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Learning from What We've Lost: Protecting LTC Residents & Staff "My passion for human rights and elder justice was rekindled."— Cinnamon St. John, MPA, MA Over the past year, COVID-19 has swept through our nation, ruthlessly claiming lives and nowhere has its toll been felt more than in our nation's nursing homes. While only accounting for 8% of total cases in the United States, almost 40 percent of all COVID-related deaths in the United States were nursing home staff and residents. Lawmakers are looking for policy solutions to help stop the destruction within the walls of our nation's nursing facilities. In this episode, we'll talk with Health and Aging Policy Fellow Cinnamon St. John and one of the nation's leading nursing home advocates, Toby S. Edelman, about the complexities of this issue, along with potential solutions. Part One: 'Learning from What We've Lost: Protecting LTC Residents & Staff' with Cinnamon St. John and Toby Edelman In February 2020, the nation saw the first appearance of COVID-19 in a nursing home in Washington state. Nine months later, the coronavirus has spread across the country and over 87,000 nursing home residents and staff have died. Older adults living in nursing homes have been more likely to die from COVID due to being our oldest, frailest, and sick citizens. Addressing the issues in nursing homes is complicated because the challenges are wide-ranging -- spanning federal, state, and local levels -- and cross-cutting sectors, all the while being interconnected. Additionally, COVID-19 potentially exacerbated cracks in the foundations of many nursing homes that existed before the pandemic. Those range from a myriad of staffing issues, such as not having enough nurses on staff and underpaid nursing home direct care workers, to racial inequalities -- where facilities with more racial and ethnic minorities had more confirmed cases and deaths -- to infection prevention and control issues. According to the Centers for Disease Control and Prevention (CDC), 8 out of 10 COVID-related deaths in the United States have been in adults 65 and older. "There are serious consequences for residents if facilities don't follow infection control rules." — Toby Edelman, Ed. M., JD Recently, a nursing home in Kansas reported that all 62 of its residents had tested positive for COVID-19 and 10 had already died. That facility was cited with the most serious level of infection control problems in May 2020, but there is no record of any penalty. If the facility had corrected its infection control problems, it's likely that the virus would not have swept through as it did. That's why the rules have to be enforced. If violations don't lead to a real penalty and a fundamental change in practices, then they're just words on paper, and that is not enough. Part Two: 'Learning from What We've Lost: Protecting LTC Residents & Staff' with Cinnamon St. John and Toby Edelman Infection control experts are currently warning that the surge in COVID-19 cases in parts of the nation is expected to get worse over the coming weeks and months. Nursing homes are in a position where they need to learn from one another's collective coronavirus experiences to ensure lives are not needlessly lost. Research has shown that there are a number of best practices that nursing facilities can implement. The trick is pulling the levers simultaneously, which requires a great amount of planning, action, and accountability. "A great society should do great things for its older adult population." — Cinnamon St. John, MPA, MA One crucial lever is increasing staffing levels. LeadingAge recently released a report arguing that paying workers a living wage (not minimum wage or just above minimum wage) would reduce staffing shortages, reduce turnover, improve quality of care for residents, and reduce workers' reliance on public benefit programs based on need, such as Medicaid. Numerous studies (including this one by previous podcast guest Charlene Harrington) appear to show that understaffing of registered nurses may increase the risk of larger outbreaks. We need to use this increased attention on nursing homes to get to other major changes. About Cinnamon St. John, MPA, MA 2019-2020 Health and Aging Policy Fellow through the American Political Science Association (APSA) Cinnamon is the Associate Director of the Hartford Institute for Geriatric Nursing (HIGN) at NYU Rory Meyers College of Nursing. She designs and manages programs that focus on ensuring optimal health and quality of life for older adults through interprofessional and patient education. Her work at HIGN has helped train over 2,000 Bronx seniors on wellness and disease self-management has strengthened collaboration between a major NYC health system and community-based organizations, and has driven the national and international dissemination of elder care training modules. She has also led the development of a strategic partnership between HIGN and a New York-based long-term care provider as part of the state's "Workforce Investment Organization" (WIO) initiative. This program is helping to build and support a robust training infrastructure that will enhance the skills and advancement opportunities of long-term care workers in the region. Prior to this placement, she was with the U.S. Senate Special Committee on Aging in the office of Chairman Susan Collins (R-Maine). For the Committee, Cinnamon helped inform policy and drive the oversight of legislation focused on improving the support infrastructure for older Americans, with a particular focus on Alzheimer's Disease. As a former journalist, Cinnamon is passionate about increasing public awareness of the needs of older adults, the challenges that our society is facing in addressing those needs, and the opportunities we have to improve how we care for our aging population. Cinnamon has received a Master's of Public Administration from the NYU Wagner Graduate School of Public Service and an MA in International Peace and Security from King's College London. Toby S. Edelman, Ed. M., JD Senior Policy Attorney, Center for Medicare Advocacy Toby S. Edelman has been representing older people in long-term care facilities since 1977. As a Senior Policy Attorney with the Center for Medicare Advocacy since January 2000, Ms. Edelman provides training, research, policy analysis, consultation, and litigation support relating to nursing homes and other long-term care facilities. Under two grants from the Commonwealth Fund, she evaluated the federal nursing home survey and enforcement system and its impact on state activities and provided technical assistance to states on effective enforcement practices. In cooperation with the Centers for Medicare & Medicaid Services, she recently completed a Commonwealth Fund project to evaluate seven states' deficiency citations for misuse of antipsychotic drugs. Since September 1999, she has written a monthly newsletter on nursing home enforcement issues. Ms. Edelman was the lead attorney for a statewide class of nursing facility residents who successfully challenged the state of California's refusal to implement the federal Nursing Home Reform Law (Valdivia v. California Department of Health Services, Civ. No. S-90-1226 EJG (E.D. Calif. 1993). As a beneficiary representative, Ms. Edelman has testified before Congress and served on federal task forces, technical expert panels, and working groups on nursing home issues. Ms. Edelman received a B.A., Magna cum Laude, from Barnard College (1968), an Ed.M. from the Harvard Graduate School of Education (1969), and a J.D. from the Georgetown University Law Center (1974). Ms. Edelman is a member of the Washington, DC Bar. About Melissa Batchelor, PhD, RN, FNP, FGSA, FAAN I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-Master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities. Find out more about her work at https://melissabphd.com/.