- 2 months ago
Sen. Bernie Sanders (I-VT) led a press briefing on Wednesday on the Big Beautiful Bill.
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00:00uh thank you all very much for being here and uh i want to thank uh katie smith sloan who's the
00:10ceo of leading age which has some uh 5500 nursing homes all over the country for being with us i
00:18want to thank dick cato who is with the ag roads nursing homes in atlanta and i want to thank
00:26heather turbine uh pollard who is with the center circle adult day services in richmond
00:32virginia thank them all for the enormously important work they do for our seniors
00:37uh and thank them for being with us today and thank all of you for being here
00:41um it is no secret i think to anyone that the american health care system uh is broken it is
00:51dysfunctional and it is cruel today we have 85 million americans in the wealthiest country on
00:58earth who are uninsured or underinsured one out of four americans cannot afford to fill the prescriptions
01:05that their doctors prescribe our life expectancy is significantly lower than other wealthy nations
01:13some 60 000 americans die each year because they can't afford to get to a doctor on time
01:20and in fact we don't have enough doctors nurses dentists and other health care professionals
01:26meanwhile because of the greed of the insurance companies and the drug companies we are spending
01:33far far more per person on health care than the people of any other country we are now over 14 000
01:41for every man woman and child which is an insane number and totally unsustainable
01:47so what we have is a crisis in health care and trump's big horrific bill will make
01:57that crisis much worse it will throw 15 million americans off of the health care they presently
02:06have so instead of providing health care to all people throwing 15 million people off of health care
02:11it will raise insurance premiums for millions of people all over the country already paying sky high
02:18prices it could well cause the closure of many rural hospitals and community health centers all across
02:26our country all of whom were significantly dependent on medicaid funding it will also in the point of our
02:35our discussion today
02:36it will also have a major impact on nursing homes in this country and that is an issue that has not gotten the kind of
02:51attention that it needs and that's why we are holding this event today according to a study commissioned by the
02:59department of health and human services 70 percent of seniors in an aging country we are an aging country
03:07will need some kind of long-term care during their lifetimes this can include assistance with
03:15activities of daily life like eating bathing and dressing in some cases family members can provide this type
03:23of care but it requires from that family member enormous time effort and skill and when you are dealing with
03:35horrific illnesses like dementia or alzheimer's it is also terrible stress on that family member
03:46and that is why families throughout the country seek our support
03:51our support through home health care providers through senior centers or nursing homes and let's be clear
04:00even before the implementation of trump's horrendous bill nursing homes and long-term health care providers
04:09were already struggling all right so it's not like we had a great situation uh we have a very bad situation
04:18which is only going to be made worse uh when you cut medicaid by over 900 billion dollars as this bill does
04:27nursing homes and long-term health care providers will be losing a major source of their revenue in other
04:34words you have institutions all across this country that are struggling today and now there's going to be a
04:42significant decline in their revenue we're going to be talking in a moment uh from our guests about what
04:49those cuts will mean uh according to a recent survey as a result of this legislation some 27 percent of
04:57nursing homes have indicated that they will be forced to close their doors and 58 percent will be forced to
05:04substantially reduced staff at a time when many nursing homes already grossly understaffed and under
05:13resourced when it comes to home and community-based care the problem may be even worse because states
05:20aren't legally required to cover these services under medicaid states could cut benefits for long-term
05:27home care altogether and what does that mean for families across the country
05:33it means that people who need long-term care will probably rely on a family member to care for them
05:42and what that will do is put enormous stress on family members so right now i want people to appreciate
05:52this if you have a mom or a dad or somebody in your family who is in a nursing home or a home daycare center
06:02if that person can no longer be in that facility and has to be at home how does it impact you well
06:09guess what you're not going to work anymore you're going to stay home taking care of that family member
06:15and if you don't go to work anymore you're not having any income
06:18coming into your house and how does that impact people in our country 60 percent of whom are living
06:24paycheck to paycheck so this bill is a disaster in general it will be a disaster for nursing homes
06:32and i want to introduce now people who know more about it uh than i do uh and let's begin uh with
06:39katie smith sloan the ceo of leading age katie thanks so much for being with us
06:44thanks so much so i want to start by acknowledging the significance of today the 60th anniversary of
06:56the medicare and medicaid programs so over these 60 years both programs have supported the services
07:04supports and care of literally millions of older persons they are a lifeline
07:11medicaid is the primary payer of long-term services and supports there is simply no other public option
07:20for the services provided in a range of care settings including nursing homes
07:26so now let's talk about need at present older adults over age 65 represent nearly 20 percent of our
07:34population and that percentage is steadily increasing and as it does the demand for services and care will grow
07:45at leading age our non-profit and mission-driven community-based member organizations are committed
07:53every day as they have been for decades to meet that demand whether it be for care in a nursing home
08:00home care in a private home through pace programs or adult day centers our members depend on medicaid payments
