As the coronavirus has continued to spread throughout New Jersey in recent months, COVID-19 infections have cropped up in a growing number of nursing homes, despite rising vaccination rates among staff and residents and other infection-control precautions.

But the news isn’t all bad, according to leaders at these facilities, which were particularly hard-hit by the virus earlier in the pandemic. These new outbreaks, they said, are generally smaller in scale, involve fewer individuals, and frail, elderly residents are not being hospitalized or dying at the high rates seen last year.

“People are still testing positive, but they’re not all going to the hospital. And we’re seeing more cases with mild symptoms,” said James McCracken, president and CEO of LeadingAge New Jersey and Delaware, which represents about 50 nonprofit long-term care providers in the Garden State.

COVID-19 outbreaks at long-term care facilities — in which positive cases are diagnosed among at least two employees, or one resident — may have peaked last week when 161 nursing homes, assisted living sites or rehabilitation hospitals reported active infections. While the number of facilities with outbreaks had dropped to 153 by Friday, that’s more than eight times the number that had active infections in mid-July, when the virus appeared to be ebbing, according to an NJ Spotlight News analysis.

Nursing home representatives in New Jersey said the trend underscores how long-term care facilities are part of the larger community and, with visitors and staff coming and going daily, the virus finds its way inside. They blame the highly transmissible delta variant, which accounts for almost all the current cases in the state and can be spread by vaccinated individuals.

“As long as cases are rising outside these facilities, we’re also going to see cases inside the facilities,” said Andy Aronson, president and CEO of the Health Care Association of New Jersey, which represents hundreds of long-term care facilities.  “But although the number of outbreaks are higher (than this summer) it’s nothing like last year,” he added. “We’re not seeing the outbreaks, by and large, spread to lots of people in these facilities and we’re generally not seeing serious illness or death.”

Nearly one-third of NJ’s COVID-19 deaths

More than 56,000 COVID-19 infections have been linked to New Jersey nursing homes since the pandemic emerged here in March 2020, and at least 8,500 residents and workers have died as a result, state data shows, accounting for nearly one-third of the state’s total COVID-19-related fatalities. As of Friday, there were 660 active infections among residents and 526 among staff.

‘The rise in facilities with COVID-19 outbreaks is alarming and we must not lose our focus.’

Evelyn Liebman, advocacy director for AARP New Jersey, agreed the delta variant is likely the cause of these infections, but urged nursing home operators to do more to reduce the potential for spread by requiring residents, staff and visitors to be vaccinated. “The rise in facilities with COVID-19 outbreaks is alarming and we must not lose our focus,” she said. “The vaccine provides strong protection against delta and saves lives. We owe it to our most frail and at-risk loved ones to do everything we can to keep them out of harm’s way.”

State health officials also attributed the increases to the more contagious delta variant, which they said is more likely to evade vaccine protection, reducing the relative protection these shots provide for nursing home residents. The state Department of Health has hosted several calls with nursing home leaders to encourage them to identify who would qualify for a booster dose, DOH communications director Donna Leusner said.

Booster doses were approved Thursday for Pfizer vaccine recipients who are age 65 or older and adults of any age who are more at risk for infection because of their health status, job or housing situation. DOH directed vaccination sites to start administering third doses to eligible individuals Friday. Leusner said the health department has also surveyed all long-term care facilities to ensure they have a pharmacy partner in place to conduct booster-shot clinics for residents and staff, all of whom are likely eligible.

Aronson, with HCANJ, agrees booster doses are key to protecting the nursing home population. “That’s what we really need at these facilities,” he said, noting that some residents have already received third doses when seriously immunocompromised individuals were given permission for a booster this summer.

Vaccine resistance

But some segments of the public are still resistant to the vaccine, in general.

In August, Gov. Phil Murphy called for health care workers, including nursing home employees, to be vaccinated or get tested regularly; federal regulators also mandated immunization for health care staff — without offering a testing option. Some employers in New Jersey have gone further, threatening to fire workers who don’t get COVID-19 shots. But while nursing homes must screen all visitors for potential symptoms, facilities can’t require visitors to be immunized.

More than nine out of 10 nursing home residents in New Jersey have been inoculated against the coronavirus, according to federal data, along with at least 73% of the workforce. That’s higher than the national average for nursing home staff vaccinations, around 63%, and up from April when barely half of these employees had received shots.

Averages can hide the outliers, however, and Liebman noted that at least one in four workers are not immunized at nearly half the facilities in the state. “So while New Jersey’s overall vaccination rates among staff are improving — and are doing better than some states, worse than others — New Jersey’s nursing home residents need bolder action now,” she said.

‘Many members also wish we could require visitors to be tested.’

McCracken, with LeadingAge, said the government mandates have certainly helped to drive up immunization rates among the workforce. “Many of my members have been able to go one step further and require” vaccination, without offering a testing option, he said.

“Many members also wish we could require visitors to be tested,” McCracken continued, something not currently permitted by federal regulators. “We do the best we can,” he said, using temperature checks and other screenings to try to keep the virus at bay.

DOH has also worked to improve infection control at nursing homes statewide following a consultant’s report from June 2020 that identified this as a perennial problem. The department hosted a webinar on the topic last week that attracted hundreds of long-term care stakeholders, including McCracken, and it has dispatched expert teams to assess infection control at 30 facilities and provide free training to staff, Leusner said.

The department has also partnered with academic and hospital groups to hold months of online infection-control training sessions for long-term care providers, she added. Last week, the state awarded $800,000 in funding to four organizations to continue this type of training.

Nursing home leaders agreed this focus on infection control needs to continue, regardless of vaccination rates. “Even if you have 100% vaccine coverage, you’re still going to have breakthrough cases with COVID-19. That’s just the reality,” McCracken said. “It’s a disease that’s very hard to keep out of a building.”

We’re in this together
For a better-informed future. Support our nonprofit newsroom.
Donate to NJ Spotlight