New Jersey has begun implementing a handful of expert recommendations to help nursing homes better respond to the ongoing coronavirus pandemic, state officials said, but they also have acknowledged that any meatier reforms would require legislation.
A group of Democratic lawmakers and a lone Republican have taken up that challenge, crafting eight bills designed to strengthen the resilience of long-term care facilities and enable them to better protect patients and staff from COVID-19 and other infectious diseases. Among other things, the proposals would raise pay for frontline caregivers, increase state oversight and fees for violations, and create a task force to advise state officials going forward.
Championed by Assemblywoman Valerie Vainieri Huttle (D-Bergen), who leads the Aging and Senior Services Committee, and Sen. Joe Vitale (D-Middlesex), chair of the Health, Human and Senior Services Committee, the measures are based largely on a report from consultants Manatt Health released June 3, for which the state spent $500,000. Hearings on the bills are likely to be held Monday.
“The COVID-19 pandemic has revealed cracks in our long-term care system,” the lawmakers said in a joint statement Friday, when details of the bills were made public. “While no one was fully prepared for the challenges brought by COVID-19, long-term care facilities were particularly unequipped to mitigate the spread of the virus.”
More than 183,000 New Jerseyans have been diagnosed with COVID-19, and one in five of these cases involved a staff member or resident at a nursing home or other long-term care facility, according to state figures. In addition, nearly 7,000 lab-confirmed deaths of the state’s almost 16,000 deaths overall — including lab-confirmed and probable fatalities — were individuals who lived or worked in long-term care sites, with the vast majority residents.
Among highest death rates
While nursing homes around the nation have struggled to prevent coronavirus outbreaks, facilities in New Jersey have experienced some of the highest death rates as staff members became infected, the workforce dwindled and care and family communication reportedly suffered severely at some sites.
Despite state efforts to provide guidance on testing and infection control protocols, deploy National Guard members to assist caregivers, and deliver what officials said was 30 million pieces of personal protective equipment — like gloves, masks and gowns — Gov. Phil Murphy’s administration has been widely criticized for its response. In May, the state tapped Manatt to provide expert guidance on how to improve its response.
State Department of Health Commissioner Judy Persichilli said in July the state was making progress on a number of the consultants’ shorter-term suggestions, including clearing a massive backlog of complaints and conducting infection-control surveys at all 371 nursing homes and dozens of other long-term care facilities. Officials have also held at least one planning meeting about the proposed long-term care emergency operations center, which the consultants suggested would enable more effective communication in a crisis.
Urging action from lawmakers
“Folks say, well what about the rest of the recommendations? A lot of them require statutory fixes,” Murphy said last month, praising efforts by Vitale and Vainieri Huttle to draft legislation. Vainieri Huttle also led a hearing in mid-June at which Manatt leader Cindy Mann testified about their findings and urged leaders to take action on the recommendations.
“The Manatt report showed COVID-19 did not create the problems in long-term care; it merely exacerbated them. Now it’s our turn to take action to address long-standing issues and ensure our long-term care facilities are prepared to get through this pandemic and future emergencies,” Vainieri Huttle and Vitale said last week, when introducing their package of bills.
Other measures may be added later, they said.
Specifically, the legislative package includes the following:
- S-2790/A-4476 – Would establish the long-term care emergency operations center within the DOH to serve as a centralized command structure and provide guidance to state emergency management officials, local and county officials, first responders and others on the needs of long-term care facilities. In an emergency, the center would be required to monitor staffing levels and other resources, communicate critical test results and oversee a regional redistribution of patients or residents, if needed. The center would also have the option of developing a data dashboard to assist with its response.
- S-2789/A-4477 – Would significantly increase the disclosure requirements for those seeking to operate nursing homes, requiring potential buyers to submit detailed information to state regulators about the proposed ownership structure, organizational structure and financial arrangements and requiring them to submit to a criminal background check and a “track record review” of other facilities they own. It would also give the state greater power in screening potential buyers, audit and review operations, and monitor spending.
- S-2786/A-4483 – Would extend sick leave provisions to all long-term care employees, permitting them to accrue one hour off for every 30 hours worked and ensuring they are credited for time worked between March 9, 2020 and the effective date of the bill. While current law requires employers provide workers this option, it did not apply to all per-diem workers, which left many nursing home staffers unprotected, according to Manatt.
- S-2759/A-4478 – Requires the DOH to establish a more aggressive oversight system, with escalating fines and potential license actions for repeat violations, and mandatory surveys by state inspectors of facilities with three or more offenses per year. The department would also need to reassess and consolidate the data obtained from operators, streamline the state process for collecting this information — which would also be made public — and establish a seven-member advisory commission to provide ongoing guidance.
- S-2788/A-4479 – Would establish within the Treasury department a program to make one-time cash payments to frontline workers at long-term care facilities who provided at least 25 hours of direct care services for a minimum of 10 weeks, beginning in early March, and earned less than $25 an hour during that period. The amount of the payments would be based on the availability of federal funding and can be adjusted as needed by the state treasurer.
- S-2758/A-4482 – Would establish a minimum wage for long-term care workers that is $3 higher than the existing wage — now at $11 and set to increase to $15 by 2024 — plus annual cost-of-living adjustments. It also enables the state Department of Human Services, which oversees Medicaid — which pays for the majority of nursing-home patients in New Jersey — to review the state rate schedule for these payments and assess how much is going to care versus administrative costs.
- S-2787/A-4481 – Would establish the New Jersey Task Force on Long Term Care Quality and Safety, a 21-member body — with representatives of the public, state agencies and other stakeholders — to recommend changes to improve patient-centered care, staff and resident safety, sustainability and more for long-term care facilities. The group would disband a month after issuing a public report.
- S-2791/A-4480 – Calls for the DHS to review the requirements for its Medicaid managed-care programs and determine what federal waivers or other changes would be needed to allow the state to end contracts with long-term care facilities with multiple health or safety violations. The vast majority of the 1.7 million Medicaid members are covered by managed-care plans, which are administered by private insurance companies.