Nearly one in four report that they cannot comply with infection control or cohorting guidance from the state health department and are not admitting (or readmitting) patients.
By Matt Skoufalos | April 23, 2020 (Data updated: April 26, 2020)
NJDOH COVID-19 Demographic Dashboard – 4-23-20. Credit: NJDOH.
As New Jersey health officials continue to drill down into the data around novel coronavirus (COVID-19) infections, they’re learning that the most vulnerable populations in the state are being hit the hardest by the virus.
The pandemic is disproportionately claiming the lives of those 65 and older and those with chronic or underlying health conditions.
In few places do those populations more closely intersect than in long-term care (LTC) facilities.
On Wednesday, New Jersey Health Commissioner Judy Persichilli said that 438 long-term care facilities statewide have reported 11,608 COVID-19 cases (12 percent of the total) and 2,050 deaths (40 percent of the total).
In Camden County, those numbers are higher. Locally, 17 of 56 LTCs have reported at least one case of COVID-19 (30 percent). Those sites are believed to account for 519 cases of the virus in Camden County (about 20 percent) and 83 of its 118 related deaths (70 percent).
Across New Jersey, 132 LTCs are prohibited from admitting new patients or accepting readmissions because they’ve reported to the state that they cannot comply with patient cohorting and infection controls required to inhibit the spread of COVID-19 at their facilities.
In Camden County, there are 13 such sites, or roughly one-quarter of the total number of LTCs.
As a disclaimer, Persichilli said yesterday that the New Jersey Department of Health (NJDOH) is working to reconcile its LTC data, which are self-reported by facilities. In some cases, she said, COVID-positive employees were counted among the resident totals, which would have brought the LTC numbers up.
“We really have to sort through that, because we really do not have a significant reporting of employee mortalities,” Persichilli said. “We will make sure, by death certificate, that we are counting all of the deaths appropriately.”
Regardless of the final counts, the trend that has emerged in LTC infections “is our number-one priority right now,” said Camden County Communications Director Dan Keashen.
“This and testing, and obviously the trace investigations, is where we’re spending the majority of our time and focus,” Keashen said.
Last week, the Camden County Health Department took over LTC site inspections from the state, and yesterday, it held a conference call with operators to assess their needs. One of their chief concerns is access to personal protective equipment (PPE): protective gowns, N-95 masks, surgical masks, protective gloves, face shields, and hand sanitizer.
Camden County OEM ships PPE to long-term care sites across the county. Credit: Rich Ratner.
That echoes Persichilli’s remarks earlier in the week that LTCs throughout the state reported an uptick in COVID-19 cases among shortages of housekeeping products and failures to follow CDC disinfection guidances.
“And then it’s staffing,” Keashen said; “having enough to run their facilities, and trying to stave off a complete depletion in that regard.”
To resolve the first point, Keashen said Camden County could facilitate a cooperative purchase agreement among facilities, much like its municipal group purchasing agreements “for everything from salt in the winter to office supplies.” Yesterday, representatives from its Office of Emergency Management distributed PPE to long-term-care sites.
For the second, Keashen said the county is looking into “a possible hiring mechanism for staffing.
“If there’s a way that we can help, we’re going to do that,” he said.
Earlier in the week, Persichilli pointed to staffing issues as a key factor in the spread of LTC infections when she suggested that nursing aides could have unwittingly spread the virus while working at multiple sites.
“There’s a reason why they’re working at several places,” she said. “It’s because the wages are not enough to support what they need to do to support their families; to put food on the table.
“What I’d rather do is take better care of them, making sure that they understand their own health and well-being, and how that’s transferred to whatever patient they’re taking care of at whatever facility,” Persichilli said.
NJ Health Commissioner Judy Persichilli – COVID-19 Briefing – 4-18-20. Credit: NJ Pen.
South Jersey LTCs as possible models for broader testing
This week, Persichilli suggested that protecting the state’s vulnerable populations might be easier in South Jersey because COVID-19 has spread to fewer long-term care facilities there than in the north.
She outlined a rough plan to “to target 16 or 20 long-term care facilities in the south, with the help of Cooper University, to test those individuals, cohort appropriately, and prevent further spread in the south of the state,” Persichilli said.
In addition to nursing home patients, Persichilli said the state plans to test a Rutgers University-developed saliva test first “in developmentally disabled homes,” followed by correctional facilities, and then among healthcare workers. By studying the efficacy of the tests in populations that live in close quarters, she said New Jersey hopes to contrive “a full testing strategy for the larger group to help open up the state.”
Keashen also said the county is working to impress upon LTC operators the importance of “transparency to both family and the local governing body.” He urged family members of someone in long-term care to call the state COVID-19 hotline (800-999-9045) with any concerns.
“If there are complaints, if they are getting messages that maybe their loved one is noticing some kind of infection control failures, they should call and report it directly,” Keashen said.
