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July 5, 2022

Is Long Term Care Broken?

Picture this: a category five hurricane converges on a city. The streets are crammed with the traffic of evacuees. Yet, rather than helping these panicked people, the number of traffic cops is increased by sevenfold to ensure they are all given speeding tickets.

Dr. Buffy Lloyd-Krejci, best selling author and a major authority on infection control and prevention in nursing homes, explains how this illogical scenario is essentially what took place in nursing homes and senior care facilities who were targeted by infection control surveyors during the early days of COVID-19.


Having worked on the front lines with hundreds of nursing homes to develop effective infection control strategies, Dr. Buffy got a firsthand look at the way in which these facilities were targeted during the height of the pandemic.

She was moved by the stories she heard and problems she observed, to write her best selling novel Broken which highlights the difficulties faced by nursing homes in implementing infection control. 

Most of these difficulties stem predictably from staffing and budget challenges. All nursing homes are required to have at least a part time infection preventionist on staff, but many take on the role while also holding other positions and with little training or hands on experience. 

Dr. Buffy’s company, IPCWell, helps in these common situations by working with facilities to teach and support their infection preventionist in developing efficient and effective methods that will function inside a facility’s means and budget. 

However, a considerable amount of difficulty is also brought about by the barrage of continuously changing rules and regulations.

Responsible regulations are always needed for the functioning of any industry. However, Dr. Buffy states that their sheer volume is crippling for senior care and makes it nearly impossible for facilities to operate inside. 

This came to a head in 2020 when, instead of helping nursing homes suffering from no PPE and with overworked staff who were risking their lives, the government invested $80,000,000 in targeted infection control surveys. 

In an effort to show that this money was being put to use, even the smallest action not following regulations word for word was cited. 

Dr. Buffy states that instead of punishing nursing homes, this funding and attention should be put towards helping them and advocating for them. 

The last chapter of Broken  explains how anyone who has a relative in a nursing home can advocate for their facility. 

 

FOLLOW DR. BUFFY

 

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Transcript

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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.

18:19.135 --> 18:22.597
And they were no longer recommendations, they were law.

18:22.780 --> 18:25.927
And if we didn't follow every word to the way

18:25.945 --> 18:29.277
it was written, we were cited. I mean, I helped

18:29.307 --> 18:32.462
facilities across the country IDR

18:33.112 --> 18:36.892
fight the state surveys, and they would

18:36.940 --> 18:40.342
quote us word for word what the CD said, even CDC said.

18:40.390 --> 18:44.377
Even if it had been different two weeks prior, even if it

18:44.395 --> 18:48.397
had been different five days prior, they would write

18:48.430 --> 18:51.847
their citation based on what the

18:51.880 --> 18:56.077
new guidance was. It was just impossible. It was impossible to

18:56.095 --> 18:59.997
keep up. And it's so inappropriate

19:00.042 --> 19:02.750
and harmful. And I don't know about you,

19:03.712 --> 19:07.372
we've always had turnover and longterm care. That's no

19:07.405 --> 19:11.017
surprise. But now I'm seeing people that have been in it for their whole

19:11.065 --> 19:14.232
career, administrators, executive,

19:14.322 --> 19:17.947
people that have really given their life to this work. They're leaving because

19:17.980 --> 19:21.425
they're like it's too much.

19:22.087 --> 19:25.302
We want to do a good job, but we're in a straitjacket and can't.

19:25.407 --> 19:28.100
So my plea to the public,

19:28.762 --> 19:32.557
to the government, is help us

19:32.635 --> 19:36.372
do the right thing instead of constantly punishing

19:36.417 --> 19:39.567
us and expecting us to deliver

19:39.627 --> 19:43.175
quality care when we're constantly getting knocked down.

19:44.812 --> 19:48.547
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

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amazing having you on the nursing home podcast.

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One last thing before we let you go, and then I want just

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also to share information about your book and where people can get it. But just

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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

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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,

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for me, if we did nothing about changing

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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

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funding, if not more funding, towards actually assisting our nursing

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homes. More boots on the ground, more coaching,

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

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at them and pointing out what they're doing wrong, but let's actually reach our

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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,

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even if we don't change anything about the regulations, let's put that

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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

38:57.717 --> 39:01.072
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

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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.

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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,

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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

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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

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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,

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staff, patients, it's interviews from academic researchers,

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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

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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

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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?

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And then the last chapter is even towards consumers, what does it

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look like for you caring for your loved one? You know, if your loved

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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

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will purchase it and share it with everybody. You know, because this

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is an issue that we as a society really need to

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work on and because every one of us is really touched

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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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