Assisted living communities in New Jersey continue to face significant staffing challenges that compromise infection control effectiveness, according to a recently released report from Montgomery McCracken Walker & Rhoads LLP that detailed the Garden State’s response to the COVID-19 pandemic.
Nursing home operators face the same challenges, noted the report, which said that confusion reigned at the start of the pandemic due to understaffing, inadequate infrastructure and poor coordination. But assisted living and nursing home provider advocates say that a silver lining of the pandemic is that providers now feel seen as a crucial part of the healthcare continuum.
“New Jersey’s assisted living communities are dedicated to providing the best possible care to their residents, and the report shows that caring for residents during the COVID-19 pandemic was made more difficult by a lack of funding, testing, [personal protective equipment] and clear regulatory guidance,” Kathy Fiery, Health Care Association of New Jersey vice president of assisted living, told McKnight’s Senior Living. “Our providers are always willing to work with policymakers to examine ways to better prepare for any future emergencies.”
The report authors said that confusion surrounded the state health department’s directives and severe staffing shortages that transformed the state’s assisted living communities and nursing homes into high-risk settings for infections.
“This report accurately summarizes the confusion long-term care providers experienced at the beginning of the pandemic,” LeadingAge New Jersey & Delaware President and CEO Jim McCracken told McKnight’s Senior Living. “This report also recognizes the important role long-term care providers play in our healthcare system.”
New Jersey had the second-worst COVID death rate among all states during the initial surge of the pandemic. In just four months, by the end of June 2020, more than 13,000 people in the state would die of COVID, almost half of all the deaths that the state would experience as a result of the pandemic.
Older adults made up most of those fatalities (85%), of which almost half came from assisted living communities and nursing homes. In New Jersey, adults living in congregate care facilities had a fatality rate around 10 times higher than that of the 65-and-older population living in the greater community.
McCracken, no relation to the law firm that wrote the report, said there were many different interpretations of the New Jersey Department of Health’s guidance and that people were admitted to assisted living communities and nursing homes to free up hospital space. At the same time, providers were unable to purchase the necessary PPE due to supply shortages as “providers did their best” to protect residents and staff with limited resources.
“We collectively failed as a nation and as a state to be adequately prepared,” the report authors wrote, adding that heroic actions were taken at the state level to respond in good faith to the crisis. “As the pandemic progressed, significant systemic improvements helped New Jersey mitigate the crisis, but no level of effort could overcome an inadequate healthcare infrastructure and scarcity of basic medical supplies.”
The authors stated that neither the state nor the federal government had “clear, executable plans in place” to respond and manage limited resources in an uncertain and rapidly evolving situation.
Drawing comparisons with the flu pandemic of 1918 and 1919, the authors said that the nation drew lessons from the earlier crisis that shaped planning for the more recent pandemic response. But the report asked why the state and nation weren not better prepared 100 years later, what lessons can be drawn from the latest pandemic, and whether the nation will fare better when it is inevitably tested again in the future.
Recommendations target improving resiliency
Among the recommendations in the report were improving the resiliency of the long-term care sector — including assisted living communities, enhancing communication between the state health department and the long-term care sector, and finding ways to promote visitation and support infection control in long-term care facilities in future health crises.
The report also recommended that the state consider increasing the number of assisted living communities that accept a high percentage of Medicaid residents if understaffed nursing homes have to curtail admissions during future public health crises.