08:10to deliver care and services payments that even before the cuts did not cover the full costs of care
08:19the undeniable fact is america's infrastructure of services and supports for older people was inadequate
08:28and unsustainable before passage of the 2025 budget reconciliation act the changes called for in the act
08:37and now law will weaken the existing system at a time when demand for services and supports is growing
08:45who will older adults and their families turn to when the services they need are not available
08:52because the funding has been cut
08:53and when providers of services can no longer deliver them and have to shutter their doors
09:01what will happen to the staff who are employed in many of these settings and who may themselves be on
09:07medicaid or have family members who rely on it who are now at risk of losing their health care coverage
09:13or possibly seeing their wages reduced
09:16here's the truth the medicaid provisions in this bill plain and simply erode an essential program truly
09:27a safety net for millions of older people as states respond to hr1 the changes will create craters in their
09:36budgets due to reduced federal medicaid contributions and the effects will be felt by older adults
09:44and their families and here too demographics don't lie as the number of people over the age of 80 increases
09:53the number of people of caregiving age 24 to 65 shrinks the supply of available caregivers is not
10:02keeping up with the growth of the older population this is not a math problem this is a reality that directly
10:12impacts our families financially emotionally and practically out of pocket talk costs time away
10:20from work or even lost jobs medicaid cuts which have been framed as a cost savings will result in an
10:29enormous expense to america's families today i'm joined by two leading age members who will share the
10:36impact of hr1 on their services while aspects of the impact are yet are yet to be discovered what we do
10:44know is that this legislation will establish more hurdles for providers whether through shortened retroactive
10:52eligibility or limits on the provider taxes states rely on to fund medicaid or by the financial decisions
11:00states are forced to make we can only look to history to understand this historically states response to
11:09budgetary pressures have been to cut medicaid eligibility to shave benefits or to cut provider payments to cover
11:17the costs of delivering care which means fewer dollars to pay staff workforce challenges for a variety of
11:26reasons are long-standing in our sector these cuts will only make it harder for our non-profit mission driven
11:33members to be competitive in the employment marketplace most of us i imagine hope we will never have to rely
11:42on services supports and care as we age but the reality is most of us will at leading age it's our belief that we
11:53have a moral and a practical responsibility as a nation to ensure everyone can access services supports and care
12:02that they need when they need it medicaid exists for this purpose with the change changes in the recent bill the
12:11fundamental purpose has been shattered the protection not the destruction of our nation's safety net infrastructure and the
12:20services it supports must be our priority thank you
12:30katie thank you very much uh our next speaker is deke kato with ag roads nursing homes in atlanta georgia
12:37thank you senator sanders um my name is deke kato and i'm the ceo of ag roads the story of ag roads which i'm going to tell
12:49you all a little bit about um is i think very interesting um we're a non-profit organization and we serve mainly these individuals that are on
12:59medicaid and we've done that for 121 years so 70 of who we care for are on medicaid um
13:09medicaid has become and is the backbone of our healthcare system
13:17for aging and senior services it is the healthcare system
13:22it is the only payer or the only real payer of long-term care so that's 70 percent that i told
13:29you about that i want medicaid medicaid is the only payer for them and we are already vastly underpaid
13:36from medicaid for taking care of them so any cuts any changes whether you disguise it as adjustments
13:45is going to have a very immediate impact and it's an impact that i cannot imagine what we're going to
13:52see in a few months from now if these individuals are in any way displaced if services have to be
14:00adjusted services that that that are not now required but that good providers like leading
14:07age providers go above and beyond to do if these changes go to play think about the staff that care
14:16for these individuals um many many of them do that for a love for caring for other individuals they are
14:26going to be impacted by this as well um i hear a lot of misnomers out there one very big one is that
14:34individuals living in nursing homes um who were not working before they choose to come to a nursing
14:40home they were not productive um working citizens totally untrue we serve about 1300 individuals a year
14:48i don't know not one of them that wasn't a teacher that want a nurse that want to engineer they have
14:56worked most of their lives and now they're sick quite frankly they're ill and they've spent their
15:03money down because of that illness so medicaid in the nursing home setting has become not only
15:10who pays for them to live with us but who cares for them medically who takes care of the medical needs
15:16um so my purpose today is just that hopefully to speak from my heart and hopefully speak to
15:24other other people's hearts this is certainly not about politics it is about policy and what is and
15:31should be sound policy in a society that is aging that we should be preparing for more of those on the
15:38rolls um and coming from a sector coming from an industry that i think we've been beaten up recently you
15:47know whether it was the threats of a staffing mandate i'm glad they have at least been postponed
15:53whether it's the threats of immigration now which in my case 35 percent of my staff are immigrants
15:59and then now on top of that i would say the threat to our main payer source that keeps nursing homes open
16:07so that's my appeal and and i hope again it falls on some hearts that can listen to it as well thank you
16:17thank you very much our next speaker is heather turbine pollard with center circle adult day services in
16:23richmond virginia we are a non-profit and a proud member of leading age and really i'd like to talk
16:39about the unique niche that places like adult day and in home and other support services that fall outside
