it was the survey process at a time when the

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guidance and recommendations were changing,

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sometimes daily, twice a day.

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And they were no longer recommendations, they were law.

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And if we didn't follow every word to the way

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it was written, we were cited. I mean, I helped

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facilities across the country IDR

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fight the state surveys, and they would

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quote us word for word what the CD said, even CDC said.

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Even if it had been different two weeks prior, even if it

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had been different five days prior, they would write

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their citation based on what the

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new guidance was. It was just impossible. It was impossible to

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keep up. And it's so inappropriate

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and harmful. And I don't know about you,

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we've always had turnover and longterm care. That's no

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surprise. But now I'm seeing people that have been in it for their whole

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career, administrators, executive,

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people that have really given their life to this work. They're leaving because

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they're like it's too much.

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We want to do a good job, but we're in a straitjacket and can't.

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So my plea to the public,

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to the government, is help us

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do the right thing instead of constantly punishing

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us and expecting us to deliver

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quality care when we're constantly getting knocked down.

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Very well said. We could definitely hear the

19:48.580 --> 19:52.477
passion and the pain, which is not just for you,

19:52.645 --> 19:56.302
but which is for all the other facilities that

19:56.320 --> 19:58.112
you visited and the ones that you haven't.

19:59.662 --> 20:03.425
I would add to it that I don't think that

20:04.012 --> 20:07.672
there's cruelty that's intended with some

20:07.705 --> 20:11.707
of this supervision. It comes from a

20:11.710 --> 20:15.597
reaction to public opinion which is generated and sensationalized

20:15.642 --> 20:19.925
in the media. So when there's a strong public pressure that

20:20.287 --> 20:24.177
is perceived that nursing homes are killing people during COVID

20:24.282 --> 20:28.867
right. That's the narrative that's being regurgitated over

20:28.915 --> 20:32.677
and over and over in the media. And nursing homes became the

20:32.695 --> 20:35.452
center of attention in the beginning. Right.

20:35.620 --> 20:38.712
That's how it's going for the country. Right? Sure, initially.

20:38.862 --> 20:42.725
So now I was like, oh my gosh, government, you have to protect our

20:44.587 --> 20:48.112
delicate and fragile seniors. What are you going to do?

20:48.175 --> 20:50.825
So there's money now. What do you do with the money.

20:53.212 --> 20:56.967
Forget the nursing home system. That's where the government system is broken,

20:57.102 --> 21:00.362
where instead of taking that money and channeling it towards PPE,

21:01.312 --> 21:03.350
nursing homes didn't even have money,

21:04.312 --> 21:07.927
even if they had access to it, but the prices were insane at

21:07.945 --> 21:12.187
that point. Instead of providing them money

21:12.250 --> 21:15.627
for staffing, providing and again, we're painting

21:15.657 --> 21:19.327
with broad strokes here, there have been funds that definitely were

21:19.345 --> 21:23.727
available and the government did give out covert payments. Maybe too little, too late.

21:23.907 --> 21:27.427
I don't know if it was too little, but maybe too late and not at

21:27.445 --> 21:30.425
the right times. And government is not government.

21:31.387 --> 21:35.182
We're oversimplifying this here. But the point is,

21:35.335 --> 21:38.682
it doesn't change what happens. Boots on the ground.

21:38.772 --> 21:42.202
The truth is, before COVID it wasn't as

21:42.220 --> 21:45.512
pronounced, but that system was broken

21:45.862 --> 21:49.827
before COVID as well. The regulations,

21:49.932 --> 21:53.502
what other industry do you have? It that they can be daily writing new rules

21:53.532 --> 21:56.975
and new laws. You're immediately responsible for it

21:57.337 --> 22:00.802
and literally to

22:00.820 --> 22:03.812
the letter. And if anything has changed even slightly,

22:05.137 --> 22:09.837
you're going to be held completely liable, completely ignoring

22:09.987 --> 22:14.037
the overall goal, which is to provide a dignified

22:14.187 --> 22:17.802
existence in this type of care setting,

22:17.832 --> 22:21.062
which is, like I said before, which is so necessary.

22:23.287 --> 22:27.252
I'm not against regulations. I mean, we do need regulations

22:27.357 --> 22:31.017
in this health care setting. We need responsible regulations.

