JOHN YANG: Tonight on PBS News Weekend, preparing for the next big earthquake, two centuries after the last one, in a part of the country not widely known for them.

MAN: They were all puzzled by it's like, why is the ground moving?

Why are objects in my house or cabins swinging back and forth for no apparent reason?

JOHN YANG: Then why an app intended to make it easier for migrants to seek asylum isn't achieving its goal for everyone, and how a new federal rule mandating Nursing Home staffing requirements is shaking up the industry.

(BREAK) JOHN YANG: Good evening.

I'm John Yang.

Late today, Israel signaled acceptance of key components of the U.S. backed ceasefire proposal and said only Hamas stands in the way of stopping the fighting in Gaza and the return of Israeli hostages held there, even as hope grows that an agreement could be finalized next week, Israel carried out airstrikes in Gaza and Lebanon.

In southern Lebanon, at least 10 Syrian nationals were killed, as Israel says it targeted a Hezbollah weapons depot.

In Gaza, 18 members of the same family died in a strike at a house and a neighboring warehouse, and Gazans are now facing a new threat, polio.

One case has been confirmed and more suspected.

Polio was eradicated in Gaza 25 years ago, but vaccinations have plunged and sanitation facilities have been destroyed since the war began.

MAJED ABU RAMADAN, Palestinian Health Minister: There should be rehabilitation of our clean, safe water resources, solving the problem of the sewage flooding our streets and homes.

JOHN YANG: Aid groups hope to vaccinate more than 600,000 children in coming weeks, but say at least a seven-day pause in fighting is needed to carry out a mass vaccination plan.

Russia is pressing its assault on Ukraine, even as Ukrainian forces push farther into Russian territory.

A Russian missile strike destroyed cars and damaged a shopping mall in northeastern Ukraine, injuring at least two people.

In Russia, Emergency Services issued a new wave of evacuations in the Kursk Region.

Ukraine now claims to hold nearly 500 square miles of Russian territory.

Ernesto now a tropical storm is slowly moving into open waters after battering Bermuda.

It was a category one hurricane when it made landfall on the island early this morning, tropical storm conditions could persist there until tomorrow.

More than three quarters of Bermuda's residents are without power, and a stone may brush Newfoundland on Monday, but it's not forecast to have much effect on the United States beyond rough surf on east coast beaches.

Still to come on PBS News Weekend, the app for migrants seeking asylum that isn't always user friendly, and the shakeup in the nursing home industry as rules about minimum staffing levels take hold.

(BREAK) JOHN YANG: This week's 4.4 magnitude tremor in Los Angeles didn't do much damage, but it was along a fault that runs through a densely populated area, and scientists warn that that fault has the potential of producing a devastating 7.5 magnitude quake.

It's again raised the question of earthquake preparedness in Southern California.

But it's not just the west coast that ought to be thinking about that.

JOHN YANG (voice-over): October 17, 1989, a 6.9 magnitude quake in the San Francisco Bay Area collapses elevated highways in a section of the Bay Bridge.

Candlestick Park is evacuated as the World Series is postponed.

Broken gas mains fuel fires that destroy buildings.

63 people die.

Damages total more than $6 billion.

February 9, 1971.

MAN: A state of emergency in California following the earthquake which disrupted the entire state.

JOHN YANG (voice-over): A 6.6 magnitude earthquake in California's San Fernando Valley leaves 65 people dead, some in the partial collapse of a Veterans Administration Hospital.

Damage is estimated at $500 million.

Quakes many still vividly remember but a less well known seismic event reshaped an area in the middle of the country more than two centuries ago.

For two months at the end of 1811 and the start of 1812 a series of quakes and smaller tremors shook the area around the tiny frontier town of New Madrid, Missouri.

The initial shock is estimated to have been about magnitude 7.5.

Witnesses said houses collapsed and the earth opened up.

Some said the Mississippi river ran backwards for a short time, trees snapped and geysers of water and sand shot up from deep underground.

KENT MORAN, Earthquake Historian: The effects were in the Epicentral Area Catastrophic.

You had landslides.

You had liquefaction.

JOHN YANG (voice-over): Earthquake historian Kent Moran at the University of Memphis studies the event.

