New Jersey’s battle to blunt the impact of COVID-19 is more complicated now that state officials have traced a half-dozen cases — including three deaths — to people in senior residences, facilities that shelter some of the most vulnerable citizens.
State officials announced the connection to elder-care facilities Thursday during their daily press briefing, which revealed an additional 318 cases of COVID-19 diagnosed overnight and four more deaths. Three of those fatalities involved residents at two nursing homes, in Essex and Hudson counties. (New Jersey now has 742 positive cases in all — ranging in age from three to 95 — nine of whom have died.)
“This was an eventuality that, I don’t know if we expected it, but we prepared for it, but it’s concerning,” Gov. Phil Murphy said Thursday. “It’s a concern (given) what we saw in the State of Washington.”
A nursing home in Kirkland, WA, is now considered the epicenter of the coronavirus pandemic in the United States; nearly three dozen residents have died of COVID-19, and the facility has been linked to a total of 129 cases, including some among staff members who unknowingly spread the virus to other elder-care sites where they worked, according to federal officials. Experts say the coronavirus will cause mild to moderate cold-like symptoms in most healthy people, but can be deadly for older individuals or those with compromised immunity.
New Jersey’s Department of Health did not release the names or locations of the nursing homes or assisted-living facilities tied to these cases, but officials ordered the sites to suspend new admissions and “cohort,” or separate, individuals with any respiratory symptoms. DOH commissioner Judith Persichilli said any long-term care facility with two or more residents with any respiratory issues — related to COVID-19 or not — must also hold off on new admissions.
As of March 13, the state suspended visitation at all long-term care sites, except with residents who are at the end of their life. Facilities must screen staff and vendors for COVID-19 symptoms, thoroughly clean buildings several times a day, and suspend communal dining and other group activities, Persichilli said.
“I’ve spoken with the administrators of all the nursing home facilities that currently have a positive case and they are working overtime to protect the patients and also the employees,” Persichilli said.
Supplies, safety and staffing
The longer the coronavirus pandemic continues, the greater the likelihood nursing-home operators will face shortages of face masks, sterile supplies, sanitizer, cleaning materials and other essentials, similar to the situation at acute-care hospitals. “Right now, I have 2,000 isolation gowns in stock, which might sound like a lot, but if there’s an outbreak, those gowns could be gone in two days,” said Isaac Sonenblick, administrator at Concord Rehabilitation & Healthcare Center in Lakewood and White House Rehabilitation & Healthcare Center in Essex County.
Adequate levels of supplies at nursing homes have been problematic even before the coronavirus, with employees buying washcloths and soap for patients, says Milly Silva, executive vice president of 1199SEIU United Healthcare Workers East. The union represents 8,000 New Jersey health care workers such as certified nursing assistants, licensed practical nurses, recreation and dietary aides and housekeepers. “Now I’m hearing from (union) members that at some facilities, face masks are being locked in an administrator’s office until things get really bad. If inventory is truly low, employees should be told, ‘We don’t have supplies, but here’s the best we can do to keep you safe.’”
She also believes there hasn’t been sufficient transparency around nursing homes’ emergency plans: what would be done to inform, educate and manage potential exposure. Also lacking, development of seamless plans to control the spread of infection when nursing-home patients go to an acute-care hospital for treatment and vice versa.
With schools closed throughout the state, facility operators and employees share concerns about how child care — or lack of it — will affect staffing at nursing homes. Workers who are unable to find care might choose to stay home. “We have employees with young children who are single parents or whose partners also work in the healthcare industry. It’s increasingly burdensome on them to find appropriate care for their children,” says Sonenblick.
“Our employees are mostly managing OK for the moment, but they’re concerned about reliable care as time goes on,” says Phil Bak, a manager partner of Atlas Healthcare Group, which employs about 500 people at three facilities in Cinnaminson, Pennsauken and Williamstown.
This week, the state announced amendments to New Jersey’s Child Care Subsidy Program aimed at providing relief to those on the “front lines of this public health crisis.” Among other provisions, the changes include waivers of parents/caregivers’ child care subsidy copayments and incentives for child care centers to stay open.
That only goes so far, addressing needs for employees who have infants, toddlers and preschoolers enrolled in the program, but not for those outside the program or with children in the K-12 population. Nursing home operators and 1199SEIU’s Silva both favor the government opening resource centers — perhaps in currently empty school buildings — for health-care workers’ children during the pandemic. “Our children deserve a safe educational environment where they can learn and receive meals and services during this time,” says Silva, noting a poll of her union members showed half have school-age children.
Advocacy from a distance
The no-visitor rule at nursing homes has changed, but not stopped, the way New Jersey Office of the Long-Term Care Ombudsman’s (LOTC) 10 investigators and more than 200 volunteer advocates perform their roles. Laurie Brewer, State Long-Term Care Ombudsman, describes her team as “problem solvers” for concerns including abuse, neglect, infection control, staff shortages, privacy, language barriers, food service, financial exploitation and more.
In 2018, the Ombudsman office received 7,783 calls on its confidential intake line — 1-877-582-6995 — and initiated 3,316 of its own investigations. “We’re receiving about the same volume of calls, but their nature has changed, and some from family members are especially heartbreaking,” says Brewer. “One woman visited her mother’s nursing home every day to feed her, as the mom won’t eat for anyone else. The daughter is concerned her mom will stop eating altogether.” Messages such as these are communicated to nursing homes to bring awareness to and actions around families’ concerns.
Brewer is worried the coronavirus will accelerate the number of involuntary discharges from nursing homes as the need for beds increases. “Facilities must give patients who are involuntarily discharged 30 days’ notice and a safe discharge plan. Already, we’ve heard about a man who was simply dropped off at a hotel,” she said.
Typically, ombudsman staffers and volunteers make regular visits to nursing homes, but with the visitor ban, they are relying on phones and technology to facilitate their work. Fortunately, says Brewer, her team has strong connections with many nursing-home staff and residents. Even with the best of technology, though, she looks forward to when they can once again have face-to-face conversations.
Challenge of a lifetime
If there is a bright spot in the coronavirus chaos, say nursing home operators, it’s how employees have responded. In addition to their “day jobs,” they facilitate FaceTime and Skype sessions between patients and family members. No longer able to have group recreation activities, they are finding creative ways to keep residents engaged.
One nursing home even made arrangements for a resident to witness his daughter’s wedding. The wedding party couldn’t enter a Williamstown facility under current rules, but the plan would allow the father, who is on a ventilator, to watch the ceremony from his window.
“COVID-19 is a challenge of a lifetime, but our staff is rising to the occasion,” said Ben Kurland, CEO, Allaire Health Services, which has four buildings in New Jersey (Freehold, East Orange and two in Morristown) and one in Danville, PA. “I’m amazed and humbled by what they’re doing for patients.”
— Lilo H. Stainton contributed to this story.