22:31.152 --> 22:34.792
And instead, what's really kind of happened is you have

22:34.915 --> 22:38.617
one bad facility or one bad incident happen.

22:38.740 --> 22:42.507
And then in response to that, we throw

22:42.672 --> 22:45.087
tons of more regulations at the industry.

22:45.237 --> 22:48.622
And it's crippling now because the

22:48.655 --> 22:53.322
burden is so great. It's impossible

22:53.442 --> 22:56.525
really to operate under.

22:57.787 --> 23:00.997
I would want to take a pause here just to focus on

23:01.030 --> 23:04.972
a comment. I think you can see on the screen now as well, that taking

23:05.005 --> 23:09.432
over relevant precautions is always important. So it's

23:09.447 --> 23:13.222
showing up with LinkedIn user. I've worked directly with Covenant and patients throughout these last

23:13.255 --> 23:16.552
years. Most of my causes have not been affected. I thought I had

23:16.570 --> 23:20.842
a higher chance of getting affected outside the hospital, which comes from that

23:20.890 --> 23:24.472
type of can do attitude, like you said,

23:24.580 --> 23:27.800
which exists so much in long term care.

23:28.687 --> 23:31.852
But I agree, taking care of Covidzing patients does it all,

23:31.870 --> 23:35.392
even on the best of us, which is true. And like you mentioned before,

23:35.440 --> 23:39.587
so many people have and are unfortunately leaving

23:40.087 --> 23:43.237
the industry because they said enough is enough.

23:43.300 --> 23:47.122
We care about it, but we care about ourselves as well.

23:47.155 --> 23:50.602
But let's move on the conversation, if you don't mind, too. Within the

23:50.620 --> 23:56.092
nursing home itself, what other systems within the nursing home were

23:56.140 --> 23:59.412
highlighted through COVID?

23:59.562 --> 24:03.262
And I would definitely want to get to maybe some possible things that

24:03.400 --> 24:07.047
anyone, whether it's administrator or adoptive nurses or even infection

24:07.092 --> 24:10.482
control specialists, which became a very important role,

24:10.647 --> 24:13.337
even more important role in many facilities,

24:14.362 --> 24:16.475
some of the things that they may be able to do.

24:17.062 --> 24:20.572
Yeah. So before COVID I very

24:20.605 --> 24:23.922
much was an advocate in implementing evidencebased practices,

24:24.042 --> 24:28.262
infection prevention practices in our longterm care facilities.

24:28.762 --> 24:32.502
We were starting to get there very slowly before COVID

24:32.532 --> 24:35.077
and then we were just kind of thrown in the deep end. Like ready or

24:35.095 --> 24:38.307
not, here you are, right? I mean, November of 2019,

24:38.472 --> 24:41.847
the federal rule was to have a parttime infection prevention

24:41.892 --> 24:45.442
assigned staff. But what I want to say about that is we

24:45.490 --> 24:49.102
need that role. But unfortunately, because of

24:49.120 --> 24:53.502
our staffing shortages, that infection preventionists cannot typically

24:53.607 --> 24:57.812
only do infection prevention. Right. They have to the DSD

24:58.312 --> 25:02.292
or the MDS coordinator or the Adon,

25:02.352 --> 25:06.337
or the Director of nurses, it's very rare they get to devote that time.

25:06.475 --> 25:10.522
And what I see is they're very, very green. So many

25:10.555 --> 25:14.007
infection preventionist, one day they walk into work and they're assigned

25:14.022 --> 25:17.847
the infection prevention role because they need to have that designated role.

25:17.967 --> 25:21.682
And so even before COVID and during COVID and long after,

25:21.760 --> 25:25.252
we need training, we need education. So one of the things that

25:25.270 --> 25:28.942
my company does is we do boots on the ground still. We're going

25:28.990 --> 25:32.932
into dozens of facilities every month. We're working

25:33.085 --> 25:36.867
with as a collaborative partner, as a mentor,

25:36.927 --> 25:40.567
a coach, we work with the infection preventionists and we

25:40.615 --> 25:43.927
support them, we celebrate what they're doing well because we all need

25:43.945 --> 25:47.302
to be celebrated. And then we identify the gaps in their

25:47.320 --> 25:51.147
infection prevention program. Simple things that don't

25:51.192 --> 25:55.102
necessarily have to cost money to fix, just some different way

25:55.120 --> 25:58.672
of thinking and training that can really make their job

25:58.705 --> 26:02.742
a lot better. So we really need this more supportive,

26:02.802 --> 26:06.402
collaborative work. And I'm very much an advocate

26:06.432 --> 26:10.087
for boots on the ground. A lot of our public health support

26:10.150 --> 26:14.075
comes remotely because it's more cost effective. I totally get that.

