New Jersey lawmakers are considering minimum staffing requirements, additional public funding and stronger regulatory oversight for the state’s nursing homes — concepts the Legislature has debated for years — in an effort to bolster the facilities’ response to crises like the coronavirus.
Members of two Assembly committees that monitor senior services heard from elder advocates, a labor leader and nursing home representatives during a joint online hearing Tuesday called to examine how long-term care providers — and state overseers — handled the COVID-19 outbreak.
Nearly half of the more than 12,000 people who have died in New Jersey from COVID-19 are connected to nursing homes and the industry has been widely criticized for its response to the pandemic.
“We must think critically and systemically about how we can better protect our most vulnerable, particularly those in congregate living settings like nursing and veterans’ homes,” said Assemblywoman Valerie Vainieri Huttle (D-Bergen), chair of the Assembly Aging and Senior Services Committee, which joined the Military and Veterans Affairs Committee for the hearing. “We do not want to point fingers, but we need to create a blueprint for long overdue reform, and make sure that we as a state are prepared for any future crises.”
Lawmakers took no action Tuesday but held a discussion centered largely on a report from Manatt Health released two weeks ago — a three-week review of the nursing home crisis for which the state paid the consulting firm $500,000.
Tuesday’s hearing featured extensive testimony from lead investigator Cindy Mann, who ran Medicaid under the Obama administration. Gov. Phil Murphy has committed to spending at least $10 million in federal funds to implement recommendations from the report.
Movement on some suggested reforms
State Department of Health Commissioner Judy Persichilli said work is underway to create a single, unified emergency operations center to better communicate with long-term care providers, something Manatt identified as an immediate need. The department is holding daily meetings to develop the structure and staffing needed and will soon post a job description for a new assistant DOH commissioner who will oversee this industry, she said at an unrelated media briefing Tuesday.
It is not clear if this person would take on other duties handled by former assistant commissioner Chris Neuwirth, who was fired in late May and, according to a report in NJ.com, has filed a whistleblower lawsuit against the administration over his dismissal.
We are “moving as fast as we can and the steps so far look exciting and good for long-term care,” Persichilli said. She and Human Services Commissioner Carole Johnson submitted written testimony to the Assembly panels but declined to appear in person, something several members called unfortunate.
More than 167,000 New Jerseyans have been diagnosed with COVID-19 since it was first detected here in early March, including nearly 12,800 who have died. Those totals include nearly 23,600 positive diagnoses among residents — and more than 11,800 staff members — at 555 nursing homes, assisted living centers and other long-term care facilities in the state. More than 6,000 fatalities are associated with these sites, all but 115 of them involving residents, according to state data.
Manatt’s report does not criticize the Murphy administration directly, but highlights a number of long-standing issues that made the nursing home industry particularly vulnerable and outlined both short- and long-term actions to improve the state’s response.
‘A tragic result’
“What we learned is that COVID fed on and exposed the weaknesses in New Jersey’s long-term care facilities,” Mann told the committees. “It’s not an unavoidable result, but it is a tragic result we want to make sure never happens again.”
Prompted by questions from Assemblyman Christopher DePhillips (R-Bergen), Mann conceded that the state did err when it issued a controversial order in late March that required nursing homes to accept patients from hospitals even if they were positive for the virus. Persichilli has said the order reflected national guidance and required facilities to be able to keep infected residents separated from others, something many eventually admitted they could not do, given their physical layout and lack of staff.
“It was not the right policy judgment to make at the time, (but) it was a common policy judgment,” Mann said, noting that it also reflected the need to free up space at hospitals. The order was reversed several weeks later.
Kevin Slavin, president and CEO of St. Joseph’s Health — which includes a hospital in Paterson and an affiliated nursing home — said the DOH guidance made sense; if St. Joseph’s Medical Center had not been able to discharge patients, it might have been forced to turn away new COVID-19 cases, he said.
Persichilli “made the very difficult but right decisions during the crisis,” said Slavin, who is also chairman of the New Jersey Hospital Association, which has worked closely with DOH during the pandemic.
Long-standing issues, perennial priorities
Improving direct communication may be among the easiest of Manatt’s suggestions to implement, as others require legislative changes and significant funding in a time when state revenues are down. Several of the reforms Mann identified in her testimony — like improving pay, staffing levels, and state oversight — reflect long-standing concerns that are perennial priorities for lawmakers as well.
“I think it was already a disaster before this started,” said Assemblywoman Shanique Speight (D-Essex). “It’s sad we are in this state now, but we were already heading in that direction before the pandemic.”
Bolstering the workforce of certified nursing assistants is particularly critical, Mann and others agreed. So-called CNAs earn an average of $15 an hour and, to support their families, many are forced to work at multiple locations in jobs that put their health at risk.
“It reflects a lack of respect for the people that provide the care, as well as a lack of respect for the people who need the care,” said Milly Silva, executive vice president at health care union 1199SEIU.
With better pay — plus more training, advancement opportunities and other support — nursing homes would be better positioned to attract and retain a workforce that has less need to work multiple jobs, reducing the potential for spreading the coronavirus, advocates note. Lawmakers have advanced multiple plans to increase CNA wages over the years but have been unable to secure the hundreds of millions of dollars needed to make it happen.
Silva and others also welcomed Mann’s call for improved CNA staffing ratios, a long-standing priority for labor leaders in New Jersey and nationwide. While nursing home operators have balked at the costs involved — and some suggest the system would be too inflexible — frontline workers and their advocates insist minimal workforce requirements must be codified by the Legislature to truly protect residents and staff.
“Safe and quality long term care does not exist without adequate numbers of well-trained staff,” said Evelyn Liebman, advocacy director with AARP New Jersey. “There should be a bill on the governor’s desk requiring these staffing ratios yesterday.”
Review of rates paid is suggested
Mann and others also urged the state to consider a review of its Medicaid rates, which cover the costs for nearly two-thirds of nursing home residents and have not been increased in years. But she urged officials to ensure any increase is tied to specific quality and safety metrics and encouraged the state to beef up its oversight capacity in general.
“That’s your key leverage, to lift the payments to facilities. And we recommend you look at that very closely,” Mann said. “We think that’s a really important part of what you do to make sure you have a strong and resilient system going forward.”
Lawmakers have called for rate reviews in the past, with support from nursing home operators who said they lose millions of dollars each year caring for Medicaid-funded residents. But identifying the funding to pay the state’s portion of this tab has also proved challenging.