Professor of Health Care Policy, David Grabowski, PhD testified to the House Select Subcommittee on the Coronavirus Pandemic at a hearing on May 17^th titled “Like Fire Through Dry Grass: Nursing Home Mortality & COVID-19 Policies.” This was his third time testifying to this Subcommittee since the start of the pandemic. Grabowski noted during his initial statement that the “impact of COVID in nursing homes could have been avoided with increased federal leadership, resources and attention.” He further emphasized that “the federal government has chosen to push the logistics and costs off to the states and the nursing homes. By failing to invest in testing, personal protective equipment, and the workforce, the federal government has allowed a problem that started in a single nursing home in Kirkland, WA, to grow into a national crisis."

Grabowski served on a National Academy of Sciences, Engineering, and Medicine committee and cited this report in a series of suggestions for future reforms. He advocated for implementing a federal policy that adequately covers nursing home care and thereby reduces the reliance on Medicaid. Grabowski highlighted the issue of nursing home corporations using complex ownership structures to divert funds from resident care and called for increased financial transparency and accountability through the collection and availability of detailed real-time data. He stressed the need for more effective and responsive survey processes that can identify caregiving problems, and finally, he suggests providing adequate resources for state survey agencies to enhance oversight and improve quality assurance activities.

The committee posed questions regarding levels of federal involvement, importance of the supply chain for rapid testing and personal protective equipment, vaccine mandates, and proposed budget cuts that would impact CMS.

In his responses, Grabowski warned against the danger of pushing policy responsibilities off to states and nursing homes to acquire personal protective equipment and rapid testing during a pandemic, stating: “When you put nursing homes in a market where they are competing with other entities, they weren’t in the front of the line… there was a role for government to help state and nursing homes.”

Grabowski addressed the importance of supporting the nursing home workers; staffing levels are still down by 7-9% relative to pre-pandemic levels due to tough working conditions faced by staff. Grabowski additionally emphasized the impact of the vaccine mandate in curbing the number of covid related fatalities by making vaccines mandatory for staff who were unknowingly carrying the virus from facility to facility.

Grabowski also advised that cutting the budget for quality oversight would be detrimental to resident care: “These are frail, older adults, many with Alzheimer’s or dementia, many are unable to monitor if their own requirements are being met.” He added that cutting budgets would be a step in the wrong direction.

In closing statements, the Committee Chairperson Brad Wenstrup stressed a path forward, learning from mistakes, and emphasized the role of data. Ranking member Raul Ruiz recognized the opportunity to transform nursing home care by reforming nursing home standards, strengthening the workforce, and maintaining funding. All parties seemed to agree that in going forward, they must “put people over politics to save lives and right the wrongs of the pandemic.”