26:15.187 --> 26:18.417
But we need support in the buildings. Our staff

26:18.477 --> 26:21.637
need us, the nursing homes need us. And again,

26:21.700 --> 26:25.412
not the only people coming in the building are typically the surveyors.

26:25.837 --> 26:29.217
We do have through the Department of Health, we do have the CDC

26:29.277 --> 26:33.192
division, the Hai, the Healthcare associated infection Epidemiologist.

26:33.327 --> 26:36.772
Sometimes they'll come on site and do like an ICAR. I know some

26:36.805 --> 26:40.372
states are very much more robust about that, which is awesome,

26:40.555 --> 26:43.597
and we need more of that. So I would say that that

26:43.630 --> 26:47.272
support, that education and training, our nursing homes are

26:47.305 --> 26:51.277
hungry for that. They want that, our staff want that and

26:51.445 --> 26:55.432
we need to be able to provide that more. Yeah, I would just like

26:55.510 --> 26:59.527
caution, you know, this, but if that support is coming from

26:59.545 --> 27:02.797
the government, they're going to be very reluctant and probably not as

27:02.830 --> 27:06.057
receptive if they're coming in as an official member

27:06.222 --> 27:10.312
of Department of Public Health or an associated government body

27:10.375 --> 27:12.950
because there's a big lack of trust.

27:15.412 --> 27:18.642
We're coming from Department of Public Health. We're not giving out any citations.

27:18.702 --> 27:21.800
We're just coming to health. Yeah,

27:22.687 --> 27:26.302
well, you are 100% correct and actually with

27:26.320 --> 27:30.382
the Department of Health, they are bound. If they do have certain

27:30.460 --> 27:34.122
criteria, if they do see something, they have to reporters,

27:34.242 --> 27:37.717
they do. That is

27:37.765 --> 27:41.572
the biggest challenge I even have in even working with Doctors Without Borders is

27:41.605 --> 27:45.807
gaining that trust right away. Like, we are truly here to help you, and we're

27:45.972 --> 27:49.702
not mandatory reporters, and we are here to

27:49.720 --> 27:53.450
support you and coach you and guide you and help you. And so

27:54.712 --> 27:58.342
once we're there for a few minutes and we start giving them some training

27:58.390 --> 28:01.702
and education, I think they get that and they're like, okay, they really are here

28:01.720 --> 28:05.782
to help. That's the biggest hurdle. I mean, we offer free

28:05.935 --> 28:09.882
on site support for hundreds of facilities. And that's

28:09.897 --> 28:13.497
the hardest part, is getting our foot in the door to help them because they're

28:13.542 --> 28:17.225
so used to the punitive nature that they're like, no thanks,

28:17.737 --> 28:22.582
we'll pass. Exactly right.

28:22.660 --> 28:26.367
It is a very punitive

28:26.502 --> 28:30.427
type of environment, which is like even during survey, you'll have

28:30.445 --> 28:32.827
a nice survey, say, oh, let me just show you. Maybe try it this way,

28:32.845 --> 28:36.937
maybe try it that way. Going back to the highway example,

28:37.000 --> 28:39.957
it's like a nice cop saying, oh, here, just pull up like this. You jump

28:39.972 --> 28:43.057
the stop sign. Oh, you just told me to still jump to stop sign.

28:43.135 --> 28:45.507
Doesn't say in the regulation, if a cop tells you to do it, that you're

28:45.522 --> 28:49.102
off the hook. And that's kind of what people come to

28:49.120 --> 28:52.672
expect. We could probably go on

28:52.705 --> 28:56.592
much longer about this, but let's shift gears specifically

28:56.652 --> 28:58.112
to solutions.

29:01.237 --> 29:04.927
Let's say infection control specialists in

29:04.945 --> 29:08.752
the facility, and they're green, like you said, and they really want

29:08.770 --> 29:10.100
to step up their game.

29:11.962 --> 29:14.450
So you spoke a little bit about what we can do for that.

