New Jersey plans to invest $155 million to help beleaguered long-term care facilities strengthen their coronavirus response, but officials said Monday the money will come with strict prerequisites designed to ensure it is spent on things like frontline staff, testing and infection control — not just counted as profit.
The bulk of the funding — $130 million, a mix of state and federal dollars — will be distributed to eligible facilities through a 10% increase in New Jersey’s Medicaid reimbursement rate, according to the state Department of Human Services, which administers the program that pays for seven out of 10 nursing home residents. More than half of this new money will be dedicated to increasing daily caregivers’ wages, which now average $15 an hour, officials said.
The state Department of Health will channel another $25 million in federal funds to pay for testing staff at nursing homes for the coronavirus, officials said. To reopen for regular visits and host group activities, facilities must conduct weekly coronavirus testing of the workforce, have full staff and a backup plan for absences, stockpile protective equipment and meet other requirements outlined in a DOH order Monday. The timeline for reopening nursing homes also depends on New Jersey’s progress in reopening the state economy.
Gov. Phil Murphy said this additional investment would enable the state to implement multiple recommendations outlined in a report from consultants with Manatt Health, which the state hired in May to provide guidance on nursing homes. But if facilities don’t meet the benchmarks outlined, he warned that the state would recoup the funds, which are slated to be available from October through July 2021.
“We will continue to work alongside the good actors in the long-term care industry who want to do the right things by their residents, their staffs, and the families who trust them — while making sure we have strong measures in place that are needed to deal with the bad actors who put profit before people,” Murphy said at a media briefing Monday. “New Jersey will learn from this pandemic and emerge as a national model for solving immediate problems and building future resilience.”
Like nursing homes nationwide, facilities in New Jersey struggled to keep out the virus or reduce its spread once inside, where it ravaged a vulnerable population of frail, elderly residents. According to federal data, New Jersey had the highest rate nationwide of COVID-19 cases per 1,000 nursing home residents and, after Massachusetts, the second highest death rate in these facilities.
A heavy toll
Since March, some 24,600 residents and 13,000 long-term care staff have tested positive for COVID-19 in New Jersey. Nearly 7,000 deaths — all but 120 of which involved residents — are associated with the facilities, accounting for half of the state’s total 14,000 lab-confirmed fatalities.
Jonathan Dolan, president and CEO of the Health Care Association of New Jersey, which represents long-term care facilities — including many of the state’s 371 nursing homes — said his members welcomed the state support and efforts to collaborate. “Our goal has always been to ensure the safety of our residents and staff, and to be in a position to welcome those who rely on our services. As is now apparent, our industry is responding diligently and aggressively to the COVID challenge,” he said.
New Jersey has already taken some steps to put in place recommendations from the Manatt report, which identified a number of long-standing issues — like low wages for caregivers and infection control gaps — that consultants said enabled the virus spread easily in nursing homes. Others will require statutory changes; a package of bills designed to implement various long-term care reforms is slated for discussion in two legislative committees on Thursday.
DHS Commissioner Carole Johnson said elements of the rate increase will also require legislative action and noted she is talking with the bills’ sponsors, Sen. Joe Vitale (D-Middlesex) and Assemblywoman Valerie Vainieri Huttle (D-Bergen), about crafting what she called an “interim solution.” The state’s proposal — which would give the department power to collect wage data from nursing home operators — also requires federal sign-off, Johnson said.
Under the plan, officials said 60% of the $130 million total, or $78 million, would be committed to increased wages for certified nursing assistants, who dress, feed, bathe and help residents with these and other daily activities. While the exact amount of the raise will depend on each facility’s wage scale, Johnson said the added funding should allow for an average increase of 20%, or a raise from $15 to $18 hourly. The total cost would be split between $68 million in federal dollars and $62 million from the state.
“This is challenging work and we have all seen the dedication and commitment of this workforce to our older residents throughout the pandemic,” Johnson said, noting that nursing homes would be required to share certain payroll data with the state. “The proposal would ensure that facilities would be subject to recoupment of funds for non-compliance, meaning if we don’t get good evidence that the wages were passed through, we would take the dollars back from the facility,” she said.
The remaining 40%, or $52 million, is designed to help facilities comply with the DOH reopening directive. The directive requires operators to craft an updated plan to address disease outbreaks, reconfigure the floor plan to better separate infected patients, conduct additional cleaning and ensure they have a stable workforce; some sites may need to hire full-time infection control professionals. Facilities that don’t meet these standards, or have repeated infection control lapses, could also lose the additional funding, officials noted.
“Medicaid has robust tools for recouping funds including clawing back funding and decreasing future payments until a penalty is settled,” Johnson warned. “We are acutely aware of the need to ensure that any new resources directed to nursing facilities are spent as intended to protect the health and safety of residents.”
Money for testing
The health department will provide another $25 million to cover costs related to weekly coronavirus testing for the state’s roughly 90,000 nursing home staff, one of the many required reopening benchmarks outlined in the 35-page directive issued Monday. DOH Commissioner Judy Persichilli said nursing homes would also be given priority access to a saliva-based COVID-test developed by Rutgers University, which can provide results in less than 48 hours.
The order outlines a detailed four-phase process, each with specific benchmarks that facilities must meet before they can allow general visitation, which was suspended in March, or restart communal dining and other group activities. Outdoor visits were initiated in late June and a mid-July directive paved the way for limited indoor visits with pediatric or developmentally disabled residents.
Each step involves an attestation from nursing home operators, pledging to the DOH they have met the requirements.
“We must proceed with caution as we reopen these facilities. There are still more than 260 active COVID-19 outbreaks at long-term care facilities. And we know the virus is still circulating in our communities,” Persichilli said. “It is essential that there are safeguards in place to keep this virus from entering a nursing home.”