KENT MORAN: The buildings literally being shaken apart at New Madrid, the river sloshing back and forth, the people screaming in panic, the ground opening up all concurrently at same time.

The effects were apocalyptic.

JOHN YANG (voice-over): It was felt as far away as Louisville, Kentucky in Cincinnati, it rang church bells in Charleston, South Carolina.

KENT MORAN: They were all puzzled by it's like, why is the ground moving?

Why are objects in my house or a cabin swinging back and forth for no apparent reason?

Why is the water sloshing back and forth in the stream or pond by my house.

It's not supposed to be doing this.

JOHN YANG (voice-over): About three and a half million acres of the Mississippi and Ohio River valleys were reshaped.

Hills and lakes appeared on previously flat, dry terrain.

Two centuries later, the effects are still visible.

Stretches of sand that the pressure of the shifting Earth forced to the surface, a phenomenon known as sand blows.

KENT MORAN: It depopulated it and depressed the population that area for years afterwards.

JOHN YANG (voice-over): But now the area is home to millions of people in at least five states, including major cities like Memphis, Tennessee, Little Rock, Arkansas and St Louis.

JOHN YANG: The U.S. Geological Survey estimates that in the next 50 years, there's a 25 to 40 percent chance of an earthquake of at least magnitude 6.0 in the area, and about a seven to 10 percent probability of a repeat of the 1811, 1812 earthquakes.

Brian Houston is Chair of the University of Missouri's Department of Public Health and director of the school's Disaster and Community Crisis Center.

Mr. Houston, this was, of course, the frontier when this happened in the 1810s but if there were a repeat, what would the results be now in that area?

BRIAN HOUSTON, University of Missouri Disaster and Community Crisis Center: Yeah, I think that's one of the big issues that you bring up is that the last time this happened almost 200 years ago, there weren't a lot of people in the area.

And now there are many more, many more millions of people that live in the area, a lot of transportation infrastructure, highways that cross the Mississippi River and other rivers.

And so the impact of an event as strong as what was experienced in the early 1800s would really impact a lot of homes, a lot of businesses, a lot of transportation.

And so would have a significant human toll and also economic impact in the area.

JOHN YANG: And you talk about spans across the Mississippi, but the Mississippi has become now an important economic pipeline, bringing coal and agricultural products to the world.

What would be the effect of having that disrupted?

BRIAN HOUSTON: We know that some of the rivers were redirected as a result of these large earthquakes.

And so you could imagine if something like that were to happen.

Now, the shipping and the transportation that occurs up those rivers could be completely unpassable and not even doable.

And of course, as I already mentioned, just getting over those rivers is a big conduit between the, you know, the eastern half and the western half of the country, and so at least in that region, that could be dramatically reduced.

JOHN YANG: So the estimates of the possibilities of this happen are relatively low, 25 to 40 percent but in the Midwest, you do have every year, you have flooding, you have severe weather, tornadoes.

How do you prioritize taking care of preparing for things you know are going to come because they come every year, versus preparing for something like this?

BRIAN HOUSTON: Yeah, that's the big challenge.

You know, we've conducted focus groups and collected survey data throughout the new mattered region and that's what we hear from people, is that there are all sorts of other day to day risks that seem very possible and are quite salient.

So flooding for sure severe storms.

And so when you put something like an earthquake risk on top of that, when there, you know, doesn't seem to be a huge chance that it's going to happen tomorrow, say, even if it could be quite severe, that in the people we've talked to really falls to the bottom of the list in terms of risks they're thinking about, or planning for, or even concerned about overall well.

JOHN YANG: Those people who are thinking about that risk, what should they be doing?

What should they be thinking about?

BRIAN HOUSTON: Yeah, there's sort of a range of activities that individuals and families can take to prepare for an event like this.

Kind of the most basic end.

There's things like prepare a disaster kit and have some water and some food and some important medications and documents in a place that if an event like this happens and there's damage to your home or you're displaced, you've got those emergency supplies that you need.

And the nice thing about something like that is it can help with an earthquake, but can also help, you know, if there's some flooding or a severe storm or that sort of thing.

And then on the higher end, there's sort of more complex ways to more specifically prepare for earthquakes.

So one of the things we recommend is to make sure heavy objects are bolted to the wall, like water heaters and heavy shells and things like that, so if an earthquake occurs, those things don't fall down and cause more injury or damage.