29:15.487 --> 29:19.152
Let's shift from there to staffing. What have you seen from staffing

29:19.182 --> 29:22.522
levels and what do you think is something that maybe

29:22.630 --> 29:25.342
facilities can do right now to address that problem?

29:25.540 --> 29:27.287
Well, first and foremost,

29:28.537 --> 29:32.437
facilities, any actually person watching this

29:32.500 --> 29:35.902
podcast today or any time they can reach

29:35.920 --> 29:38.537
out to their state representative,

29:39.637 --> 29:42.897
their congressman, or woman, they can reach out to their senators.

29:43.017 --> 29:47.017
The TNA program, the temporary nursing assistant program, actually went

29:47.065 --> 29:50.437
away June 6, which was three days ago. And that program

29:50.575 --> 29:54.172
actually was instrumental in helping us get people in the building

29:54.355 --> 29:57.747
and to have a pathway towards becoming

29:57.792 --> 30:02.017
a certified nursing assistant. And right now that's so critical because

30:02.215 --> 30:06.157
with inflation and the rates high everywhere, people need work now.

30:06.310 --> 30:09.727
So if it's going to take them three months to go through a

30:09.745 --> 30:13.747
CNA training program without pay, they're going to go get a job somewhere else

30:13.855 --> 30:17.242
versus this TNA program. They can start work

30:17.290 --> 30:20.647
immediately in the facilities, and then the facility can train them up and

30:20.680 --> 30:24.177
go through it. To where? Then they can become a certified nursing assistant.

30:24.282 --> 30:27.457
So we need that pathway. And we've been told by CMS it's going

30:27.460 --> 30:30.952
to take an act of Congress to bring it back. So let's reach out to

30:30.970 --> 30:34.477
our representatives and tell them we need this. Especially with

30:34.495 --> 30:38.497
the staffing shortages that we have right now. This is a no brainer and

30:38.530 --> 30:42.127
it's not requiring any funding from the government. The nursing homes pay for the

30:42.145 --> 30:45.832
training. It's been a tremendous support

30:45.910 --> 30:49.267
to getting staff in our buildings. There's definitely

30:49.390 --> 30:53.032
calls right now for 24/7

30:53.110 --> 30:57.157
nursing on site. What I say about that is

30:57.310 --> 31:00.577
just like what you said earlier, if we don't have the staff to bring them

31:00.595 --> 31:04.402
in, we can't mandate these items until we have

31:04.420 --> 31:07.550
the staff that we can support to do the work.

31:09.262 --> 31:12.847
But in order to be able to bring in the staffing, we need

31:12.880 --> 31:16.702
to be able to have competitive wages. There's also

31:16.795 --> 31:20.137
on the books and actually people have till tomorrow, June 10,

31:20.275 --> 31:24.062
to write in there's a proposed

31:25.012 --> 31:27.962
budget cut for a 3% from CMS.

31:28.612 --> 31:32.622
And, you know, we don't need budget cuts from Medicare.

31:32.667 --> 31:36.522
We need increases. So this budget cut, the proposal

31:36.567 --> 31:40.297
is that it happens in a year and the industry is

31:40.330 --> 31:43.942
like, no, just expand it over three. We'll take the cut, but just

31:43.990 --> 31:47.077
don't make it all at once so you can write to

31:47.095 --> 31:50.662
your legislators and

31:50.725 --> 31:54.502
ask them to extend this. And we

31:54.520 --> 31:58.477
just can't take these financial hits right now. As an industry, we need

31:58.495 --> 32:02.127
to pay our staff competitive wages

32:02.307 --> 32:06.247
or we won't have staff and then we won't have an industry. And we need

32:06.280 --> 32:09.997
post acute care. Like we need it. And I'll just say,

32:10.030 --> 32:13.797
you know, in my book I talk about post acute

32:13.842 --> 32:17.527
care is not just for elderly. I mean, I talk about a 24

32:17.545 --> 32:20.797
year old in my book that was in a car accident and needed six weeks

32:20.830 --> 32:24.427
in postacute. I talk about a mom that son was in a nursing home for

32:24.445 --> 32:27.892
20 years. So we need to care

32:27.940 --> 32:31.242
more and we need to support this industry

32:31.302 --> 32:34.625
more. Yeah,

32:37.237 --> 32:40.272
I hate saying it out loud, but I know that it's

32:40.317 --> 32:43.687
true. And you just said you said it yourself,

32:43.750 --> 32:47.075
which is why I'll take the liberty. You said we need to care more.

