After 14 months in various stages of lockdown, residents at long-term care facilities in New Jersey can once again hug their friends and relatives who come to visit. They can even remove their masks if everyone involved is fully vaccinated against COVID-19.
Elder advocates and long-term care leaders welcomed the policy change, included in guidelines released last week by the New Jersey Department of Health that also addressed coronavirus testing and visitor-screening protocols. Until then, residents were required to wear masks and maintain distance and, except in rare exceptions, family visits were highly restricted indoors — regardless of immunization status.
Nursing homes and other long-term care facilities were hit hard by COVID-19, which spread rapidly in the close-quartered communities and wreaked havoc on the frail, elderly residents. But as immunizations continue to rise and infection rates fall, families and advocates have pushed facilities to return to a more normal routine with social activities and visitation.
Re-opening these facilities and allowing for safe in-person visits is an important step in “the fight against social isolation many have endured for too long,” AARP New Jersey’s advocacy director Evelyn Liebman said. Virtual visits — the only connection some residents had with family members outside — must also continue to be available, she said.
“These (state health department) guidelines address a critical issue that had been largely overlooked: freedom of movement within a long-term care facility,” said Laurie Brewer, New Jersey’s Long-Term Care Ombudsman, whose office serves as an advocate for residents and their families.
READ: Expert report maps out transformation of NJ’s troubled nursing home industry
Welcoming back the ‘old normal’
Brewer said the changes are a huge step forward the re-opening process, noting they allow for long-term care residents to return to communal dining and other group activities inside facilities and also enable visits from hairdressers, entertainers and volunteers, like the team of trained advocates her office oversees. “This will significantly reduce the social isolation and loneliness that so many residents had been experiencing,” she said.
Long-term care operators said they are eager for their residents to have more social interaction, but that need must be carefully weighed against the threat of new cases. Some also concede they are wary of actions that could prompt a visit — and possibly a fine — from state regulators.
“You’re balancing residents’ rights and their need for activities, and their need for social activity, and their need for visitation, with the infection-control side of the operation,” said Andy Aronson, president and CEO of the Health Care Association of New Jersey, which represents hundreds of long-term care facilities. “As providers, we fully support” the changes in the new guidelines, he said, “but obviously we want to do it safely.”
Roughly 60,000 New Jerseyans live in long-term care facilities, an industry that was struggling with workforce shortages and low reimbursement rates long before the pandemic struck the state last year. COVID-19 cases started ticking up at nursing homes in particular early last spring — likely introduced by asymptomatic staff members working at multiple sites — and fatalities quickly followed. By late May 2020 roughly half the state’s coronavirus deaths involved long-term-care residents or staff.
“We literally went through hell last year,” said Beth Findura, the director of nursing at Greenwood House, a senior living facility in Mercer County that lost a number of residents to the outbreak. “We don’t want to open up and do it again,” she said.
Some staff still need to be jabbed
In total, more than 55,000 COVID-19 cases and at least 8,000 deaths have been linked to long-term care in New Jersey, according to state data. Outbreaks continue, with 195 facilities reporting active infections among their residents and staff. And while close to nine in 10 nursing home residents here are now vaccinated, the immunization rate is much lower among staff. During pandemic press conferences, Gov. Phil Murphy has urged families to put pressure on nursing home operators to do more to get the workforce inoculated.
Aronson said that the numbers of vaccinated staff continue to inch up, although many employees remain hesitant. “Nobody wants their staff vaccinated more than these facilities do,” he said.
AARP New Jersey is also encouraging family members to ask questions about the immunization efforts at their loved one’s long-term-care facility, current COVID-19 case counts and infection control practices. “We must remain vigilant and recognize that there is more work to do and cannot lose sight of the chronic, ongoing problems in our long-term care system that were exposed by COVID,” Liebman said.
Consultants hired last year by the state Department of Health recommended a bevy of changes to the state’s nursing home system, many of which are now being put in place. AARP and other advocates have supported the bulk of these reforms, but not all were embraced by the nursing home industry, which argued they would drive up costs in an already fragile system. Several facilities are now in the process of closing, a situation operators blame partly on the additional costs associated with COVID-19.
Overcoming negative images
Industry leaders said many operators are struggling to overcome the negative public perception of nursing homes that flowered during the pandemic. Elder advocates are hoping the issues that emerged under COVID-19 will lead to changes in how we support aging adults, including more funding for services designed to keep people in private homes; long-term care representatives said there will continue to be a need for these highly specialized facilities. “People benefit from these services,” Aronson said.
Some operators have worked hard to reduce social isolation among their residents, even at the height of the pandemic, industry leaders said. Greenwood House organized weekly activities for each unit or wing, which masked residents could attend in person, and hosted virtual art classes, entertainment and family visits, according to staff. It also launched a popular pen pal program and, when weather permitted, held art classes and musical performances outside.
“Long-term care facilities do recognize the essential nature of residents remaining connected with family and friends and the need to combat isolation and loneliness,” said Richard Goldstein, Greenwood’s executive director. “There must be some perspective noted by elder advocacy agencies on the balance of safety and quality necessary to ensure the health and wellbeing of all residents.”
Under the new guidelines, facilities will continue to screen all visitors — inquiring about COVID-19 symptoms and potential infections — but they can scale back on some of the testing currently required for staff and residents fully vaccinated. But the rules don’t permit operators to test visitors for coronavirus or refuse those who have not been vaccinated, something Goldstein said could make nursing homes even more safe.
Masking is still required for those who aren’t immunized, but Goldstein said enforcing that mandate can be a challenge. “We certainly want to find a fair balance of privacy for residents and their visitors to enjoy in-person quality time together and mitigate risk for all residents and employees throughout the entire facility,” he said.