‘It’s Backbreaking and It’s Heartbreaking’: Working in NJ’s Long-Term Care Facilities

As legislation is crafted to address inability to keep out coronavirus, nursing-home workers among those who testify
Nursing-home workers and advocates were among those to testify Thursday before a panel of New Jersey lawmakers considering how to improve the long-term care industry’s ability to withstand disease outbreaks.

After 17 years caring for nursing-home residents in New Jersey, Margaret Boyce is paid $15 an hour to feed, clean and otherwise care for as many as two-dozen frail, elderly individuals at a time.

“It’s backbreaking and it’s heartbreaking,” the certified nursing assistant (CNA) testified Thursday before a panel of New Jersey lawmakers considering options to strengthen the long-term care industry and improve its ability to withstand disease outbreaks. Nursing homes have struggled to contain the spread of the novel coronavirus, frustrating family members and public officials.

Under the pandemic, Boyce said supervisors at the Edison facility where she works commandeered the better protective gear — leaving frontline workers like her with less effective options — and failed to warn her when those she cared for were diagnosed with COVID-19. Eventually, Boyce, a member of health-care union 1199SEIU, said she became ill, which she called “the worst experience I ever had.”

‘To some people our lives aren’t worth that much’

“As a nursing-home worker, you feel invisible,” Boyce told members of the Assembly Aging and Senior Services and the Senate Health, Human Services and Senior Citizens committees. “And in this pandemic, we’ve learned that to some people our lives aren’t worth that much.”

Assemblywoman Valerie Vainieri Huttle (D-Bergen), who chairs the assembly panel, assured Boyce her life and work are valued. Vainieri Huttle and Sen. Joe Vitale (D-Middlesex), the longtime health committee chair in his house, are working with colleagues to craft legislation to address gaps in nursing homes and other long-term care facilities. Gaps were identified by Manatt Health, a consultant hired by Gov. Phil Murphy’s administration to recommend ways to improve the coronavirus response in these facilities.

Advocates for long-term care residents and staff largely embraced the legislative proposals, which are designed to increase the state’s regulatory oversight and penalties for violations, strengthen infection control protocols and boost pay for CNAs like Boyce.

But they also urged lawmakers to go further — expanding the scope of some measures to cover frontline workers who care for elderly and disabled residents at home and adding more family and staff voices to an advisory task force, for example — and to fill in missing pieces. The committees did not vote Thursday; lawmakers said they will make changes to some bills and may add others.

AARP and other organizations called for legislators to add to the package a long-debated measure that would set a statutory cap on how many residents each CNA could care for at once; the ratio is currently governed by regulations that are far less specific. The concept is a priority for labor unions but opposed by industry representatives who raise concerns about the cost and the existing workforce shortages.

Adequate staffing is key

“Adequate staffing levels are the linchpin to ensuring that the bold actions we are discussing here today are successful,” said state Long-Term Care Ombudsman Laurie Facciarossa Brewer, who said the legislation “will move New Jersey toward a more resilient long-term care system that can navigate future crises with much less tragic results.”

Some representatives for the long-term care industry offered tentative endorsements of the proposals, but stressed the need for state officials to support nursing-home operators in the reform process. While they welcomed the additional funding — including $155 million Murphy announced Monday to support frontline workers and infection control programs — operators said appropriations must be sustained over time to fund real change.

“Each of the bills in this package require notable investment,” said Jim McCracken, president and CEO of LeadingAge New Jersey & Delaware, a coalition of nonprofit nursing homes. He said New Jersey has “fallen short” in providing funding for nursing-home residents over the past decade, however, adding, “it would be a travesty to let this happen again.”

Defending the nursing homes

But Jonathan Dolan, president and CEO of the Health Care Association of New Jersey, which represents many long-term care facilities, called the legislative proposals “not helpful” and suggested they distorted conclusions in the Manatt report “by advancing a debunked narrative that somehow nursing homes are to blame.”

The 100-page report noted that community spread influenced what nursing homes were affected, but also identified long-standing issues at these facilities that made it hard for them to contain or control the virus. “Despite efforts to manage spread of coronavirus in NJ and elsewhere, COVID-19 fed on and exposed weaknesses in our health-care system, perhaps most notably in our nursing homes,” the consultants wrote.

“All these bills accomplish is to heap additional regulation on an already highly regulated industry,” Dolan said, noting he welcomed the forum to “push back” on claims that the industry can’t police itself. “We were fighting this with all we had, but we didn’t know the enemy. We all did the best we could,” he said.

Milly Silva, executive vice president of the state’s 1199SEIU chapter, said reforms must be focused on protecting and honoring both residents and caregivers. “I wish the industry was reflective of all good actors, ones that put care before profit,” she said. “But wishing doesn’t make it so.”

Nursing homes have been hard-hit by the pandemic across the country, but federal data shows New Jersey’s long-term care facilities have had the highest positive case rate and second-highest death rate, based on resident population, nationwide. More than 37,600 COVID-19 cases have been diagnosed among residents and staff at the state’s nearly 600 long-term care facilities — 20% of New Jersey’s total case count since March  — and more than 7,000 of these individuals have died, accounting for half the state’s total lab-confirmed fatalities.

Fatalities in veterans homes

New Jersey’s state-run veterans homes have also suffered significantly under COVID-19. Data from these facilities is tallied separately from other long-term care sites but shows at least 650 residents have been diagnosed with the virus, and 146 have died.

But veterans and resident advocates testified Thursday that they suspect the total number of fatalities at these facilities is higher. They described how the workforce dwindled as more people became sick and administrators told frontline workers not to use gloves or masks in order not to frighten residents or kept the more effective equipment for themselves.

“Even in combat you wanted to be counted where you died and when you died,” said Glenn Osborne, an Army vet who heads the resident council at the New Jersey Veterans Memorial Home in Menlo Park, where he also lives. “Their friends and their families deserve better,” he added, noting, “Sadly, today there’s only 167 residents left.”