50% of New Jersey’s COVID-19 Deaths Occurred in State Regulated Nursing Facilities
the staff of the Ridgewood blog
Trenton NJ, On January 21, the State of Washington announced its first confirmed case of COVID-19. Within a month, the virus had taken hold and people were dying. It was quickly evident that many of the deaths were in nursing care facilities.
The outbreak made national news and should have gotten national attention, including from elected officials and health care agencies in New Jersey.
Unfortunately, New Jersey’s failure to heed the warning signs and its inaction to support our long-term care facilities has been nothing less than devastating. Of the 8,000 deaths that have occurred in New Jersey due to the coronavirus, a full 50% have occurred in New Jersey’s nursing home facilities.
While the population of New Jersey’s nursing homes is 61,000 people – just 0.67% of the 9 million people in the Garden State – they have accounted for half (4,151) of New Jersey’s COVID-19 deaths.
Although the deaths in the Garden State’s nursing facilities are not unique, other states have fared far better with fewer fatalities in their facilities. Nationally, COVID-19 deaths in nursing homes account for approximately 25% of all lives lost, as is the case in our neighbor, New York, the state hit hardest by COVID-19.
The results in Florida have been far better. As of May 3, nursing facilities accounted for 423 of the Sunshine State’s 1,314 total COVID-19 deaths. For comparison, that’s about one-tenth the number of deaths that occurred in New Jersey’s nursing homes due to COVID-19.
Where did our state go wrong?
On March 31, the New Jersey Department of Health issued an order to long-term health facilities saying they could not deny admission to COVID-19 patients. Unprepared for the onslaught, the result was devastating to those facilities.
Applying common sense, one could surmise that moving a COVID-19 patient in an isolated and frail environment such as a nursing home would wreak havoc among that elderly and most vulnerable group of citizens.
On April 19, The New York Times reported that 70 patients died in the Andover nursing facility. The Times also reported workers in nursing care facilities were pleading to the government for help. The Governor said he was “outraged” and would send the Attorney General to investigate.
The Attorney General, however, should not have to look very far to discover who is responsible. Nursing homes and assisted living facilities fall under the jurisdiction of the State of New Jersey’s Department of Health for regulation and oversight.
Although these facilities may look like hospitals, the levels of infection control they employ and their ability to treat the vulnerable populations they serve does not match the care available in a hospital setting.
Knowing this, the State’s Department of Health should have stepped up oversight and outreach to these facilities. They should have offered to supply personal protection equipment (PPE) that many nursing homes were lacking. Testing of all residents and staff should have been instituted immediately.
Although the State has jurisdiction over testing and labs, it failed to adequately prioritize the limited tests available at the outset for our vulnerable nursing home populations. While many facilities had invested heavily in PPE, it still was not enough.
“Lack of testing within nursing homes and lack of resources contributed to outbreaks,” said Jon Dolan, President and CEO of Health Care Association of New Jersey.
With little indication that sufficient State support was forthcoming, facilities such as Seacrest Village in Little Egg Harbor began buying their own PPE.
By advancing a broad shut down and the isolation of every New Jerseyan, the State failed to focus on protecting the most vulnerable people in our population, our elderly residents living in the close quarters of nursing homes.
It now appears that the closing of schools, religious intuitions, and many businesses had little effect in allaying the contagion among our nursing care facilities.
I believe it is critical that we undertake an immediate retrospective review to understand exactly what was done and to identify what could have been done better.
Here are some clear issues that underscore the shortcomings with respect to our nursing homes:
- Strict Isolation – Sending COVID-19 patients to nursing facilities was a huge mistake. It was done to free up hospital beds for a projected huge influx of patients that never occurred. Applying common sense tells us that you shouldn’t contaminate a closed system of vulnerable patients with a patient carrying a communicable pathogen. The results were devastating and expected.
- Lack of State Oversight – Nursing facilities are controlled and regulated by the New Jersey Department of Health. Before large numbers of fatalities occurred, the State should have reinforced infection control procedures, prioritized obtaining PPE for staff and patients, and made sure sufficient numbers of skilled staff, including doctors and nurses, were available and supplemented to care for residents. Surely, there were some bad actors among these long-term facilities, but certainly not all of the 600 New Jersey facilities were non-compliant.
- State testing, which was limited in supply initially, should have been prioritized for nursing care facilities, including patients and staff. Those who tested positive should have been sent to a hospital setting where they could have received critical, compassionate care with superior infection control, while being segregated from the remaining nursing home population.
- Additional staff should have been deployed statewide in these facilities. The federal government deployed the USNS Comfort, a 1,000 bed Navy hospital ship, to New York and constructed a 2,500-bed facility in Manhattan. Additionally, the President ordered 1,000 military personnel to the New York City area. When it was determined that these facilities were no longer needed, it doesn’t appear the federal government was approached by the State about the possibility of shifting medical personnel to New Jersey’s most vulnerable nursing care facilities. Similarly, medical staff volunteers were called to help New Jersey’s hospitals, but it doesn’t appear they were ever asked to voluntarily in our overwhelmed nursing facilities.
- Other states saw the value in early treatment of nursing home patients with Hydroxychloroquine (HCQ). The results retrospectively were very good. Why did the State not allow treatment with HCQ from the outset, and why was it so insistent that it only be prescribed to treat symptomatic infected patients? Why did the state not allow doctors to try to prevent the disease using HCQ as an early treatment for both staff and patients? Many doctors wanted to treat nursing home patients with HCQ proactively, but the State prohibited them. It may have saved lives.
- Florida managed to limit deaths in its nursing facilities to one-tenth of the 4,151 deaths that occurred in New Jersey’s long-term care homes. Was Florida ever contacted and asked to share their protocols and preventative measures with New Jersey officials? If so, how do we account for the huge discrepancy? If not, why not?