16:47of nursing homes but other community-based so these are home and community-based services
16:52as the senator alluded to these are electional and optional services for states then to dole out
16:59to local communities like me it's a critical component our non-profit just 50 years old has been caring for
17:07largely moderate to severe dementia those who are living with dementia and alzheimer's but are choosing
17:14to stay home right they're a community-based model that lets all of us which is what i want and what you
17:21want probably to age home as long as we possibly can and so we serve 130 older adults at our facility
17:30medicaid is a large part of that and currently the reimbursement rate for the state of virginia for
17:36medicaid is 64.17 it is 150 a day for me to deliver that care that is a math problem
17:45and it's critical and we're working with leading age on increasing that state reimbursement but now
17:53when we're faced with the chance of it getting reduced or eliminated you can see if you do the
18:01math along with me how it may put home and community-based care folks like me out of business
18:06who grew up from community started by five churches in richmond virginia and have evolved into a center
18:14that's well known and supportive services senator sanders talks about the caregiver and it's so
18:20important i could probably ask you to raise your hand or think to yourselves as you're watching
18:26who of us knows somebody with dementia or alzheimer's we've cared for right we all have been touched by
18:33that and so these caregivers are burdened with that they're also working 60 of our caregivers work
18:40and they need a community-based option by which to send their loved one so adult day though it's little
18:46known in the long-term care services continuum is a social model that offers health monitoring a very
18:53important part of a staff that's well qualified to deal with dementia friendly practices and education
19:01we are an extended member of that family community-based care models like ours are extended care for
19:08families so a very critical part of the component at a time when some others in front of me said we
19:16should all be turning up the dial on all the services across our continuum that can support older adults
19:22and their caregivers caring for them as they age it's not the time to take that away from folks so
19:31thank you for the opportunity heather thanks first let me start i think we'll have some questions
19:39coming i want to start off with a question myself because i can't imagine that there are too many jobs
19:46more difficult than taking care of people with dementia or alzheimer's can somebody say a word what
19:53does that take out of what does that require out of a caregiver
20:02thank you for the opportunity to speak on behalf of our caregivers we talk with them every day it
20:09is a joy they would want me to say that but it's also a heck of a burden the psychological toll it takes
20:18when your husband no longer remembers your wedding day or your children's names
20:25it is very very heart-wrenching for them on a daily basis and you can imagine sitting in that space
20:35with what am i doing am i doing the right thing in addition to some of the behaviors once you've met
20:44someone living with alzheimer's you've met one person living with alzheimer's right my grandmother resorted
20:50to german her tongue which she never spoke to us and completely forgot english so that's what it looked
20:56like for her for others it looks very different and so thank you for the opportunity because
21:02and i hope i've represented caregivers it is a a joyful job at times but soul-wrenching
21:10many other times and they don't know how to deal with the disease as well like some of our staff people
21:16long-term care service staff we get trained um to do that work and families don't
21:25uh any questions for meteor yes
21:33i'm curious you talked a lot about how these
21:35um nursing homes receive what percentage of their revenue from medicaid 70 that's what i'm
21:57concerned about all right does anybody want to specifically answer what these
22:01cuts will mean so in the nursing home setting um and i'm actually um from the state of georgia um
22:09that has not been as impacted um particularly in the provider tax side um but the um the retroactive
22:16medicaid provision which we call medicaid pending in the industry is a huge um it's it's gone from 90
22:22days to um 60 days uh for a 60-day period we barely get someone approved now in a 90-day period
22:30so going to 60 days we i can't see how that happens during that period of time we are actually giving
22:36free care so if that person's not approved you know um the other huge concern i have is the bill
22:44obviously is pushing um the responsibility um straight onto the states and beside the states
22:50and again i come from a state that i think has been on the right side and will continue to be on the
22:54right side of aging but you know nationwide we don't have many states that even have that that um
23:00fiscal position that georgia has to be able to to fill in those gaps so again any adjustments may
23:07not necessarily be cuts right but these are adjustments that that would be extremely difficult
23:12even that retroactive process we the nursing home is who is applying or assisting the interview to apply
23:20that takes time most of these individuals many living with dementia they're not the best historians
23:26we have to to you know check their finances we have to see if there are any other bank accounts so
23:30it's a process that we do on behalf of the the elder so very very onerous indeed
23:40and all of this once again starts at a moment when nursing homes are struggling today struggling
23:47to get staff struggling to pay staff the wages you would like to pay etc all right other questions
23:53anybody else all right let me thank um our guests today i want to thank them we've heard the word
24:02moral and it's right uh it seems to me and i think to all of you that in the richest country in the
24:09world we should take care of our most vulnerable citizens with the respect and compassion and dignity
24:18that they are entitled to often as you've indicated after working their entire lives helping our society
24:24and that is not the case today so i want to thank you all for what you've done and let's go forward
24:28and let's go forward together thank you all
24:39you
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