WAYNE, NJ - History will likely show that, for the general public, the COVID-19 pandemic was only slightly more deadly than a bad flu season, but for those with underlying conditions and particularly for senior citizens, the pandemic will be considered deadly.

However, for seniors in long-term care (LTC) facilities, this may go down as the worst pandemic since the Bubonic Plague raged through Europe in the mid 1300s.

For Wayne residents alone, there has been a death rate of nearly 25% for people aged 70 or older, and Mayor Chris Vergano has repeatedly told the Township that 75-80% of these deaths have occurred in long-term care facilities.

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It was a perfect storm for nursing homes.

In an Op-Ed dated March 7, Executive Vice President of the United Healthcare Workers East, Milly Silva said: “Taking into consideration the unique vulnerabilities of seniors who already require 24/7 care, an outbreak at any one of our state’s 370 nursing homes could spell disaster. So, we need to be proactive and make sure that nursing homes and their staff are fully equipped and trained — now — to head off a sudden crisis”

This turned out to be prescient.

Staff Shortages

Lucinda Corrado, the Executive Director for the Passaic County nursing home, Preakness Healthcare Center explained that there had already been a shortage of staff industry-wide before the pandemic. She feels the transition from fee-for-service Medicaid to Managed Medicaid was a big factor in the staff shortage, especially in for-profit, private LTC facilities.

“For-profit nursing homes look at what they can afford in terms of staffing based on the reimbursements they receive from Medicaid,” she said. “The less money you get, the less staff you can afford to have. You need hands on Certified Nursing Assistants (CNAs). They're the ones who provide the care and you definitely need to be able to pay them. Right now, there's a shortage because there's so many other opportunities for skilled nursing.”

When COVID entered nursing homes, it infected both residents and staff.  This worsened the shortage.  On top of this, there were reports of staff members who refused to work in fear for themselves and their families.

A Deadly Decision

Two days before the World Health Organization declared the crisis a global pandemic, Governor Murphy issued an order that did not allow LTC facilities to deny admission or re-admission of residents “solely based on a confirmed diagnosis of COVID-19.” 

“The order stated that we had to create the space, and we had to take them,” said Corrado. But Preakness Healthcare defied the order to a degree. “We took back our residents, but I wasn't taking new people because I knew we couldn't take care of them. We had many an argument with the hospital social workers, but I didn't take them.”

“They then came out with a counter-order to curtail new admissions when the public outcry started. They backtracked, saying we couldn't take them unless we could take care of them in cohort,” she said, meaning that positive patients had to be kept in a separate are. “So, the first order was: ‘You were taking them,’ and then it got changed and it's all on their website.”

Personal Protective Equipment (PPE)

PPE shortage was big news, and it affected nursing homes much more drastically then it did hospitals.  PPE includes disposable gloves, masks, gowns, face shields, disposable booties and more. 

“We couldn't get the PPE supplies in the beginning from vendors because the hospitals were the priority,” Corrado explained. “Any sector of the health care industry is important.  You can't just single out the people who end up in hospitals.”

“So, to be in a position where you couldn't get masks; where you couldn't get gowns; we're even now still trying to get hand sanitizer,” Corrado said. “That's something that needs to be looked at on a national basis: how do you get the supplies you need for basic care in a global situation like this.”

Corrado mentioned that the New Jersey Health Department gave a clear directive early on not to wear masks unless you were sick. “Which later got reversed,” she added. “But, we started universal masking before we were required to do it.”

COVID-19 Testing

With a global demand for COVID-19 testing, kits and labs were in short supply and highly sought and weren’t even available until early March for anyone. Without knowing who was positive before they became symptomatic, the highly contagious virus spread fast within LTC facilities.  It was speculated that staff members who worked multiple jobs may have unknowingly spread the virus from one facility to another.

The State Health Department has only recently mandated testing for all LTC facilities. The program began May 26, which was after what many have considered the peak of the pandemic in NJ. The results of this testing are just coming in.

Corrado was asked if the outcomes would be different if this testing was started sooner.  "Without a doubt," she replied. "We would have been able to identify staff and residents that were carrying the virus before they became symptomatic.  Lives would've been saved."

Lessons Learned

LTC facilities across the nation are preparing for lawsuits and are currently seeking immunity.  The state and the federal governments have begun to fine facilities for their handling of the crisis.

But Corrado feels this is unwarranted. “There shouldn’t be finger pointing, because nobody knew about this virus, which is why it’s called ‘novel,’” she said.

The word ‘unprecedented’ has been used liberally to describe the fall out of the COVID-19 pandemic, but it cannot be used in the future.  A precedent has been set and the deficiencies in our systems have been exposed.

“I hope that in the end, people look at what can be learned and not just point out all the things that went wrong,” Corrado said. “I think long-term care will change because it has often been, sort of, back seat to the hospitals. And to be maligned through this whole thing is wrong.”

Corrado was asked if the plan at Preakness Healthcare had changed.

“It's stronger. It really is,” she said with confidence. “Our focus had been on infection prevention for one person, with shingles, for example, keeping them isolated. Whereas, now it's really looking at everybody. We will be better prepared in the future.”

The Future of Senior Care is About Options

“Because of the media coverage, I expect that there will be a lot of hesitation for people to place their elderly parents in nursing homes,” said Corrado. “But you have to look at what a skilled-nursing home can provide compared to what can be provided at home.”

Facilities like Preakness can provide 24-hour nursing care for seniors with serious medical conditions like dementia, or who are on IV medications.  They can also provide a social aspect, that may not be found at home.

Another option for senior care is skilled-nursing home care that can provide the medical attention for an elderly person who wants to stay at home.

Lastly, is non-medical senior care.  Liz Johnson of Always Best Care Senior Services of Wayne provides a way for seniors to stay at home where they are comfortable. This kind of service offers care professionals who will help seniors take care of daily activities that may have become difficult for them.

“There are things we all take for granted,” said Johnson. “Something as simple as getting up out of bed and going to the bathroom can be a challenge for some seniors. We provide professionals that can help seniors in all aspects of their daily lives, such as answering the door, medication reminders and management, preparing a meal, taking care of a pet and so much more.”

“Some seniors lose their abilities to handle these daily activities due to age and that’s where we step in to help,” she added. “We also provide the social aspect with companionship and conversation to help keep loved-ones stimulated and challenged. And, we offer in-home care can be hourly or can be live-in, 24-hour care."

“Long-term care facilities will always be needed,” added Johnson. “But there are options that some people aren’t aware of and are never considered. COVID-19 will change this, as I know there are plenty of people who are deathly afraid for their loved ones in many nursing homes right now.”

The COVID-19 pandemic seems to be waning, but its not over yet. Residents of nursing homes are being taken care of as best as can be done in very difficult circumstances.  But they are isolated and fearful. Almost daily, people they reside with have died and it must be a very fearful time.  Loved ones cannot visit them, which must make the feeling of isolation worse. And, its difficult on the loved ones who cannot see their elderly relatives and cannot advocate for their care.  

The positive news is that there are people who do win their personal battle with COVID and come back healthy. The PPE shortage has eased, testing is now in place and long-term care facilities are getting more attention and resources.

Some compare the COVID pandemic to the proverbial 100-year flood.  We all hope this is true, and we don't see something like this again in our lifetimes. But if we do, we all hope that the lessons learned now will prevent this kind of tragic outcome in the future.