While the spread of the coronavirus appears to have slowed in general in New Jersey over recent weeks, there is growing concern about the impact COVID-19 is having on individuals in nursing homes and other long-term care facilities — sites connected to more than half the disease-related deaths in the Garden State.
State officials have taken multiple steps in recent days to provide additional support to long-term care facilities, including hiring a team of national experts and deploying members of the National Guard to one particularly hard-hit nursing home in Sussex County. They have also promised universal testing of all residents and staff and waived regulations to allow nursing students to be hired by these facilities.
But some experts are concerned these actions have come too late and fail to address some of the basic concerns nursing homes face: insufficient personal protection equipment, or PPE — the gowns and masks needed to reduce the chances of infection — and not enough staff to properly care for residents, including those who can help with essential daily needs like bathing, dressing and eating.
“It’s stunning to me that (state officials are) not doing anything to flatten that curve,” said Dr. David R. Barile, who heads geriatric and palliative care services at UPENN Hospital in Princeton, pointing to state data that shows deaths in long-term care have climbed steadily to nearly 4,600 in recent weeks. Close to 24,900 residents and staff at these facilities have tested positive for COVID-19, according to the state.
‘Turn on the lights, count the death’
“All they’ve done is said, ‘Let’s turn on the lights and count the death.’ We’re just watching that bar graph go up,” Barile said Thursday, echoing the comments he made in an open letter to Gov. Phil Murphy he published on May 1.
Barile, who founded the Goals of Care Coalition in New Jersey, which seeks to improve end-of-life and palliative care, said he is pleased with the state’s decision to tap outside expertise. But that alone won’t solve the problems these homes are facing, he said. “We need bodies — physical people in there to help feed and care for these frail elders sequestered in their rooms.”
COVID-19 has been diagnosed in more than 133,600 New Jerseyans, including 8,800 who have died, according to state figures, taking a particularly hard toll on individuals who are elderly or have underlying health issues like diabetes and heart conditions. Nursing homes — which have struggled with staff shortages for years — care for those who are frail and elderly, have significant medical needs, or have been hospitalized and need more time to recover before going home; 513 facilities have been diagnosed with at least one case, according to the state.
“We are taking aggressive measures within state government to protect the residents and staff at these facilities,” Murphy said at his daily briefing Wednesday. “But we also know we won’t have all the answers, and in the midst of their efforts, we will also need to look more broadly at this issue. Not just for the immediate days ahead, which obviously is our priority, but also for the months and the years to come.”
Calling in outside help
That led the state draft two experts associated with Manatt Health, a nationally recognized consulting firm with offices in New York City and Washington, D.C., among other cities. Murphy said the team — led by former Obama administration health policy leader Cindy Mann and Carol Raphael, who led the Visiting Nurse Service of New York and served on AARP’s national board — has three charges: to provide “immediate support” to the Department of Health, conduct a “two to three-week review to address immediate concerns” to protect residents and staff, and to make “long-term, systemic, reform recommendations.”
“The review will look at what additional protocols, resources and equipment should be put in place to best protect our residents,” said DOH commissioner Judy Persichilli in outlining the plan Wednesday. “They will compare New Jersey’s oversight of these facilities to other states and examine differences in outcomes. They will make recommendations on potential state or federal action to improve quality, safety, resilience and funding within New Jersey’s long-term care system.”
Mann and Raphael are true pros, experts agree, and will certainly benefit the state’s response. But details about their contract with the state have been scarce. Officials in the governor’s office and DOH declined to comment on the cost or other terms of the deal, or why the decision was made to bring them on now, when deaths at these facilities have been on the rise for weeks.
State officials also did not respond to questions about the role the group would play in immediately supporting the health department, or what the need for their assistance suggested about the department’s own capacity; some have said the DOH’s response has been hampered by staff losses it has suffered over the years.
“It’s easy to play the blame game,” Barile said, “but you have to ask, ‘are they up to the job?’” he said of the DOH.
Urging more aggressive action
AARP New Jersey, which has been urging the state to take more aggressive actions for weeks, also welcomed the assistance from the Manatt team. But advocacy director Evelyn Liebman said the current situation requires an urgent response in advance of longer-term study.
“We’re pleased to see these experts come in and help us in New Jersey but we continue to need immediate action in the areas of staffing, testing, PPE and a reliable point of contact for families,” she said. “And that has to happen now. Not in two or three weeks.”
DOH has worked on multiple levels to assist nursing homes during the pandemic; Persichilli noted Wednesday her team has issued 18 guidance documents to help them protect residents and staff, shipped facilities more than 10 million pieces of PPE and circulated a list of more than 200 licensed professionals that operators could hire. The department continues to work on a larger multiphase plan to roll out universal testing, she said, and support efforts to separate infected residents from those who are not.
Persichilli said the DOH has also dispatched inspectors to 60 facilities to review operations; federal officials have also visited Andover Subacute and Rehab, the Sussex County facility at which bodies were found piling up in a makeshift morgue on Easter weekend. Attorney General Gubir Grewal is also conducting a criminal investigation into actions at various long-term care operations.
Barile, AARP and others have for weeks urged the DOH to bring in the National Guard or health care volunteers to assist at nursing homes. Persichilli had noted the guard members available did not have the clinical skills needed, but on Thursday she announced that 120 soldiers would be deployed to long-term care sites in the days and weeks to come. Nearly two dozen members will report to Andover Subacute on Friday, she said, noting, “we are extremely appreciative of their services.”
Guard members will be assisting these facilities seven days a week, Persichilli said, in roles that include janitorial services, coordinating PPE supplies and other logistics and some culinary services. But Barile – who cares for dozens of patients and local long-term care facilities — said he’s been told these soldiers won’t be allowed to actually serve food or help residents eat, assistance many depend on in order to get daily nutrition.
“It’s a real problem,” he said. “I’m pleased they’re doing something. But if (guard members) just go in and drop the tray, that’s not enough.”