Nursing homes will face new frontline staffing requirements

Nursing assistants will be limited to eight residents as a means of ensuring safe, effective care, while task force will examine workforce recruitment and retention
Credit: (AP Photo/Wilfredo Lee)
New legislation signed by Gov. Phil Murphy limits the responsibilities of nursing assistants to no more than eight residents during the day shift.

Come February, New Jersey nursing homes must adhere to strict frontline staffing level requirements, the latest in a series of state reforms designed to improve resident care in an industry that has struggled to effectively respond to the pandemic.

Gov. Phil Murphy signed legislation Friday that limits the responsibilities of nursing assistants to no more than eight residents during the day shift, something elder advocates and labor leaders said is needed to ensure safe, effective care. The bill, which Murphy called “long overdue,” also set caregiver-to-resident ratios of 1:10 for the evening and 1:14 for overnight hours and creates a task force to examine workforce recruitment and retention.

Deaths of both patients and staff at long-term care sites account for half of the state’s nearly 14,500 confirmed coronavirus fatalities. Since March, some 39,500 COVID-19 cases have been tied to long-term care, out of more than 225,400 diagnoses statewide.

“Today, New Jersey enacts one of the most meaningful pieces of nursing home legislation our state has seen in decades,” Milly Silva, the executive vice president of health care union 1199SEIU, said as the bill was signed. “This law will fundamentally improve standards of quality care in nursing homes by ensuring that facilities hire sufficient frontline staff to meet the basic needs of residents.”

Increasing regulatory oversight

The measure — strongly opposed by nursing home operators concerned about the cost and lack of available staff — is one of six Murphy has recently signed into law to increase regulatory oversight and boost support for these facilities, which care for roughly 45,000 frail elderly individuals or patients recovering after being hospitalized. Currently, regulations require residents get a certain number of hours of care daily, but don’t spell out how many frontline workers this requires.

“Staff caring for our most vulnerable residents in long-term care settings are the backbone of these facilities,” said state Health Commissioner Judy Persichilli, a nurse herself. “We have to support this workforce and give them an opportunity to grow and advance in their careers, so it is not only a more rewarding job, but also results in improved care.”

The reforms are based on a June 3 report from consultants at Manatt Health, which the state hired to provide short and longer-term recommendations to improve the COVID-19 response among New Jersey’s 272 nursing homes. The state Department of Health has also initiated changes outlined in the report to improve communication and beef up its oversight of these facilities.

Active outbreaks continued at 164 of these facilities as of Friday, according to state data.

Beyond the numbers of deaths and infections, family and caregivers describe nightmarish conditions at some nursing homes during the peak of the initial COVID-19 outbreak this spring, with residents left in dirty diapers, facing food long gone cold, or not getting medications as prescribed. Frontline staff members said they were overwhelmed, without the protective equipment needed to stay safe or reinforcements if they fell ill.

‘Bring accountability to the industry’

“Sadly, too many nursing homes are run by companies more interested in making money than protecting patients,” Murphy said. Industry officials declined to respond to his comments Friday. “These long-sought reforms will help bring accountability to the industry and protect residents, staff, and family members with a loved one living in a long-term care facility.”

The situation at New Jersey’s three veteran’s homes was also dire; the state has reported 149 deaths at the three facilities, but family members insist some individuals who died were not tested for COVID-19.

Murphy announced a change at the helm on a Friday afternoon earlier this month, when he said Col. Dr. Lisa J. Hou would replace Major General Jemal Beale as the interim leader of the state Department of Military and Veterans Affairs, which oversees the three homes. But he has declined to speak further about what he called “personnel matters.”

In addition to the staff ratio bill, Murphy signed legislation Friday that requires long-term care facilities to institute policies designed to combat isolation, an issue that has physical and mental health consequences. “Even before COVID-19, many residents in long-term care felt socially isolated and lonely,” said Assemblywoman Angela McKnight (D-Hudson), one of the lead sponsors. “The pandemic has exacerbated this problem.”

To help address industry concerns, the staffing ratio bill was amended during the legislative process; the initial version called for six residents per day shift worker. It was also changed to allow other skilled nurses to be considered as frontline caregivers in the evening and overnight shifts, when residents tend to be less active and require limited assistance.

In addition to the long-term care measures Murphy signed Friday, he has also enacted the following recommendations based on the Manatt report, according to Assembly staff:

  • Established new state requirements for responding to infectious disease outbreaks
  • Created a task force to examine nursing home safety and quality
  • Raised minimum wage standards for frontline workers; established thresholds for investments in resident care
  • Authorized a temporary Medicaid rate adjustment and appropriated more than $62 million in additional funding

Other reforms remain in the legislative pipeline, including:

  • Stricter reporting requirements for licensing and ownership
  • Higher financial penalties for facilities that violate state regulations
  • Changes to allow workers to accrue sick leave
  • Measures to provide additional supplemental funding

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