Reforms coming to N.J. nursing homes after huge number of deaths, but other major changes stalled

More money will be earmarked for New Jersey nursing homes and their workers, under a package of legislative reforms signed into law Wednesday in response to the deadly COVID-19 pandemic that killed so many in the state’s long-term care facilities.

However, several other measures proposed in the wake of the shockingly high death toll among nursing home residents as well as those who cared for them are still being fought over in the Statehouse — including a long-debated push to mandate minimum staffing levels in often understaffed nursing homes.

“These are big steps forward to make sure that we live, we learn; that we can address what was an uneven performance in that industry and put some pieces in place that will have permanent significance and allow us to weather future storms,” said Gov. Phil Murphy before signing the four bills in a ceremony at the Trenton War Memorial.

Murphy’s administration has been under fire for months over its handling of the nursing home crisis here.

While nursing homes across the country were devastated by the pandemic, with at least 50,000 deaths nationwide, New Jersey has had the highest rate of death per capita, according to federal data. As of Wednesday, 6,757 residents and 121 staff members have been killed by the virus in the state, which has reported outbreaks in 695 long-term care facilities.

Earlier in the day, veterans groups along with dozens of healthcare workers and relatives of residents who died gathered outside the state’s own Veterans Memorial Home at Menlo Park, demanding an investigation into the deaths of at least 65 residents and one staff member — one of the highest tolls in New Jersey.

“There has not been enough movement to improve things there,” said Gary White of the Marine Corps League, who helped organize the protest.

He said veterans in the nursing home, whether they fought in war or served in peacetime, deserved far better.

“You don’t need a ticker tape parade. They just need to be treated with dignity in their final days,” White said.

Nearly half of the lab-confirmed deaths from the coronavirus in New Jersey to date have been in nursing homes, according to state Health Commissioner Judith Persichilli. An investigation by NJ Advance Media earlier this year based on internal records and interviews with players behind the scenes, showed the state failed to react fast enough or take aggressive actions to curb the spread of the outbreak in nursing facilities.

SETTING NEW MANDATES

The bills approved by Murphy included A4547, which allocated $62.3 million for a nine-month Medicaid rate increase that would raise direct care worker salaries and buy personal protective equipment. Also approved was A4482, which would raise the minimum wage for direct care staff in long-term care facilities to $3 higher than state minimum wage, beginning in July 2021. In addition, it would give the Department of Human Services authority to set a still-controversial minimum “direct care loss ratio” that would dictate how much profit is allowed versus the amount spent on workers’ salaries.

The package also creates a so-called Long-Term Care Emergency Operations Center in the state Department of Health. Under A4476, the center will serve as a centralized command center to respond to future outbreaks in long-term care facilities including state psychiatric hospitals, as well as home health care providers. And under a fourth bill, A4481, the state will establish a task force to develop recommendations to improve the safety and quality in long-term care.

Those bills came after the administration hired outside consultants in May to assess the state’s response to the coronavirus in long-term care facilities and come up with recommendations.

“We were crushed, like every American state by COVID, deaths — especially long-term care facilities. That includes both residents and staff members,” Murphy said. “It spread like dry wood in a forest fire.”

The governor said the state must not only learn from what happened, but “put in place pieces to make sure this never happens again.”

Acknowledging the rally at the state’s veterans home in Menlo Park, Murphy said earlier in the day at his latest coronavirus briefing he did not blame people for being upset about the outbreaks there and other long-term care facilities.

“We have complete sympathy,” he said. “We need to make sure we hold the mirror up to them, and ourselves.”

With the signing of the reform legislation, nursing home officials said while they were on board with most of the measures, they took issue with the impact the so-called minimum “direct care loss ratio” would have on already financially troubled facilities.

Jonathan Dolan, CEO of the Health Care Association of New Jersey, which represents long-term care providers in the state, said there was appreciation for the administration’s efforts on providing COVID-19 emergency relief funding and other mechanisms meant to improve the stability and resiliency of the industry.

But he noted that the federal CARES Act funding that nursing centers received earlier this year does not even cover the additional costs that centers faced responding to COVID-19, adding that the recently passed state funding is mostly dedicated to wage increases for certified nurse aides.

“The balance of funding is to be directed to COVID-related costs. We are not permitted to use this funding for anything other than this,” Dolan said.

He and others raised objections to the issue of setting a direct care loss ratio, which was among the measures signed into law on Wednesday.

Murphy, in explaining the issue, said that in its most simple terms, a bar would be set on “how much are you putting at the point of attack,” in regard to patients and residents, as opposed to what goes to overhead and other items.

“We’re going to require a certain commitment to that,” the governor said.

Dolan called the provision “constitutionally questionable,” asking whether the state could set such ratios on revenues outside of Medicaid.

Milly Silva, executive vice president of 1199SEIU United Healthcare Workers East, which represents 8,000 nursing home workers in New Jersey, applauded the reform package approved by the governor.

“For too long, nursing homes in our state have operated without proper oversight and some have put their bottom line before the needs and wellbeing of their vulnerable patients,” she said. “As we head into the fall, these reforms will help protect nursing home patients against future viral outbreaks by establishing better statewide coordination among facilities and developing stronger safety requirements.”

Silva said legislative package signed by the governor recognizes the importance of investing in these frontline caregivers.

“Restructuring our nursing home industry cannot end here, however,” Silva added, pointing specifically to the legislation on the table in the Assembly to set minimum staff ratios of certified nurse aides. She said that advocates and residents “have all pointed to deplorable staffing conditions as a primary failure to meeting residents’ physical and emotional needs, both before and during this pandemic.”

On Thursday, meanwhile, the state Assembly Appropriations Committee is set to debate several additional legislative measures. Among them would include a requirement that hospitals and nursing homes maintain 90-day supply of personal protection equipment such as masks, gowns and gloves; a mandate that nursing homes maintain a supply of personal protection equipment for residents; and the proposal to set minimum certified nurse aide-to-resident ratios in nursing homes, which legislators failed to pass in January.

Our journalism needs your support. Please subscribe today to NJ.com.

Ted Sherman may be reached at [email protected]. Follow him on Twitter @TedShermanSL.

Brent Johnson may be reached at [email protected].