New Jersey Health Department pledges to solve several long-term care concerns by end of July

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by Lilo Stanton for NJ Spotlight

State addressing backlog in nursing home complaints, infection control and emergency operations, among other recommendations by outside consultants

New Jersey health inspectors have nearly cleared a massive, multiyear backlog of thousands of nursing home complaints in recent months, the state now says, and they have conducted infection control surveys at almost 450 sites and taken initial steps to establish an emergency operations center to support long-term care facilities’ response to the pandemic.

State Department of Health Commissioner Judy Persichilli announced the efforts Wednesday as part of an update on the agency’s progress in implementing recommendations from Manatt Health, a consultant the state hired in May amid growing concerns about the coronavirus’ impact on nursing homes. More than one in five of New Jersey’s 177,600-plus COVID-19 cases and roughly half of the nearly 13,800 deaths have been connected to long-term care facilities.

Persichilli said the state plans to phase in changes Manatt called for in its June 2 report, as well as additional initiatives, with 17 of the consultant’s 35 near-term recommendations slated to be in place by the end of July. “These steps that I announced today will support the improved performance hopefully of long-term care facilities moving forward,” she said.

Like facilities across the country, Garden State nursing homes have struggled to maintain sufficient staff levels and supplies during the pandemic, and despite a months-long ban on visitors at these facilities, COVID-19 was likely transmitted inside by asymptomatic staff working at multiple sites or via infected individuals returning there from hospital. Reports suggest that in many places a skeletal workforce was unable to effectively separate sick from healthy residents, properly provide daily care, or update desperate family members in a timely manner.

Workforce pay, infection control, regulatory oversight

The Manatt consultants flagged numerous nursing home concerns — including an underpaid workforce, a history of infection-control problems and weak regulatory oversight — which they said diminished the capacity of these facilities to withstand a pandemic. The experts also worried about the DOH’s ability to effectively oversee nursing homes, noting a lack of state investigators and a backlog of some 4,000 complaints, some dating to 2017.

Health department officials have acknowledged a combination of retirements and hiring freezes have diminished the staff ranks over the past two gubernatorial administrations, and a lengthy hiring process and relatively low wages make it hard to fill these spots. While regular complaint inspections were suspended during the pandemic, the DOH continued to investigate what could cause “immediate jeopardy” — the most urgent category — in 48 hours or less, as required by federal law.

On Wednesday, Persichilli said DOH inspectors who were not able to work in the field were assigned to address the backlog; as a result, the list of complaints has been whittled down to fewer than 400 over the past three months. Addressing this backlog, “was not only a recommendation of the Manatt report, but a priority of mine since I became commissioner just about a year ago,” she added.

Manatt’s report — which took about three weeks to complete and cost the state $500,000 — also called for the DOH to be more proactive in promoting infection control at the state’s 375 nursing homes, three-quarters of which are for-profit operations. Federal guidelines released this spring also called for states to conduct infection-control surveys in these and other long-term care facilities by the end of July; New Jersey hired an outside vendor to help with this process, but the state has declined requests for more detail about that arrangement.

Persichilli said Wednesday that nearly 450 Garden State facilities have now been surveyed, including 369 nursing homes, 46 assisted living programs and close to three-dozen other health care facilities of various kinds. COVID-19 has been identified in some 581 long-term care facilities since March, and the outbreak remains active in 369 of them, according to state figures.

COVID-19 testing strategy

The consultants also urged the state to work with nursing home operators to implement a rigorous COVID-19 testing strategy to allow facilities to safely reopen to family members, health care providers and other critical visitors, and to guard against new outbreaks. Persichilli said these plans have been discussed on recent calls with nursing home operators, and they are also exploring how to provide a weekly coronavirus screening to all staff.

Initial COVID-19 testing of the approximately 46,000 residents and 90,000 staff members was completed in May, Persichilli said, and those who were negative have been repeatedly retested; in total, close to 600,000 tests have been administered to these two groups so far. The results indicate good news; the positivity rate declined from 6% among residents and 3% among staff in May to less than 1% in both groups as of July, according to the commissioner.

The state has also provided facilities some 30 million pieces of personal protective equipment, or PPE; the masks, gowns and gloves that help protect frontline workers during testing or caring for infected residents, Persichilli said. But facilities need to remain vigilant, she warned, adding, “We need to keep the presence of the disease that is still in our communities out of our long-term care facilities.”

In addition, Persichilli said the DOH and other state leaders have convened an initial planning meeting on how to set up a long-term care emergency operations center, a system Manatt recommended as a way to improve communication during a public health emergency. DOH deputy commissioner Dr. David Adinaro, who the state hired in June to oversee long-term care and other public health programs, will lead the effort. (Adinaro leads the division that included former assistant commissioner Christopher Neuwirth, who filed a lawsuit claiming he was fired for raising ethics concerns after he was asked to conduct COVID-19 tests on family members of Gov. Phil Murphy’s chief of staff, at a time when testing was scarce.)

Some concerns not yet addressed

Other near-term recommendations from Manatt — like increasing the state’s schedule of financial penalties for regulatory violations or providing emergency payments to nursing home operators to help defray pandemic-related costs — have yet to be addressed by the state. And some of the consultant’s suggestions — like a review of the state’s Medicaid rates, which pay for much of nursing home care, and changes to the sick-leave policy for frontline nursing home workers — require legislative changes.

“A big bunch of the rest are statutory,” Murphy said at a coronavirus briefing Wednesday, adding one of his customary “shout-outs” to Assemblywoman Valerie Vainieri Huttle (D-Bergen) and Sen. Joe Vitale (D-Middlesex), who he said are planning to introduce bills to “round out” the state’s response. Vainieri Huttle, who chairs the Assembly Aging and Senior Services Committee, led a joint hearing on the Manatt report in June.