And then maybe I kind of the highest end of preparation is something we talk a lot about with people, which is getting earthquake insurance.

So homeowners insurance does not cover damage to a home from an earthquake, and so for people living in this region, even though it may be a small percentage chance that it's going to happen tomorrow, when you imagine a major event that could significantly damage or even destroy your home.

Having something like earthquake insurance might be something that you want to consider doing.

JOHN YANG: What about state and local emergency preparedness officials?

Are they worrying about this?

BRIAN HOUSTON: Definitely, and one of the things they really work on is just making sure people know that this risks exist, because, you know, you don't get a lot of big earthquakes in the area.

You talk about earthquakes in the U.S., and you think about California, Washington, you don't usually think about Missouri.

So they're very active in getting the word out that this is a risk, and then doing things like community drills, so people know what to do, right when an earthquake occurs, to stay safe.

But again, people have a lot on their minds and a lot on their plates.

So even though this may be one risk, it doesn't always seem like the most obvious and likely to occur risk this week.

JOHN YANG: And on the west coast in California, a lot of attention to building codes for new construction and trying to retrofit existing buildings.

Is anything like that going on in the new management area?

BRIAN HOUSTON: Not nearly as much as you see on the West Coast, for sure, because not as many people are aware of this risk.

I don't think that there's quite as much emphasis and support on building codes.

There are definitely some efforts in some areas, but you don't see a lot of statewide policy in places like Missouri or Tennessee in this area.

So, there's definitely a lot of opportunity for improvement in terms of helping prepare communities relative to building codes, but not a lot going on and not a lot has been done so far.

JOHN YANG: Brian Houston of University of Missouri, thank you very much.

BRIAN HOUSTON: Thank you, John.

JOHN YANG: The U.S. Customs and Border Protection says that in July, arrests of people illegally crossing the U.S.-Mexico border were the lowest they've been in nearly four years.

It comes after the Biden administration imposed new rules intended to encourage migrants to use legal pathways to seek asylum.

There's even an app for that.

But as Gustavo Solis of KPBS in San Diego reports, the app isn't always helping the most vulnerable migrants.

JOE BIDEN, U.S. President: Migrants will be restricted from receiving asylum at our southern border unless they seek it after entering through an established lawful process.

GUSTAVO SOLIS (voice-over): When President Joe Biden announced the new restrictions in June, he said asylum seekers should use existing legal pathways to enter the United States.

JOE BIDEN: Those who seek come to United States legally, for example, by making an appointment and coming to a port of entry, asylum will still be available.

GUSTAVO SOLIS (voice-over): Make an appointment.

Sounds easy, and it is, at least in theory, all you have to do is download the CBP One on your smartphone, fill out the application and schedule an appointment.

But in practice.

JEREMY JONG: The app is famously glitchy.

In preparing for this interview, I tried to use the app.

I downloaded the app and I tried to make an appointment, and it glitched out.

GUSTAVO SOLIS (voice-over): That is Jeremy Young.

He's an attorney with Al Otro Lado, a nonprofit law firm that represents migrants with asylum claims.

And Young says that CBP One has bigger problems than just being glitchy.

JEREMY JONG: Not everyone has a smartphone.

GUSTAVO SOLIS (voice-over): Migrants without smartphones cannot get appointments.

Also the app only comes in three languages, so good luck if you do not speak English, Spanish or Haitian Creole.

And using the app is practically impossible for migrants with certain disabilities, for example, people who are blind.

JEREMY JONH: What the app does effectively is it precludes these people from the asylum process.

GUSTAVO SOLIS (voice-over): The app's biggest problem might be that demand heavily outweighs supply.

There are only 1,450 CBP One appointments available every day, but tens of thousands of migrants trying to get one.

JEREMY JONG: What you're doing is you're funneling everyone into one line, and the line is already longer than any line you've ever seen in your life.

GUSTAVO SOLIS: President Biden's executive actions do not increase the number of CBP One appointments.

Already, the average wait time in Tijuana is seven months, and local officials worry that shelters will overflow with people waiting for appointments.

Jasmine an asylum seeker from Mexico, says that the long wait times are taking a toll on everyone's mental health.

