NJ's Long-Term Care Issues Exacerbated By COVID-19 To Be Fixed

NEW JERSEY — Sweeping changes are coming to long-term care facilities to repair the deficiencies exposed and exacerbated by the COVID-19 pandemic, according to Gov. Phil Murphy.

Speaking at his Wednesday COVID-19 briefing, Murphy said that the goal is to fix the system in both the short and the long term.

“The sad fact is that eldercare is a national problem and, too often, a national failure. During this crisis we have seen that in state after state, seniors and those who work with them in long-term care facilities made up a disproportionate number of the positive cases and tragically the losses. We are all humbled by that,” Murphy said. “The solutions recommended by the Manatt team provide a comprehensive and systemic approach to ensuring the safety of the residents and staff of New Jersey’s long-term care facilities. My Administration looks forward to implementing Manatt’s recommendations to mitigate and protect one of our most vulnerable populations from future outbreaks.”

The changes are coming as the number of COVID-19 cases at long-term care facilities is at 22,575 and staff cases are at 11,051. Deaths reported is where there remains an issue. The number of resident death self-reported by facilities is 6,020 and 110 staff deaths. But the state is also reporting a combined lab confirmed number at 5,076.

Mannat Consulting conducted a rapid review of New Jersey’s long-term care facilities to address systemic challenges in long-term care and mitigate the impact of COVID-19 and reduce impacts of future outbreaks.

The report gives guidance for new residents and visitors after the current COVID-19 outbreak and addresses mitigation, protection, and resiliency against future outbreaks, both in the near- and long-term. The recommendations also present a roadmap for rebuilding a high-functioning long-term care system that emphasizes quality of care, patient safety, robust data infrastructure, and strong staff supports.

“COVID-19 has brought to the forefront underlying weaknesses in our long-term care system. Manatt is honored to have been able to work with New Jersey in its efforts to provide the best support possible to the state’s nursing homes and their vulnerable residents and staff, and to develop a set of recommendations to not only address the COVID-19 crisis but to ensure that New Jersey has a sustainable, high-quality, safe and resilient long-term care system,” said Cindy Mann, partner with Manatt Health who worked on the report.

New Jersey Department of Health Commissioner Judith Persichilli said she started her career as a caregiver in Trenton and spent her entire career supporting vulnerable populations, noting I know there is no more important role than a direct care giver.

“I want to thank Manatt for a thorough, in-depth review and recommendations that will help to strengthen New Jersey’s nursing homes and improve their resiliency,” Persichilli said. “Nursing homes care for our most vulnerable residents--our mothers, fathers, and grandparents. Their caregivers are healthcare heroes for what they do every day. These workers—and the residents who call these facilities home—need a system that supports a culture of quality, care, and infection prevention.”

Based on their assessment, the Manatt report outlines the following recommendations to improve New Jersey’s long-term care facilities:

Strengthen Emergency Response Capacity by strengthening the ability to plan, coordinate, and execute effective responses to the emergency protential surges.

• Consolidate and strengthen response through a central Long-Term Care Emergency Operations Center that would coordinate all activity and communications for nursing homes and long-term care facilities and obtain real-time input regarding staffing, supplies, and operational issues;
• Implement a “reopening” and forward-looking testing plan; and,
• Reinforce existing pathways for resident and family communications.

Stabilize Facilities and Bolster Workforce by increasing the responsibilities of and support for New Jersey’s nursing homes and their workers in the short and long-term.

Recognize, stabilize, and resource the workforce by

• Ensuring staff have access to paid sick leave;
• Instituting wage enhancements;
• Implementing minimum staffing ratios for direct care;
• Establishing a wage floor and wage pass-throughs for Medicaid rate increases; and,
• Strengthening training and career development opportunities;
• Institute COVID-19 relief payments for facilities and review rates.
• Create a Medical Loss Ratio to ensure payments to nursing homes, including any increases, are used for patient care.

Increase Transparency and Accountability by implementing stronger mechanisms to ensure a greater degree of accountability and increase transparency through data and reporting.

• Institute new procedures to regulate and monitor facility ownership, with a focus on increasing transparency;
• Improve oversight of and increase penalties for nursing homes; and,
• Centralize long-term care data collection and processing.

Build a More Resilient and Higher Quality System by establishing structures for stronger collaboration and advance payment and delivery reforms and increased reliance on home and community-based services.

• Improve safety and quality infrastructure in nursing homes by requiring facilities to maintain Infection Control Preventionists and by supporting the state’s current surveillance efforts;
• Strengthen state agency organization and alignment around long-term care operations; and,
• Create Governor’s Task Force on transforming New Jersey’s long-term care delivery system.

'This Pandemic Is Not Over'

Executive Vice President of United Healthcare Workers East Milly Silva said that she hopes that officials will move deliberately and swiftly to implement the changes because nursing home residents and caregivers need help.

"Whether it is about personal protective equipment, enhanced testing, addressing the mental well-being of residents that haven't seen their families for months and ensuring adequate paid sick leave and hazard pay for workers who are struggling," she said at the briefing. "We are still in a moment about saving lives. This pandemic is not over."

Silva said she hopes that the debate about the future of care is guided not be politics but by epidemiologists, clinicians, public health experts and with the voices of nursing home residents, their family members and the caregivers being front and center.

"If we don't include them, we will not get New Jersey's long term care system to the place where we all deserve for it to be," she said.

As Silva was delivering her remarks, Senator Steven Oroho, Senator Declan O’Scanlon, and Senator Kristin Corrado released a statement remarking that the "superficial report" commissioned by Murphy does not absolve his administration for its clear failures that led to the massive loss of life in New Jersey’s long-term care facilities due to COVID-19.

“The Murphy Administration paid a consulting firm $500,000 to rush a report that attempts to shift blame for thousands of nursing home deaths to anyone but the governor,” said Oroho. “What taxpayers received back is a glossy report that repackages the State’s data in colorful graphs and charts. The report glosses over the fact that the administration forced our LTC facilities to admit COVID-19 patients, which led to thousands of deaths. With that glaring deficiency, the entire report is suspect.”

For his part Murphy has repeatedly denied this allegation noting that the guidance never asked for patients to be admitted into the general population, but rather in a cohort or a separate wing or floor of the facility.

“The administration paid a consultant to write a report at taxpayer expense that advocates for the governor’s policy agenda while shifting blame for the governor’s bad choices,” said O’Scanlon. “I wish I could say I’m shocked. It’s undeniable that our long-term care facilities warned that they didn’t have sufficient supplies of PPE or the ability to manage the highly infectious patients that the Department of Health was forcing them to accept from hospitals. By failing to address these simple truths, this rushed report was irrelevant the second it was released.”

The senators said the administration’s attempts to stifle dissenting opinions, shift blame, and perhaps even cover-up its failures serves to heighten the need for a legislative investigation with subpoena authority.

The complete Manatt report can be found on the Department of Health website.

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