An extensive report by consultants evaluating the condition of New Jersey long-term care centers shines a light on underlying deficiencies and challenges in the system.
By Matt Skoufalos | June 3, 2020
NJDOH COVID-19 Dashboard – 6-3-20. Credit: NJ DOH.
Another 652 New Jersey residents have tested positive for novel coronavirus (COVID-19), bringing the statewide total to 162,068 cases, Governor Phil Murphy reported Wednesday.
New Jersey still tops the country in COVID-19-hospitalized patients, ranks third in deaths per day, and is 15th in new cases per day.
Murphy attributed the continued growth in new cases to increased testing, saying that the state has “significantly slowed the rate of spread of the virus.”
Sadly, 112 more residents have perished from complications related to the virus, bringing the statewide death toll to 11,880 lives lost during the pandemic.
Throughout New Jersey, 2,250 people are hospitalized with a case of COVID-19, or while awaiting confirmation of their symptoms.
Of those 2,250 patients, 612 are in intensive or critical care; 459 of ICU and critical-care patients (75 percent) are on ventilators, a fifth consecutive day at less than 500 people and unchanged since yesterday.
In the past 24 hours, 71 New Jersey hospitals admitted 107 new COVID-19 patients and discharged 193 others, either to a lower-acuity care setting or to their homes.
Across New Jersey, 545 long-term care (LTC) centers have reported at least one case of COVID-19, and account for 33,626 infected patients and staff, or 21 percent of total cases.
That includes 22,575 residents and 11,051 staffers sickened by the virus, as well as 5,232 lab-confirmed resident deaths (44 percent of the statewide total) and 110 facility-reported staff deaths.
After completing a baseline round of COVID-19 testing in the state, 11 percent of 54,000 LTC residents and 4 percent of the 65,000 staffers who work in those facilities have tested positive for the virus, New Jersey Health Commssioner Judy Persichilli said Tuesday.
NJ Health Commissioner Judy Persichilli – COVID-19 Briefing 6-3-20. Credit: NJ Pen.
Of 654 veterans residing in a state-run home, 385 residents have tested positive for COVID-19, and 145 have died from complications related to the virus.
Seven veterans presently are hospitalized with COVID-19, and 212 have recovered from the virus.
At state-run psychiatric facilities, 211 of 1,235 patients and 486 staff members have tested positive for COVID-19.
Seven staffers and 13 patients have died from complications related to the virus; unchanged since last week.
Twenty-one patients are presently receiving care at one of the state’s field medical stations, which have served 471 people in total.
The statewide average of COVID-19 spot positivity testing stood at 4.3 percent from 31,000 samples taken May 30.
Persichilli offered no updates on cases of pediatric multisystem inflammatory failure Wednesday. To date, 32 patients aged 1 to 18 have been stricken by the syndrome; all have tested positive for exposure to COVID-19, and seven of those have been hospitalized.
No deaths have been associated with this syndrome in New Jersey.
Recommendations from the Manatt consultancy on New Jersey’s long-term care facilities. Credit: Manatt.
Long-term care center update
Murphy and Persichilli presented highlights of a Manatt consultancy report on the condition of long-term care sites in New Jersey and the impact of COVID-19 on underlying issues in these facilities, which have borne the brunt of deaths and infections in the state.
Among contributing factors in those sites, the Manatt report identified structural issues with LTCs, including old, multi-bed living quarters, “documented infection control deficiencies and citations,” and staffers “who are also subject to community spread… [and who] came from communities with large outbreaks.”
“Most tragically, high community spread in New Jersey brought COVID-19 into New Jersey’s nursing homes,” the report noted.
LTCs house some 45,000 New Jersey residents, or half of one percent of the state population. They are staffed by direct care workers, 91 percent of whom are women, 84 percent of whom are racial or ethnic minorities, and half of whom are immigrants, according to the report.
One-third of all New Jersey nursing homes surveyed in 2017 were cited by the state for deficiencies in infection control and prevention, and one-quarter of them were cited for those deficiencies over multiple consecutive years. Inconsistencies in responses by those facilities “may have exacerbated outbreaks,” the report claims.
Camden County OEM ships PPE to long-term care sites across the county. Credit: Rich Ratner.
Among its recommendations, the report urged New Jersey to centralize its oversight, data collection, and reporting of LTC issues at a centralized operations center.
That center would oversee a coordinated response to future health issues, which consultants suggested could be connected with affiliated hospitals or the Federal Emergency Management Agency (FEMA).
They noted also that such an arrangement is “more challenging to stand up” and “would require additional funding.”
The report also suggests overhauling communication with patient families, “forward-looking” testing and readmission strategies, and improved wages, benefits, and working conditions for caregivers.
Murphy said the state would divert as much as $10 million from its CARES relief fund to implement some of the recommended changes. The governor also promised to ensure that any “increases in payments to nursing homes are used for patient care and not lining owners’ pockets.”
“This is a national problem, and too often, a national failure,” Murphy said. “As deep-seated and longstanding as this situation is, we will aggressively and directly confront this challenge,” citing the “two-or-three-hundred thousand people whose lives we’re trying to save” among LTC staff and residents.
Asked whether her department failed to appropriately prioritize LTCs when distributing personal protective equipment (PPE) during the pandemic, Persichilli replied that LTCs were as resource-depleted and overwhelmed as any other healthcare entity, and that “long-term care was in the allocation methodology.
“We were having nurses throughout systems wearing garbage bags,” she said. “I think we’re forgetting how the supply chain had contracted. There was no PPE nationally, and we were sourcing as best we could.”
“We started out in an awful place, with a peashooter at best,” Murphy said of the state’s PPE resources at the onset of the pandemic.
Bars and restaurants reopening guidance. Credit: NJ Pen.
Guidance for in-person dining coming soon, public spaces to open
Finally, the governor offered a few words about the upcoming reopening of bars and restaurants for in-person, al fresco dining, which will commence June 15.
Among the forthcoming safety and sanitization protocols for establishments, tables must be six feet apart from one another, Murphy said.
He also noted that as communities reopen their dine-in businesses, they may allow bars and restaurants “to expand their service footprint, both on their own property and maybe onto shared property, such as sidewalks, streets, parks.”
In support of that, the state division of Alcoholic Beverage Control (ABC) issued a special ruling enabling liquor-license-holders to apply for “a special one-time permit to expand their service areas,” until November. Municipal approval of such will be required to do so, he said.