JASMINE, Mexican Asylum Seeker (through translator): There's a lot of anxiety and depression here in the shelters, especially among the women and children.

GUSTAVO SOLIS (voice-over): She says that a lot of the women and children in the shelter are depressed and anxious.

Some of the women are experiencing hair loss.

JASMINE (through translator): Yes, it's frustrating.

Several mothers here are going bald.

The ones who have waited here five or six months.

GUSTAVO SOLIS: Mariam, a woman traveling with her two teenage sons, started to cry when asked her how long she had been waiting.

WOMAN (through translator): It's been such a long time to wait.

We're fleeing because of organized crime back home.

GUSTAVO SOLIS (voice-over): Maria says she decided to flee her home in the Mexican state of Michoacan after a local drug cartel burned her business to the ground and tried to recruit her sons.

She doesn't feel safe in Tijuana.

Maria has tried to request asylum in person at the legal border crossing, but every time, border patrol agents just keep turning her back telling her to use the CBP One app.

MARIA, Mexican Asylum Seeker (through translator): They say that we have to cross legally.

But what do we do if there are no legal options available?

GUSTAVO SOLIS (voice-over): Maria says she wants to follow the legal process, but she's starting to lose hope, and she's not alone.

Officials in Tijuana say CBP One's long wait times actually contribute to illegal crossings.

Enrique Lucero is head of Tijuana's Migrant Affairs Department.

He says roughly 1/3 of migrants who cross the border illegally only do so after they try to schedule CBP One appointments.

ENRIQUE LUCERO, Migrant Affairs Officer, Tijuana, Mexico (through translator): They come in with a lot of post-traumatic stress.

They want to come across as quickly as possible, because they believe that whatever they're fleeing will follow them to Tijuana.

GUSTAVO SOLIS (voice-over): He says migrants lose hope after waiting several months.

Lucero believes that forcing more migrants to use the app without increasing the number of appointments could intensify the crisis that Biden says he's trying to solve.

ENRIQUE LUCERO (through translator): If you're going to impose these new rules, then you should increase the number of CBP One appointments, right?

GUSTAVO SOLIS (voice-over): In June, several immigrant advocacy groups filed a lawsuit to block the new rules.

For PBS News Weekend, I'm Gustavo Solis in Tijuana.

JOHN YANG: This week, Texas sued the Biden administration to try to block new federal minimum staffing requirements for nursing homes.

The new rules could eventually require facilities that get money from Medicare to hire tens of thousands of nurses and aides.

Ali Rogin looks into this controversial mandate.

ALI ROGIN: The nursing home rule announced in April phases in staffing requirements, including that a registered nurse be on site 24 hours a day, and that each resident get a minimum number of hours of direct care each day.

But like many industries around the country, these facilities are grappling with staffing shortages.

We spoke to one nursing home worker who has been on the front lines of care for 34 years.

BONNIE GAUDRAEAU, Licensed Practical Nurse: Not everybody's teeth get brushed every day.

People's nails aren't cut like they used to.

Beds aren't being made.

Staff has to take shortcuts to get things done because there's less of them to provide all those -- all the care that the residents need.

The system is so broken and so short-handed and so difficult to manage with the different combinations of patients that you're not able to provide the care for the people that really need it at the moments they really need it.

ALI ROGIN: The new rule faces pushback from the nursing home industry for being unrealistic, and from patient advocates who say it doesn't go far enough.

Jordan Rau is a senior correspondent at KFF News, and has covered nursing homes for more than a decade.

Jordan, thank you so much for being here.

Why did the Biden administration want to put this role in place?

JORDAN RAU, Senior Correspondent, KFF News: Well, the pandemic really exposed the degree to which nursing homes were in dire straits.

Over 200,000 people died in them just from COVID alone, and that put a lot of pressure on it.

And so they really, there's been pressure for years, really decades, to improve the core issues there, which are, you know, some of those were mentioned in just before, but also people falling a lot because of low staffing, bed sores or regular problems, people not getting their medication, people not getting food on time and such, and they saw this as an opportunity to really push hard and make some fundamental changes on staffing.

ALI ROGIN: It has been getting some backlash from various stakeholders.

Why the backlash?

JORDAN RAU: Well, it's very expensive.

