TRENTON, NJ — Despite the nearly 7,000 lab-confirmed coronavirus deaths reported across 679 long-term care (LTC) facilities in New Jersey, health officials and Gov. Phil Murphy believe that some will soon be able to safely re-open their doors to visitors.
New Jersey Health Commissioner Judy Persichilli signed a directive on Monday for “phased-in” re-openings at LTC facilities across the Garden State, with concerns continuing to mount for elderly residents largely kept locked in over the last five months.
“We must proceed with caution as we reopen these facilities,” Persichilli said as she outlined measures during Murphy’s coronavirus press briefing in Trenton. “There are still more than 260 active COVID-19 outbreaks at LTC facilities in our state, and we know that the virus is still circulating in our communities.”
Monday’s announcement will allow for wider breadth of permissions at LTC facilities statewide, where nearly 25,000 coronavirus cases have been confirmed, as well as almost 13,000 staff cases.
“Over the past nearly five months, one of the most-impacted communities in our state has been the residents and staff of our long-term care facilities,” said Murphy. “They have borne an outsized burden of this pandemic. We cannot understate the enormity of either the spread or the loss of life within these facilities.”
Persichilli explained that as part of “phase zero,” a new designation has been created called "essential caregivers," which caps visits at two hours once per week with residents who are confirmed as COVID-19 negative, asymptomatic and/or have recovered from the coronavirus.
Phase one and two comprise safeguarded re-openings, which will require facilities to ensure they have enough staff, personal protective equipment (PPE) and a virus-free center for at least 28 days. According to the commissioner, two visits per week for a maximum of four hours will be permitted if all the applicable boxes are checked off.
“Please bear in mind that facilities may need time to provide attestations to the department of health that they have met the requirements that I have outlined including having updated outbreak plans and enough staff and PPE before they can begin scheduling visits,” said Persichilli. “The attestations will be coupled with enforcement activities. And if someone attests, and they do not adhere to the requirements of the attestation survey [...] they will be fined."
Monday's announcement was paired with the recent news that New Jersey will make $25 million in federal and state funds available to LTC facilities to test employees for COVID-19.
Another $130 million in federal and state money will be accessed to “stabilize and support our nursing facility workforce and critical infection control practices in the facilities," according to Murphy, with 60 percent to flow directly to the state's nursing home workforce.
Human Services Commissioner Carole Johnson said on Monday that her department will guarantee the money goes to LTC employees across New Jersey. In the event that compliance is not met, the state can withhold future funds in the interest of making up for it, she said, adding that a bill is currently pending in the state legislature in order to allow for a review process.
“Certified nurse aides are the frontline of the nursing facility workforce and spend their days and nights helping our loved-ones with what we call activities of daily living,” Johnson said in reference to the 60 percent lump sum dedicated toward that workforce. “These are the essential tasks that include things like bathing, dressing, transferring someone in and out of bed, toileting, and eating. This is challenging work, and we have seen the dedication and commitment of this workforce to our older residents throughout the pandemic.”
According to Johnson, the value of the increased funding will depend on the current certified nursing assistant (CNA) wages at each facility, but an average hourly wage increase of roughly 20 percent is anticipated.
In addressing visits, Persichilli said LTC facilities must have enough personal protective equipment (PPE) on hand as well as a stockpile for emergencies that is not touched in daily use.
An updated outbreak plan must also be written out, she said, including lessons learned from COVID-19 and “communication strategy” that describes what is regularly communicated with residents and families.
“The plan must also include methods for video communications in the event of visitation restrictions,” said Persichilli. “Once visitation begins, there will be rigorous Infection Prevention and Control protocols, the facility must follow.”
The following rules are among those that will be observed, according to the commissioner:
- Visitors must be screened including temperature checks upon entering facilities
- Facilities must require that visitors practice routine Infection Prevention and Control precautions, including wearing a mask and social distancing
- Facilities must have a plan to limit the hours of visitation and the number of visitors that will be allowed in the facility at any one time
- Residents are allowed only two visitors at a time
- Facilities may provide visitation in the residence room if they are in a single room
- If a resident is in a shared room the facility needs to identify a visitation area that allows for social distancing and deep cleaning
- The facility must receive informed consent from the visitor and, if appropriate from the resident, acknowledging that they are aware of the risks of exposure to COVID-19 for both the resident and the visitor, and that they must follow the rules set by the facility
- Visitors should be instructed to monitor for fever and other COVID-19 symptoms for at least 14 days after the visit (if they experience symptoms, they must immediately notify the facility and provide details on their visit)
- For residents residing in facilities that meet requirements for phase two, we are also allowing additional activities for more social interaction
- Limited communal dining will be allowed for individuals who are COVID negative, asymptomatic or recovered
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