Report tears into NJ’s beleaguered long-term care centers, COVID-19 response

Listen to this article

A new report outlines dozens of recommendations for a major facelift to the state’s long-term care industry and its centers, should it hope to avoid a repeat of the devastation that the COVID-19 pandemic brought to these facilities in recent months.

The 100-page report was released on Wednesday by consulting firm Manatt Health, which the New Jersey Department of Health contracted in early May to gauge holes in the response from LTC’s for a price tag to taxpayers of $500,000.

The state’s roughly 670 long-term care centers, which include nursing homes and veterans and senior centers, have seen the lion’s share of fatalities from the virus since it slammed the state in early March.

As of Wednesday, 11,880 New Jersey residents died from the virus – 6,020 of them at LTCs, or 50 percent.

The report faulted the pandemic for severing communications between residents and their loved ones, and for preventing “family members from playing a role in caring for residents and monitoring the day-to-day operations in nursing homes.”

For one, it recommends that the DOH centralize the LTC response to this outbreak and its potential new cases – like a widely-expected second wave – as well as for future pandemics.

“Today, oversight of the LTC system is spread across DOH and various divisions within DHS. No single department or division is responsible and accountable for overseeing the LTC system as a whole,” the report reads.

“The pandemic has shed light on the need for strong cross-agency alignment and communication to ensure that the state has a cohesive LTC policy, financing, licensing, oversight and regulatory strategy and that LTC activities are aligned and coordinated across the departments,” the report adds.

Gov. Phil Murphy, at his daily COVID-19 press briefing in Trenton Wednesday afternoon, said he would support that proposal, as it would enable centers to “plan, coordinate and executive effective responses.”

“We will directly and aggressively confront the challenge in our long-term care facilities,” Murphy said. “Together, we will make New Jersey a national leader and national model.”

Recommended remedies

The state will allocate $10 million of state aid under the federal Coronavirus, Aid, Relief and Economic Security Act to comply with many of the report’s recommendations.

Centers need to offer better pay, as well as sick leave benefits, to workers to prevent high turnover, and the likelihood of staff members working at multiple facilities, in turn increasing the chances that someone will be exposed to the virus.

Minimum staffing ratios between patients on the one hand, and nurses and other medical workers on the other, need to be maintained. That proposal is also getting the administration’s backing, the governor added.

LTCs need much better surveillance of potential cases and outbreaks, infection protocols to identify and isolate staff and patients that might have the virus, and plans to make sure staff have access to personal protective equipment, the report states.

“We did not have a full picture of their back-up plan,” State Health Commissioner Judith Persichilli said on Wednesday.

Ownership changes would need to be monitored by the state, and data-reporting to the state would be a requirement.

The report decried shady and “opaque” oversight at for-profit long-term centers, where “a facility may change ownership multiple times in a single week.”

“For-profit facilities have opaque financials and can use complex ownership and management structures to obscure the entities responsible for delivering care, curtailing the ability of the state and residents to hold them accountable,” the report reads.

New Jersey’s state response to the deadly virus has been marred by allegations of secrecy, lack of communication between patients and their families, allegations of holes in oversight, and reports of political infighting between the governor’s office and health department over the administration’s response.

The blame game

The national spotlight shone on New Jersey in April and May, when 17 patients were found dead at the Andover Subacute and Rehabilitation Center, in what was described as a makeshift morgue.

Staff were poorly equipped to respond to the virus as the outbreak spread across the state’s LTCs—lacking training, failing to properly isolate potentially positive cases, and due to inadequate supplies of personal protective equipment, such as facemasks.

Murphy, on Wednesday, faulted “bad actors” for the catastrophic outbreaks, even though many critics have argued it’s a failure of the statewide industry and health department under Murphy.

“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,” Sen. Steven Oroho, R-24th District, said less than an hour after the report was officially released.

“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,” he added.

Overall, New Jersey’s Republicans have been highly critical of how the state’s LTCs managed their responses to the outbreak, calling for strict federal scrutiny into how they handled the pandemic.

On May 23, Senate President Stephen Sweeney, D-3rd District, and Senate Republican Leader Tom Kean, R-21st District, said they are putting together a committee that would hone in on the “surge” of fatalities at the state’s long-term centers.

A letter to the two lawmakers – first reported by NJ Advance Media – tore into the administration’s response, and many alleged failures that led to a score of “preventable deaths.”

“We believe that the combination of a lack of action where we should have seen it, and a willful desire to focus only on where most media attention was afforded during the peak of the crisis (the general public and hospitals), led to preventable deaths in long-term care, prisons, and other institutions,” reads the four-page letter, authored by the self-identified and anonymous “NJ Pandemic Response Team.”

State health officials over-emphasized hospitals, failing to prioritize long-term centers and provide them with enough PPE and testing kits to handle these vulnerable populations, namely the elderly, according to the letter.

That was confirmed by the Wednesday report, even though Persichilli denied it, arguing that “we actually prioritized all of our facilities.”

Murphy was pressed several times during a June 2 press briefing on the letter, and would not comment.

“[W]e’re not going to respond to a letter from three anonymous people. It’s just not going to happen,” he said.