I mean, it's going to cost billions of dollars to staff up for the industry as a whole.

Now, some of these nursing homes already have enough staff to meet the minimum requirements that the Biden administration is requiring, but most don't, and it's going to be extremely expensive to hire those people, and a lot of people don't want to take these jobs right now.

I mean, if you're a nursing aide, the average pay is about $19 an hour.

People don't want to do that.

It's a very, very difficult job.

So in some places they'll have to increase the wages.

So the industry claims that they can't afford it, and so they've resisted it, both politically, they've gone to Congress, and they're looking to block and overturn the rule, and also legally and going to the courts.

ALI ROGIN: So what else is behind these staffing shortages?

Because apparently, you know, industry insiders will say there are 99 percent of these nursing homes that have open jobs, but they simply can't find people to fill the jobs.

Why is that?

JORDAN RAU: A lot of it is the money, but a lot of it is people also got burned out doing these jobs during the pandemic.

I mean, it was brutal work.

And, you know, watching your patients die was really, really difficult.

The fact that these places are understaffed becomes a really bad cycle, because you -- if you are in a nursing home that doesn't have enough staff, your job is so much harder, and so it becomes harder to recruit people for those.

In most nursing homes, the average turnover in a nursing home is about 50 percent every year.

There's also a problem, and if there's not really a career ladder for some of the people, so if you go in at the lower level, you're not really working towards something.

And so a lot of people are like, hey, I can make, you know, the same amount of money, or more money working at Target or even working at McDonald's, and it's, you know, a much easier job.

ALI ROGIN: The labor unions that represent a lot of these nurses do support this role.

And we heard from April Verrett of the Service Employees International Union, SEIU, who said, caregivers have been demanding safer staffing for years, and finally, feel heard now.

So what are nursing home workers who are currently in the industry telling you?

JORDAN RAU: Well, I mean, they've, you know, for a long time, felt undervalued, underpaid, also really resentful, because while there are a lot of nursing homes that are really in dire straits financially and closing up, there are also owners and corporations that have been making a lot of money off of the nursing homes.

There have been, you know, ones that are buying it up, and they just feel like there's a lot of money out there that should be spent on the quality of staffing, and that has sort of been one of the major issues that isn't being addressed in this rule, which is, you know, how much money can these do these nursing homes, or some of them, need to staff up at this level.

And there's no money attached to the rule.

It's just, you've got to hit this level or else you're in trouble.

ALI ROGIN: Are these nursing homes equipped to comply?

JORDAN RAU: You know, it's hard to generalize, right?

I mean, I think that there's some nursing homes.

There's about, let's say 20 percent that are doing it, there's going to be about 20 percent that are going to be able to get a waiver from it, because they're going to be able to demonstrate that there just aren't enough, you know, qualified workers in their area.

And then the other ones, it really depends.

It really comes down to what the administration does in terms of penalties, because if you are going to just cite them with a small financial penalty, for instance, it's still in a nursing homes financial just forget the patients right for a second, and just look at the books, it's still cheaper to pay the penalty than it is to staff up.

And so that's the problem that the administration has when they decide exactly how they're going to penalize or enforce this, because, on the flip side, if they penalize them too much, you can drive a struggling nursing home out of business.

ALI ROGIN: What do analysts say about whether this is a band aid on a bigger issue, or is this really getting to the heart of an industry that has been problematic for decades?

JORDAN RAU: It's both.

It's a floor, right?

This is minimum staffing.

So no one is saying, like, if all your nursing homes are staffed at this level, the care is going to be fantastic.

So it's considered a good first step to bring up some of the worst nursing homes in the country to levels that are acceptable.

There's some really good nursing homes out there.

There's some really good care being given.

There's some really good owners, but still, overall, the quality of care is not at the same level that you get in a hospital or you get in private pay, you know, at your home.

And there's still a long way to go to really get a high quality of care for some of the frailest Americans.

ALI ROGIN: Right at the heart of all of this is the patients who are very vulnerable people.

Jordan Rau with KFF Health News, thank you so much for breaking this down for us.

JORDAN RAU: Thanks for having me.

JOHN YANG: And that is PBS News Weekend for this Saturday.

I'm John Yang, for all of my colleagues, thanks for joining us.

See you tomorrow.