State officials announced a number of steps Tuesday in the effort to limit the spread of COVID-19 in New Jersey’s nursing homes, as well as a plan to enlist the public’s help in an attorney general investigation of why the virus hit long-term care facilities so hard, with more than 4,000 deaths reported to date.
Included is a four-phase plan to expand universal testing throughout the state’s long-term care system.
Officials also announced a way for family members of residents, staffers and others anonymously to share evidence of misconduct with a task force impaneled by Attorney General Gurbir Grewal. The group is looking at the extent to which those who run the long-term care system bear responsibility for the virulent spread of the disease among one of the state’s most vulnerable populations.
“We know the long-term care issue has been among our biggest challenges, if not the biggest,” said Gov. Phil Murphy on Tuesday, during his daily press briefing on the crisis. “The data spells out why we need to undertake these efforts. The number of long-term care facilities reporting cases of COVID-19 continues to increase and the number of cases continues to increase with it.”
Murphy noted that the deaths within the system account for roughly half of the more than 8,000 fatalities now reported in New Jersey.
“And just as tragically, we have seen some in the industry be slow to respond and adapt to the emergent threat of COVID-19,” Murphy said. “We intend to hold folks accountable, as we should and as you would want us to.”
State Health Commissioner Judith Persichilli said the first phase of the plan for expanded testing has already started, in the form of a pilot program in 16 facilities in South Jersey that were thought to have only limited cases of COVID-19 among staff and residents.
Persichilli said that, when all 4,000 staffer and residents were tested, however, the rate of infection was found to be much higher — 9.75% of staff members, and 24.4% among residents — even though most were asymptomatic.
“We recognized that increased testing in these facilities, especially those that have yet to experience large outbreaks, is critical to stopping the spread,” she said.
Next up, starting this week, facilities that have fewer than five cases will undergo universal testing, followed by nursing homes and other long-term care facilities that are now reporting between six and 25 cases.
The final phase will expand testing to all staffers and residents at the remainder of the long-term care facilities in New Jersey.
“We’re prioritizing facilities with fewer cases so immediate action can be taken to increase infection control protocols to further prevent spread and ultimately save lives,” she said. Follow-up guidance has been given to the 16 facilities in South Jersey, including a requirement that all those who tested negative be tested again.
Independently, Persichilli said, testing will be conducted over the next two weeks by a private consortium of nursing home chains and hospitals among 10,000 residents and 20,000 staffers at 74 facilities in the state.
The stepped-up testing comes on the heels of a number of other actions taken by state health officials, including the cessation of all family visits and mandatory screening of all staffers, required disclosures of outbreak statistics, ordering specific remedial steps at four hard-hit long-term care facilities and boosting supplies of personal protective gear for staffers.
Meanwhile, Grewal said that his team had created a web portal for family members, staffers and others involved in the long-term care community to report first-hand accounts or other evidence of misconduct at a facility during the pandemic or before. The portal will accept documents and photographs, he said, and will accommodate anonymous users.
“We want to be as thorough as possible in this endeavor and for us to do our job well, we need the public’s help,” he said.
Grewal noted that his investigation — prompted both by the high death toll in general and reports about severe problems at specific long-term care facilities — was in its initial stages and still a work in progress. Depending on his team’s findings, it could result in criminal charges, civil penalties, or simply a report on best practices going forward, he said.
“To be clear, at this particular time we are not alleging any misconduct about any particular facility or any entity or any individual,” he said. “We’ll simply follow the facts and the law wherever they lead us.”
He acknowledged that COVID-19 had posed unprecedented challenges for long-term care.
“I certainly understand that for many of these facilities this was the equivalent of a 500-year flood,” he said. “But that doesn’t mean that we shouldn’t examine how folks responded when those flood waters started rising. And it also doesn’t mean that we shouldn’t examine how they operated before that flood, if they cut corners, if they … ignored red flags or other warnings, if they lied to regulators or others, if they put profits over patients.”
Grewal also announced that state oversight officials would temporarily allow recent graduates of nursing schools and other health professional training programs to join the ranks of those on the front lines of the pandemic without first taking their licensure exams.
“We’re taking this step because we know that there are many out there, many future health care workers, who stand ready and willing to help us but they can’t simply because the centers where they would take the required test are closed during the pandemic,” he said. “Our new program temporarily removes these roadblocks and will allow thousands of nurses, pharmacists, physician assistants and respiratory care therapists to enter practice more quickly at a time when our health care system needs their help the most.”
Family members of nursing-home residents have pressed hard for universal testing of residents and staffers at the state’s 600-plus long term care facilities; at least one positive test result has now been reported in 509 of them.
“Because, remember, people got sick in these nursing homes after being locked down for a few weeks,” said Anthony Waclawski. “It came from the outside. It came from asymptomatic caregivers.”
Both his parents live at Sunrise of Bridgewater, with 14 COVID-19 cases and one death. It’s been weeks since he’s seen his dad, who has dementia, because of the ban on visits by non-residents.
“We go to the facility, we wave to them through the window,” he said. “He’s very confused. He thinks we left him there. My mother calls, and says we have to talk to Dad. He doesn’t understand why nobody sees him.”
Geriatric expert Dr. David Barile has predicted New Jersey could lose perhaps a third of its long-term care patients to COVID-19. He’s been urging Murphy to mobilize the National Guard to help perform basic care.
Persichilli said Tuesday that officials are discussing that option.
Barile said many frail elderly patients, isolated in their rooms, can’t even feed themselves without help.
“You can’t just plop the tray in front of the frail elder and come back an hour later and expect it to be eaten,” he said. “You need to take time and carefully feed that person. We have less aides, now. The nurses are out sick. The aides are out sick. And people simply aren’t getting fed.”