Trying to avoid a repeat of COVID-19 disaster in NJ nursing homes

Training program underway to improve infection control, keep residents and workers safe
Credit: (AP Photo/Seth Wenig)
File photo: March 25, 2020, a resident of St. Joseph’s Senior Home, Woodbridge is helped on to a bus after an outbreak of COVID-19 there.

Health care leaders in New Jersey — and across the nation — are hoping a collaborative training effort to improve infection control and resident care at nursing homes can help avoid a repeat of what happened in spring, when coronavirus cases nearly overwhelmed many long-term care facilities.

To sweeten the pot, $6,000 in additional federal funding is available to each nursing home that participates in the training, organizers note.

The collaboration — led in New Jersey by Rutgers Robert Wood Johnson Medical School, in New Brunswick — involves 16-weeks of online training led by clinical and policy experts and is open to the state’s 364 Medicaid and Medicare-certified nursing homes. Lessons will touch on how to prevent COVID-19 from entering facilities; how to reduce the spread if it does; and how to better care for residents with and without the virus, including steps to reduce social isolation, which can take an enormous toll on residents’ physical and mental health.

“Together, we want to support our nursing homes and do what we can to avoid a repeat of those dark days this past spring,” Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute, wrote in a blog post Thursday. The institute is one of Rutgers’ partners in the New Jersey project, along with the state Department of Health, experts from Trinitas Regional Medical Center in Elizabeth, and other organizations.

Schwimmer said more than half of New Jerseys’ qualified nursing homes had already signed up as of last week. The first training session started in late October and a second is planned to begin on Nov. 9.  The aim is to enroll the remaining eligible facilities before Nov. 16, so a third and final session can launch the following day, she said. (Details and registration information are here.)

Veterans homes included

“So far in New Jersey, they’re responding very well,” Schwimmer said. Long-term care trade groups have encouraging their members to participate, she said, and the DOH has made calls to ensure the three state-run veterans homes are enrolled.

“This gives us an opportunity to work together on the issues you face daily. We’re in this unprecedented situation together,” said DOH commissioner Judy Persichilli in a video message directed at nursing home leaders, which was distributed by the Quality Institute. “Taking this course is an important step that keeps us on the path of continuous best-practice quality improvement and, most importantly, demonstrates our commitment to some of our most vulnerable elderly residents,” she said.

The program is part of a national initiative created by the Agency for Healthcare Research and Quality, a federal office charged with improving safety and quality in the nation’s health care system, along with the Boston-based Institute for Healthcare Improvement and the University of New Mexico’s ECHO Institute, which has developed video training programs to improve health outcomes in various treatment areas, like maternal child health and substance use disorders.

The program was launched in April, at the height of the initial wave of coronavirus cases, and tested in other states. The nationwide initiative is funded with $237 million in federal coronavirus relief dollars, which will cover the program costs and stipends for participating facilities. “It’s a unique example of where there is strong federal leadership and vision and funding behind it,” Schwimmer said.

While the situation is not as dire as it was earlier this year, 191 of the state’s nursing homes were facing active outbreaks last week; there have been nearly 40,000 positive COVID-19 cases among residents and staff at these facilities since March, according to state data. More than 7,300 coronavirus deaths have been linked to nursing homes since then, half of the state’s total 14,600 lab-confirmed fatalities.

Charged with caring for some of society’s most fragile elderly citizens, who live close together where infection can easily spread, nursing homes faced significant challenges during the pandemic. Workers said they did not always have proper protective equipment or training on infection control; and, in some cases, when staff members got sick the workload became overwhelming for the few who remained.

Nursing homes often not prioritized for PPE

“In the midst of this crisis, we must do more to keep nursing home residents and health care staff safe as they shelter in place,” said Dr. Fred A. Kobylarz, a geriatrician at Rutgers RWJMS and director of the Parker at Monroe Nursing Home, who will assist with the training. “Nursing homes are not often first in line for personal protective equipment, and they need clear guidance and support to implement and adhere to standards.”

The state DOH, which regulates nursing homes, took multiple steps to help reduce the likelihood of coronavirus outbreaks in these sites. But consultants with Manatt Health, hired by the state to provide recommendations, found long-standing issues — including staffing shortages and low pay, gaps in oversight, and infection control lapses — made it nearly impossible for some facilities to effectively address the pandemic.

Based on Manatt’s recommendations, the state has taken multiple steps to improve the COVID-19 response at long-term care sites, including providing more than $150 million in emergency funding and establishing an emergency operations center to improve communication with these facilities. State lawmakers also proposed multiple bills designed to improve outcomes, several of which Gov. Phil Murphy has signed, including a controversial measure that set strict requirements for frontline staffing numbers.

ECHO training is, by nature a cooperative process and the new nursing home program is designed to  encourage nursing homes to participate, not penalize them for gaps in care.  . Rutgers’ Kobylarz said this kind of collaborative learning is essential if these facilities are going to succeed in keeping residents and staff safe.

“Our nursing homes need greater understanding of how to prevent infections in their facilities, and how prevention differs in hospitals and at home,” he said. “We need to use key population health strategies to help nursing homes provide care for residents.”

The training — which Schwimmer said would also involve weekly follow-up discussions for the remainder of the year — will specifically address strategies to prevent COVID-19 from entering nursing homes and how to properly separate residents and staff to reduce the spread if an outbreak occurs. It will also explore care strategies for residents who test positive for the coronavirus but do not need to be hospitalized, as well as advance care planning — ensuring residents articulate what medical care they want should they become incapacitated — and protocols to allow dying residents to safely receive visitors.

While the federal funding requirements limit participation to Medicaid and Medicare-qualified nursing homes only for this program, Schwimmer said she hopes the New Jersey partners can find a way to build on this initiative and offer lessons to other long-term care providers, including assisted living facilities, in the future.

“I think everyone would benefit,” she said. “The goal is building an infrastructure to support long-term care.”