32:48.262 --> 32:52.017
The real truth is our society

32:52.077 --> 32:55.527
as a whole, or decision makers as a whole, numbers don't

32:55.557 --> 32:58.977
lie, as they say. So where we allocate our resources tells

32:59.007 --> 33:03.387
us the level of importance something has by making cuts

33:03.462 --> 33:07.637
in such a vulnerable, barely surviving industry,

33:08.812 --> 33:12.342
unfortunately, is indicative of where decision makers

33:12.477 --> 33:15.922
see this on the general scheme of

33:15.955 --> 33:19.767
things. It's unfortunate, but I think that that is the reality.

33:19.827 --> 33:23.392
And even if which I completely disagree in so many different

33:23.440 --> 33:27.157
levels, even if someone doesn't share

33:27.310 --> 33:29.667
the same respect,

33:29.802 --> 33:33.967
fascination, really, respect is the right word and

33:34.015 --> 33:37.372
dignity for our seniors. But like you pointed out, this is not

33:37.405 --> 33:40.625
other people. This is everybody. Everybody.

33:41.437 --> 33:44.752
There's plenty of post acute care. Someone goes through

33:44.920 --> 33:48.727
a very significant surgery and doesn't have a home setting that they

33:48.745 --> 33:51.877
can go to, to recuperate properly. They may need some.

33:51.970 --> 33:55.902
Inpatient rehab. Almost every nursing

33:55.932 --> 33:58.625
is called the nursing and rehab center. It's two separate services.

33:58.987 --> 34:02.600
There's a rehab service, rent, which has nothing to do with old people,

34:04.162 --> 34:06.575
and the fact that there are cuts coming down.

34:07.762 --> 34:11.497
Yeah, I don't like saying it so much. The people who

34:11.530 --> 34:14.872
go into this, by the way, people also say you see a guy pull

34:14.905 --> 34:18.067
up the nursing home in a big fancy car,

34:18.115 --> 34:22.257
let's say, and owns ten nursing homes, 20 nursing

34:22.272 --> 34:25.797
homes, whatever it is, if you're like, well, he's trying such a fancy

34:25.842 --> 34:28.957
car, and look, I'm still making 1250 an hour.

34:29.035 --> 34:32.302
You realize that this same businessman could have bought hotels, could have

34:32.320 --> 34:35.527
bought cryptocurrency, and Kobe did, and this is just

34:35.545 --> 34:39.412
a part of the portfolio. And they're choosing to invest their time,

34:39.475 --> 34:43.242
money, and resources into this industry. I'm sure that financially

34:43.302 --> 34:46.537
makes sense for them, but many of them, they care deeply about the people

34:46.600 --> 34:50.225
that are cared for in their facilities. I'm not speaking for everybody,

34:50.812 --> 34:54.727
but this certainly is the case. This is a

34:54.895 --> 34:58.437
business that they want to be busy with, with all the challenges,

34:58.587 --> 35:01.852
and it starts from the

35:01.870 --> 35:05.572
very top. It should. And the healthy companies start

35:05.605 --> 35:08.987
from ownership level, and all the financial stakeholders,

35:09.937 --> 35:13.822
I'm not even saying down or up, but including whether

35:13.855 --> 35:17.577
it's the CNAs, the housekeepers, whether it's the person fixing the oven in the kitchen,

35:17.682 --> 35:19.475
or whoever it is,

35:22.012 --> 35:26.272
it comes from such a place. And it's important that we

35:26.305 --> 35:29.677
realize who's who on whatever level that

35:29.695 --> 35:33.427
they're on. So it's a solution based.

35:33.520 --> 35:37.797
Number one is the DNA program, which certainly helped solution

35:37.842 --> 35:41.632
wise, is reaching out to our government officials, which certainly

35:41.710 --> 35:44.525
is a step.

35:45.562 --> 35:50.647
Are you familiar with I'm not. Are you familiar with any maybe

35:50.680 --> 35:54.382
I am. Organized efforts to

35:54.535 --> 35:58.417
sway the government opinion in regards to Ta program.

