NEW JERSEY – Governor Phil Murphy, Department of Health Commissioner Judith Persichilli, and Department of Human Services Commissioner Carole Johnson Monday announced the Administration’s proposal to provide long-term care facilities with $155 million in additional funding as they look to reopen to visitors and resume normal operations. The funding—which will be a mix of state and federal monies—will allow for the implementation of a new DOH directive for the safe reopening of long-term care facilities for indoor visitation by appointment and other activities if the facilities have no COVID-19 cases among residents or staff. Before reopening, facilities must meet certain public health benchmarks including adequate infection control, staff and Personal Protective Equipment (PPE) to ensure preparedness.
“Throughout this pandemic, one of the most-impacted communities in our state has been the residents and staff of our long-term care facilities,” Murphy said. “Today’s announcement will allow facilities to meet the ongoing challenges created by the COVID-19 pandemic, while also ensuring both high-quality care and the health and safety of residents and staff going forward. And, most importantly, it will allow for residents to safely reunite with loved ones.”
Commissioner Persichilli announced a directive for the phased reopening of long-term care facilities to implement certain requirements, preparations in the event of a surge of COVID and to attest about their preparations to the Department of Health (DOH). When facilities conclude their outbreaks and implement the requirements of the DOH’s directive, they will advance in phases, and in each phase, will be able to restore services for residents and ultimately allow for indoor visitation and resumption of normal activities.
The phased-in reopening is based on the outbreak status of a facility, its ability to meet criteria including but not limited to testing of staff and residents, infection control protocols, and adequate staffing and Personal Protective Equipment (PPE), and is tied to the timing of the state’s reopening plan. In order to assist facilities with the cost of testing benchmarks, DOH also announced $25 million in funding, which will assist long-term care facilities with the cost of weekly testing for all staff. These facilities will have priority access to the Rutgers University saliva test.
To date, more than 30 million units of PPE have been distributed to long-term care facilities. Stockpiling for these facilities is underway, along with ongoing inventory assessment. Infection control-focused surveys also have been completed in 467 facilities including: 370 nursing homes, 49 assisted livings, six dementia care homes, four specialty hospitals, 27 end stage renal dialysis centers, five ambulatory surgery centers and six acute care hospitals. In addition, over 3,600 backlogged complaints, some dating to 2017, have been cleared.
In implementing a key recommendation outlined in the nursing home review conducted by Manatt Health, DOH also developed a forward-looking testing plan for residents and staff. Baseline testing for both was completed by the end of May, and retesting continues for those who have tested negative, which is a recommendation of both the Centers for Disease Control and Prevention and the Department. To date, over 310,000 tests have been completed on residents and more than 495,000 tests have been done on staff. The positivity rate for long-term care residents has been reduced from 6% in May to less than 1% in July. The positivity rate for staff has also fallen from 3% in May to less than 1% in July.
Under another recommendation in the nursing home review conducted by Manatt Health, DOH created a Long-Term Care Emergency Operations Center (EOC) to provide a centralized command structure to manage the emergency response to COVID in long-term care facilities. The EOC, chaired by Dr. David Adinaro, DOH’s Deputy Commissioner for Public Health Services, monitors COVID testing of residents and staff, supplies of PPE and therapeutics needed to protect residents and staff.
“Reuniting families with their loved ones in these facilities is critical for the mental, physical, social and emotional well-being of our most vulnerable residents,” Persichilli said. “With the virus still circulating in our communities, we must balance the health and well-being of residents with proper infection control and employee safety protections. The restart plan will give long-term care facilities, residents and families direction for resuming normal activities.”
The Department of Health curtailed visitation at long-term care facilities in March due to COVID-19. Outdoor visits have been allowed by appointment since June 21. DOH issued another directive on July 15 that permitted parents, a family member, legal guardians and support persons of pediatric, developmentally disabled and intellectually disabled residents of long-term care facilities to arrange for by-appointment indoor visits with their loved ones. DOH reviewed the guidance with the New Jersey Long-Term Care Ombudsman, state disability rights advocates, unions and the long-term care industry.
The Department of Human Services (DHS) also unveiled a proposal to provide increases in Medicaid funding to nursing facilities to support wage enhancements for the front-line certified nurse aide workforce and to support compliance with Department of Health infection control directives.
Under the proposal, new Medicaid funding of $130 million—$62 million in state funding, the remainder in federal matching funds—would be available to nursing facilities for the next fiscal year from October 1st to June 30th. This funding would increase a nursing facility’s Medicaid rates by 10 percent.
Of the proposed $130 million, $78 million must be used to increase wages for certified nurse aides (CNAs). On average, this funding will support a 20 percent hourly wage increase for CNAs depending on a facility’s current wage rates. The remaining $52 million would assist facilities in supporting COVID-19-related infection control and compliance with specifics in DOH directives, including infection control, PPE, cleaning, other staffing needs, etc. Funding would be subject to recoupment if a facility fails to meet DOH-specified requirements or is found to have repeat infection control failures.
The proposed legislation would give DHS the authority to require facility reporting of the relevant wage data to ensure compliance and be subject to recoupment for non-compliance. Facilities that fail to pass-through the funding to wages or fail to comply with specific DOH infection control requirements and/or are found to have repeat infection control violations would be subject to recoupment of funds by the DHS. The Department of Human Services proposal requires legislative approval and approval from the federal Centers for Medicare and Medicaid Services.
Under the DOH directive, when a facility is permitted to enter a reopening phase depends on compliance with the following benchmarks:
- Facilities must not have an active outbreak. An outbreak is considered concluded when a facility has 28 days – two incubation periods with no new positive staff or residents – and, if a CMS-certified facility, a DOH survey inspection.
- They must be fully staffed and have a plan for additional staffing in case of an outbreak or emergency.
- Staff testing must continue to be conducted weekly.
- It is essential that they have enough PPE for present use in addition to a stockpile for emergencies.
- They must have an updated outbreak plan with lessons learned from the COVID-19 pandemic. The plan must also include a communications strategy that outlines regular communication with residents and families about cases and outbreaks or any other emergency. The plan must also include methods for virtual communication in the event of visitation restrictions. The plan must be posted on their website.
- Facilities must contract with an infection control service within two months or hire a full-time employee in the infection control role if they have more than 100 beds or hemodialysis.
- Facilities with ventilator beds are required to hire an infection control employee per current statute.
- Every facility will be required to put in place within nine months a respiratory protection program that complies with Occupational Safety and Health Administration (OSHA) standards including medical screenings and fit testing of employees using respirators (N95 Masks).
There are four phases of DOH’s reopening plan as outlined in the directive, all tied to the state’s planned stages of reopening. All facilities start in Phase 0 as of today.
Once visitation can begin, facilities must follow rigorous infection prevention and control protocols, including:
- Visitor screening, including temperature checks;
- Requiring visitors to practice routine infection prevention and control precautions including wearing a mask and social distancing;
- Having a plan that limits hours of visitation and number of visitors in the facility at one time. Residents will be limited to two visitors at a time;
- Identifying a visitation area that allows for social distancing and deep cleaning if the resident is in a shared room;
- Receiving informed consent from the visitor and resident acknowledging that they are aware of the risks of exposure to COVID-19 and that they will follow rules set by the facility;
- Instructing visitors to monitor for fever or other COVID-19 symptoms for at least 14 days after their visit, and to immediately notify the facility if they experience symptoms.
Recognizing that some residents need additional support regardless of the situation at their facility or their COVID status, a new category of essential caregiver will be added for all residents with proper precautions such as screening and the use of PPE.
To read the DOH directive, click here.