Nursing home reforms called for after COVID deaths are now law

Hazard pay bonus and higher wages; requirement that most revenue goes to direct care
Credit: (AP Photo/Ted S. Warren, File)
File photo: March 10, 2020, a woman who tested positive for COVID-19 is treated as her daughters look on from outside a facility near Seattle, Washington. Outbreaks at nursing homes including in New Jersey highlighted the industry’s long-running problems with infection controls and staffing.

Frontline nursing home workers in New Jersey should receive a hazard pay bonus for their work during the peak of the coronavirus pandemic and higher wages under four bills Gov. Phil Murphy signed into law Wednesday.

The legislative reforms also call for the state to establish a requirement that $9 out of every $10 in revenue collected by long-term care facilities be invested in direct care, not go to administrative costs or profit; it would take effect next July.

Other measures create a task force to oversee the nursing home industry, provide funding to offset their coronavirus expenses and codify in statute the state’s efforts to set up an emergency operation center dedicated to long-term care, a process officials said is well underway.

The reforms grew out of a June 3 report by consultants at Manatt Health, which the state hired to provide short- and longer-term recommendations on how to improve the coronavirus response at nursing homes. The Department of Health is already working to implement changes recommended by Manatt and plans to establish a new, internal long-term care division to advise the industry, while the state is investing at least $155 million in new funding to support the reforms. Murphy also reiterated a pledge for a deeper review of what went wrong.

“The residents and staff of our long-term care facilities have borne an outsized burden of this pandemic,” Murphy said Wednesday after signing the bills. “While we know this has not been a tragedy unique to New Jersey, we will learn from this crisis and emerge as a national model for solving immediate challenges and building future resilience.”

As the pandemic unfolded this spring, nursing homes around the country struggled to keep the virus out of their buildings or prevent its spread once inside; frontline workers said they were overwhelmed and unprotected; residents complained of isolation and substandard care, and families were left without answers to basic questions.

Half of state’s COVID-19 deaths

In New Jersey, roughly half of the state’s nearly 14,300 lab-confirmed COVID-19 deaths are associated with residents or staff in long-term care facilities. Of the more than 197,400 New Jerseyans diagnosed with the illness, some 38,500 cases have been linked with these facilities.

Murphy and DOH Commissioner Judy Persichilli have defended the state’s efforts to advise and support nursing home operators, but Manatt suggested there was more the state could do to protect those living and working at the state’s 272 nursing facilities.

The consultants also faulted a lack of transparency within the nursing home industry, the growing presence of for-profit models — which now account for three out of four facilities in New Jersey — and historically low pay and limited development options for frontline staff.

Murphy has also highlighted the role of what he calls “bad actors” in the nursing home industry and insisted the report, which cost the state $500,000, is part of a larger state response to the crisis.

“There will be a full accounting,” he said Wednesday, adding that the death counts at the three state-run veterans homes are the first statistics he consults daily. “I don’t blame folks for being upset for one second. We have complete sympathy,” he said. “We need to make sure we hold the mirror up to them and to ourselves.”

Persichilli told an Assembly committee on Monday that the health department so far has enacted “nearly two dozen” of Manatt’s short-term recommendations, including implementing a plan for regular testing of the more than 45,000 nursing home residents and 90,000 staff members. The department has also issued detailed guidance for reopening these facilities, required new reporting and monitoring of staffing capacity and resources, and called for nursing homes to hire infection control experts, officials said.

The DOH has already set up an emergency operations center for long-term care facilities, overseen by a new deputy health commissioner — emergency physician Dr. David Adinaro — to monitor testing, infection control supplies and medications, among other things. There is $1 million in new funding in Murphy’s nine-month state budget proposal for this initiative. There are also new requirements to encourage better public communication, officials said.

Extra $155 million

In August Murphy committed to invest at least $155 million — a mix of state and federal dollars — to increase pay for certified nurses aides, or CNAs, the nursing home employees who provide most of the daily care, and to help facilities fend off outbreaks of COVID-19.

Several of the laws Murphy signed Wednesday codified the use of those extra funds and make it possible for the state to use its own monies to increase Medicaid payments to eligible facilities by 10%; nursing homes must use 60% of the funds to reward CNAs who worked a certain number of hours at the height of the pandemic, while the rest can be used for infection control.

The measures, championed by Assemblywoman Valerie Vainieri Huttle (D-Bergen) and Sen. Joe Vitale (D-Middlesex) and colleagues from both parties, attracted support from advocates, frontline workers and nursing home residents who provided powerful testimony at legislative hearings on the bills and other reform measures last month. AARP, which advocated for the changes, praised the governor’s action Wednesday.

“These bills, the first of a larger package of legislative reforms making their way through the legislature, make significant and necessary improvements to protect residents and staff at New Jersey nursing homes and other long-term care facilities,” AARP New Jersey state director Stephanie Hunsinger said, noting she would continue to push for other reforms. “This is a tragedy that should never have happened and one that we must ensure never happens again.”

In addition to raising CNA wages close to $18 hourly, one measure would require the Department of Human Services — which oversees the Medicaid program that pays for nearly 70% of nursing home residents — to study the “costs and payments” associated with nursing homes, review the rates DHS now pays for this care and recommend changes, if needed, to lawmakers. This bill also requires DHS to establish the direct-care ratio that requires most of the revenue to go to resident care; the state would essentially get credit for future payments if audits turn up violations.

“These measures not only support our ongoing efforts to get things right for our long-term care residents, staff, and families, but also ensure we have strong measures in place to deal with bad actors in the industry who put profit before people,” Murphy said.