Credit: (U.S. Air National Guard photo by Master Sgt. Matt Hecht)Several hundred additional federal medical personnel and National Guard members have been dispatched to assist New Jersey nursing homes struggling to contain the spread of coronavirus, as state officials vowed to collaborate on efforts to ensure “this never happens again.”
Gov. Phil Murphy announced Thursday that 300 National Guard members had been deployed to long-term care facilities like nursing homes and assisted-living sites and hospitals throughout the state; this includes 120 soldiers who were dispatched earlier this month to several hard-hit operations. Locations with high numbers of staff and resident infections were prioritized, officials said.
The federal Department of Veterans Affairs has also dispatched five teams of 10 clinicians each to nursing homes, Murphy said. More than 100 VA employees are already at work at two of the three state-run veterans’ homes, in Paramus and Menlo Park, he noted.
“Any additional support, be it direct care or direct caring and comforting, is welcome,” state Department of Health Commissioner Judy Persichilli said. State data suggests more than half of New Jersey’s COVID-19-related deaths are tied to a long-term care facility and roughly eight out of 10 have at least one resident infected.
“I’ll reach out to anyone that will help us determine what we should be doing going forward so this never happens again. The resilience of the long-term care industry is thin and they work at the margins, we know that,” Persichilli said. “At the end of the day, the tragedy of long-term care will haunt us for a long time. But we will definitely put things in place that will prevent that from happening again.”
Fighting in close quarters
Thursday’s developments came amid growing concerns over the Murphy administration’s response to the novel coronavirus at long-term care facilities and other congregate-living sites, like prisons and group homes. COVID-19 — which has now been found in more than 142,700 New Jerseyans, including nearly 10,000 who have died — spreads easily in these types of close quarters and can also be transmitted by asymptomatic staff working at multiple locations. More than 27,000 cases and as many as 5,200 deaths are connected with long-term care.
Long-term care facilities have been plagued by chronic resource shortages, including a lack of staff and personal protective equipment or PPE, the masks, gowns and gloves worn to reduce the spread of the disease. In addition to the rising number of infections and deaths, facilities have struggled to keep family members informed; officials discovered bodies stored in a shed after the morgue was overwhelmed at one Sussex County home.
Geriatricians and other clinicians, academics and state lawmakers have said the administration should be moving faster to get direct assistance to long-term care facilities in particular, including staffing and test kits, and some have urged the administration to step up enforcement and oversight of these operations. Legislators, including leaders from Murphy’s Democratic Party, have called for hearings to examine what when wrong.
“This requires a full-court press with all hands on deck to prevent many further deaths. The state has stepped up to provide more direction but even more is needed,” said Stephen Crystal, a lead research professor with Rutgers University’s Institute for Health, Health Care Policy and Aging Research. Crystal stressed that he was not “condemning (state officials) overall,” given the task they’ve faced and the nature of the pandemic, but the issue is, “What do we do, starting today, to save lives.”
More than 60,000 frail residents
Officials at the DOH have been closely tracking the rising numbers, and Persichilli has issued at least 18 guidance documents to long-term care operators to advise them of existing and changing state protocols; these facilities house more than 60,000 frail elderly residents or patients with significant medical needs. The state has provided more than 10 million pieces of PPE and provided staff lists to those with shortages, the commissioner has said. What’s more, the department joined with a hospital system to test staff and residents at 16 nursing homes in South Jersey.
The DOH has also sent regulatory inspectors to at least 60 facilities since the outbreak began, officials said, and the state attorney general’s office has also launched a criminal investigation into nursing-home conduct in general. A federal team also found numerous violations at Andover Subacute and Rehab, the facility where the bodies were discovered.
Last week Murphy announced the state had “contracted” with two experts connected to the national health-consulting firm Manatt Health — former Obama administration policy expert Cindy Mann and Carol Raphael, who led the Visiting Nurse Service of New York and served as an AARP board member — to provide immediate support, an assessment of the current crisis and to make longer-term recommendations. On Thursday Murphy said the team was hard at work, but his communications team has declined to answer repeated questions about what the agreement will cost and who will pay.
Senate Health, Human Services and Senior Citizens Committee Chairman Joe Vitale (D-Middlesex) — whose district includes St. Joseph’s Senior Home, which had to be evacuated in late March when caregivers became overwhelmed — has announced plans for legislative hearings into the long-term care concerns, although he plans to wait until after Manatt delivers its report. More than a dozen Senate Republican leaders have also called for a special legislative probe into the administration’s response.
Crystal, with Rutgers, welcomed these efforts and praised the experts hired to examine the system. But he and others agree the state can’t wait for these findings to take further action.
Kicking the COVID-19 can down the road
“What you can’t do is use any kind of expert study to kick the can down the road,” he said. The actions need to start today. And they can start today.” Among other things, Crystal underscored the need for widespread testing and real co-horting of patients, to separate those infected from those who are not, including moving residents to hotels or renovated former hospitals that have been reopened to support the coronavirus response.
In early May, the state announced its intentions to ensure residents and staff at all long-term care facilities are tested for the virus, regardless of if they have symptoms or not. (Most public testing had, until recently, been limited to those who showed signs of being infected.) On Tuesday, Pershichilli said that this screening process would be planned and executed by nursing home operators — with repeat exams required for those who test negative — and that the initial round of tests be performed by May 26.
However, it’s not clear these facilities have the needed resources, starting with test kits, to meet this deadline. “Until we receive the tests, we have limited ability to conduct widespread testing,” said Jonathan Dolan, president and CEO of the Health Care Association of New Jersey, which represents long-term care facilities. Dolan said, as of Wednesday, it was not clear when the tests needed would even be delivered to New Jersey.
“As soon as we have the tests and the related instructions, we will do everything we can to meet the deadline,” he said.
But some, including Crystal, question if the state’s plan places too much faith in the ability of long-term care operators to begin with, given their performance to date.
“By their actions, the industry is telling us, without saying so, that (the testing protocol) is beyond their capabilities,” Crystal said. He urged the state to organize outside teams and provide them with sufficient supplies to operate a consistent, statewide testing program at these facilities. “We need to treat this like we’ve treated the hospital system, with the same urgency,” he said.
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