35:58.540 --> 36:01.912
So I know they have all the association I'm just thinking here of

36:01.975 --> 36:05.077
all the different associations. So they do put pressure to

36:05.095 --> 36:08.047
try and change. Yeah, I mean, I was in DC on Monday and Tuesday on

36:08.080 --> 36:11.827
Capitol Hill with Aka and Cal, and there's over 500 of

36:11.845 --> 36:15.927
us that were talking with our House representatives,

36:16.032 --> 36:19.327
senators, and really advocate that's why

36:19.345 --> 36:22.522
we have until tomorrow, basically. Well,

36:22.555 --> 36:26.287
tomorrow is for the Medicare cuts. We have that's kind of the

36:26.350 --> 36:29.825
time period. We have to write about

36:30.412 --> 36:34.072
the TNA program that

36:34.105 --> 36:38.047
just basically went away on the 6th. But yes, we were

36:38.080 --> 36:44.752
in Washington advocating for change, and we

36:44.770 --> 36:48.050
need the government approach. We need that support.

36:49.312 --> 36:53.052
It's just everyday people, but they're making decisions that they don't

36:53.082 --> 36:57.297
necessarily know about. Right? And so we have to be the voice, and that's

36:57.342 --> 37:01.087
very important, because we need to bring these issues to them

37:01.150 --> 37:05.362
so they can make the right decisions. Because I think that

37:05.425 --> 37:09.427
it's easier to kind

37:09.445 --> 37:13.147
of do things the way we've always done them. And with the system being so

37:13.180 --> 37:16.882
punitive, it's kind of easy just to lean in towards

37:16.960 --> 37:20.602
that. And so it takes courage to say, you know what, we're going

37:20.620 --> 37:23.977
to do it a little bit differently and see if we

37:23.995 --> 37:26.150
can get some different results from that.

37:26.962 --> 37:30.352
Amazing. Dr. Buff, it's been

37:30.370 --> 37:33.812
amazing having you on the nursing home podcast.

37:34.762 --> 37:38.062
One last thing before we let you go, and then I want just

37:38.125 --> 37:41.272
also to share information about your book and where people can get it. But just

37:41.305 --> 37:44.632
before we get to that, what do you see

37:44.710 --> 37:48.007
as the next two years in the

37:48.010 --> 37:51.322
nursing home industry? Where do you see, like,

37:51.355 --> 37:54.907
best case scenario where we can be what would be considered success

37:54.985 --> 37:58.657
in progress with an eye to the future,

37:58.810 --> 38:03.192
in regards to regulatory enforcement,

38:03.252 --> 38:06.742
in regards to staff, in regards to everything we've discussed? Well,

38:06.790 --> 38:10.182
for me, if we did nothing about changing

38:10.272 --> 38:13.942
the regulatory enforcement, let's just say that stayed the same.

38:14.065 --> 38:17.842
Let's put the same effort towards collaboration and support. Let's put the same

38:17.890 --> 38:21.507
funding, if not more funding, towards actually assisting our nursing

38:21.522 --> 38:24.717
homes. More boots on the ground, more coaching,

38:24.777 --> 38:28.767
training, educating. And let's just stop throwing punishment

38:28.827 --> 38:32.272
at them and pointing out what they're doing wrong, but let's actually reach our

38:32.305 --> 38:36.597
arm across and help them to be successful.

38:36.717 --> 38:39.847
So, you know, we need to do that.

38:39.880 --> 38:42.950
Absolutely. And I'm not even saying fine,

38:43.387 --> 38:46.747
even if we don't change anything about the regulations, let's put that

38:46.780 --> 38:50.307
amount of effort into helping and supporting and that collaborative effort.

38:50.397 --> 38:53.772
We need to be more proactive in preventing infections.

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The research shows anywhere from 40% to 70% of our infections

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are presentable. So we really need support in

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that area too. Again, coaching,

39:04.612 --> 39:08.257
guidance, training, we need to help our

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nursing homes. And I think if we took that approach of how can we help

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them versus we're going to punish them because of all the horrible

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things they do, I think we can go really long ways.

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Amazing. I really would

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hope to see that actually happen,

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to see that shift. You just got me thinking,

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is there something else that you said, if we continue as

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is or continuing leaning into the way things were,

39:40.705 --> 39:44.422
might not be so pretty. It's time to change things up a bit.

39:44.605 --> 39:47.632
One of the things that's important for us to realize is that nursing homes are

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not a completely different institution than what they were 30

39:51.790 --> 39:55.192
years ago or 60 years ago. That they're not

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places for everyone who calls it the little old ladies,

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they're knitting and playing bingo and doing whatever

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they're doing. And this is a place where they're living. It's the community hospitals

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of yesterday. So nothing has adjusted.

40:10.002 --> 40:14.047
Reimbursement is not adjusted. The regulatory compliance is not

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adjusted for that. The hospital regulations is less

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primitive. It's less and over there,

40:21.220 --> 40:24.862
we're talking deaths happen there all the time.

40:24.925 --> 40:28.357
And are those preventable? Maybe. I mean, that's all in

40:28.360 --> 40:31.477
this training to be an expert in. But there's no reason why they should have

40:31.495 --> 40:34.625
less regulation, right? That is the way that it is.

40:36.937 --> 40:40.482
So your book is out broken? Yes, as you mentioned in the beginning

40:40.497 --> 40:41.687
of the podcast.

40:43.462 --> 40:47.052
So give us a blur about your book. And whereas

40:47.082 --> 40:50.352
if someone can pick up a book well, like I said, I've really felt compelled

40:50.382 --> 40:53.887
to write this book and tell the story. It's not just my story.

40:53.950 --> 40:56.637
It's interviews from nursing home administrators,

40:56.712 --> 41:00.792
staff, patients, it's interviews from academic researchers,

41:00.852 --> 41:04.452
even the regulatory side of things. I had our Arizona

41:04.482 --> 41:08.172
Bureau Chief interviewed her to give a really well round perspective

41:08.292 --> 41:12.337
of what's going on. I talk about what happened before the pandemic and

41:12.400 --> 41:16.152
how we were really ramping up and starting to really focus on infection

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control. And then, of course, what's occurred during the

41:19.645 --> 41:23.352
pandemic, the challenges our nursing homes have had to endure.

41:23.457 --> 41:27.777
And then really, the last few chapters are leaning into the solution

41:27.957 --> 41:31.972
what can we do? How can we support our staff? How can we

41:32.155 --> 41:35.547
support best practices? How can we change the broken

41:35.592 --> 41:38.872
regulatory system from constantly being punitive to

41:38.905 --> 41:42.247
more supportive and really what that looks like going forward?

41:42.280 --> 41:45.352
And then the last chapter is even towards consumers, what does it

41:45.370 --> 41:48.732
look like for you caring for your loved one? You know, if your loved

41:48.747 --> 41:52.777
one is a nursing home, what can you do to advocate for change and

41:52.795 --> 41:56.377
to support and support the care that

41:56.395 --> 41:59.722
your loved one is receiving? And there's a great

41:59.755 --> 42:02.902
story in there about Twyla. Bridges, who cared for

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her son who was in a nursing home 20 years, and her great advocacy and

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work that she did. So this is the first

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step. The book is on Amazon.

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You can get it. It's available. Hope you

42:17.590 --> 42:21.622
will purchase it and share it with everybody. You know, because this

42:21.655 --> 42:24.997
is an issue that we as a society really need to

42:25.030 --> 42:28.812
work on and because every one of us is really touched

42:28.887 --> 42:30.875
by this issue.

42:32.737 --> 42:35.375
Amazing. We can definitely share a link to that.

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Okay, I'm waiting to see what's going to be available on Audible.

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I got to get that out.

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I think I need to get on that sooner rather than later.

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Especially a lot of the people that should be reading this book, spend a couple

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of hours a day commuting. Sure. That's when I got really into

42:57.055 --> 43:00.232
all that stuff. That's amazing. Thank you so much, Dr. Buff, for coming on the

43:00.235 --> 43:03.847
Nursing Home podcast. To listen to this podcast and to listen

43:03.880 --> 43:08.692
to previous episodes can head on over to the nursing homepodcast.com

43:08.740 --> 43:12.447
or you can go to any other place where you get your podcast.

43:12.567 --> 43:16.152
Again, thank you so much for coming on the show. We definitely appreciate you sharing

43:16.182 --> 43:18.962
your perspective with our listeners and viewers.

43:31.312 --> 43:34.882
Now that you've enjoyed this episode of the nursing home

43:34.960 --> 43:38.862
podcast, I'd really appreciate if you'd rate this podcast

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43:45.805 --> 43:51.127
the nursing home industry. So head on over to ratethispodcast.com

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