The coronavirus devastated New Jersey’s nursing homes this spring, killing thousands of residents and prompting a raft of measures to better protect the state’s most vulnerable population.
Since that time, long-term care facilities say they have stockpiled personal protective equipment. They’ve developed protocols for testing residents and staff and isolating those who are sickened. Visitors continue to be limited by state regulators, amid fears the virus will be reintroduced as families reunite with their loved ones.
Yet despite those precautions, the coronavirus continues to creep into the state’s nursing homes, assisted-living centers and other senior facilities, even among those that managed to eradicate their original outbreaks, Department of Health data shows.
Across New Jersey, at least 102 long-term care facilities saw new outbreaks this summer or fall after being declared COVID-19 free, according to a review by NJ Advance Media. Included in those were 11 facilities in which residents or staffers died in the new contagions.
That points to a somber reality as New Jersey grapples with a concerning resurgence of coronavirus in recent weeks: Even as nursing homes have had nearly seven months of experience combating the virus, many remain unable to keep it wholly at bay. Still, those outbreaks are proving less deadly and easier to contain than in March or April, when underprepared facilities were floored by a pandemic that caught them, the state and the country flat-footed, flooding New Jersey’s hospitals and morgues.
On Friday, a union that represents 8,000 nursing home workers in New Jersey expressed concerns about a second wave of the disease and the impacts it could carry.
“Nursing home operators need to be taking every precaution, including giving frontline workers access to n95 masks, gowns and surgical masks before, not after, new outbreaks emerge,” said Milly Silva, the executive vice president of 1199SEIU United Healthcare Workers East. “Facilities need also to staff-up now, to prevent the type of short-staffing crisis that we experienced earlier this year.”
James McCracken, who heads a trade association of nonprofit senior care organizations, called preparedness a difference of “night and day” from what it once was. Nursing homes have learned to better protect residents and staff, he said, and have largely secured the personal protective equipment that was in such short supply.
“It’s pretty clear that there’s just a much better understanding of the disease, which no one had in the beginning, which was new to everyone,” said McCracken, the chief executive of LeadingAge New Jersey & Delaware.
But seniors and the workers who care for them do continue to be sickened and die, if at rates far lower than at the height of the disease’s sweep. It takes just one positive test for a nursing home to be considered to have a new outbreak, and in many cases, those small-scale infections are not spreading.
The state began publishing an online list of infections and deaths by facility in April after complaints that nursing homes were not being transparent as the disease ripped through New Jersey. But since mid-July, the state has regularly winnowed that tally by removing any center that has been coronavirus free for at least 28 days, which represents two incubation periods of the virus.
To count new outbreaks, NJ Advance Media used archived versions of the state’s daily list to track nursing homes that were removed, then later returned from late July through Monday with new infections.
As long as the virus is active in the community at large, some facilities will have cases of it coming into their buildings through employees, contractors or those family members who are permitted visits, said Laurie Facciarossa Brewer, New Jersey’s long-term care ombudsman, which advocates for seniors in the system.
“I expect that you will see quite a bit of ping-ponging back and forth between being coronavirus free and having an outbreak,” Brewer said.
At the 11 facilities with new fatal outbreaks, a total of 18 residents and two staff members succumbed to the virus, the data showed. In addition, since Aug. 1 at least six facilities recorded their first outbreaks of the pandemic, with no deaths reported.
Some of those places remain on New Jersey’s active outbreak list, which contained 149 facilities on Friday. But others have gotten their outbreaks under control and no longer appear. Reached for comment, several of the facilities with deaths cast the new cases as isolated incidents that came despite their best safety precautions.
The Sunrise of Lincroft, a senior community in Middletown, Monmouth County, lost four residents to COVID-19 in the initial months of the pandemic, after it began reporting infections in late May, according to state data. Then this summer, the facility reappeared on the state’s list, with new cases that claimed the lives of two residents by Aug. 17.
In a written statement this month, Sunrise of Lincroft’s parent company said the facility is now free of the disease, with no current confirmed cases.
“Our heart goes out to every family that has lost a loved one to COVID-19,” said Denise Falco, a regional vice president of the Virginia-based Sunrise Senior Living. “The pandemic has presented us all with significant challenges, and our response to those challenges continues to evolve and improve.”
Atrium Post Acute Care of Livingston had 10 residents die of coronavirus in the early sweep of the pandemic, and another in late July.
“The July case was isolated — the only COVID-19 we have had since April and the only one we have had since,” said Christina O’Leary, a spokeswoman for Atrium’s Edison-based parent company, Spring Hills Senior Communities. She said the facility has “strict measures” for infection control in place, including separate quarantine units, frequent temperature checks and regular testing.
“We can’t predict where COVID-19 may surge next, but we are committed to doing all we can to ensure the safety of those in our care,” O’Leary said.
Recently, the state has seen coronavirus cases leap, with Health Commissioner Judith Persichilli warning on Thursday that she anticipates a second wave of the disease.
In the first wave this spring, New Jersey’s nursing homes were hit particularly hard, and the state has the second highest number of coronavirus deaths at long-term facilities in the nation per capita, according to the Centers for Medicare & Medicaid Services.
Overall, about half of New Jersey’s confirmed coronavirus death toll — which tops 14,350, excluding nearly 1,800 deaths considered probable COVID-19 cases — has been attributed to senior facilities. In the state-run Menlo Park Memorial Veterans Home alone, 101 people are suspected to have died from the disease, or one out of every three of its residents.
The staggering counts have raised scrutiny about the adequacy of the state’s response, with critics accusing Gov. Phil Murphy’s administration of sending infected patients back into nursing homes when they were released from the hospital — a charge Murphy has denounced as “a myth,” saying facilities that could not isolate and protect residents were not supposed to be readmitting them.
In May, an investigation by NJ Advance Media found New Jersey did not react quickly or aggressively enough to slow the disease’s spread in long-term care facilities, short changing them on protective equipment and failing to send inspectors into buildings for more than a month into the pandemic. A state-commissioned report, meanwhile, concluded nursing homes were unprepared and understaffed, prompting a slew of reforms that the Legislature approved last month.
The Department of Health says it has been working with facilities to bolster their early coronavirus detection systems, including through the weekly testing of all residents and staff. Since May, the department says, about 550,000 tests have been completed on residents and about 1 million on staff.
Nancy Kearney, a department spokeswoman, highlighted positive trends in the results of those tests: Positivity rates among residents have fallen from 7% in May to less than 1% in September and October, she said. Among employees, positivity rates are also less than 1%, down from 3% in May.
Since the early difficult days, practices at nursing homes have improved, said Brewer, New Jersey’s long-term care ombudsman. She said her office is no longer fielding calls from families concerned their loved ones’ caregivers lack protective gear to prevent the disease’s spread.
“My sense is that New Jersey has put in a pretty rigorous program in place in order to be prepared for any potential second waves,” Brewer said.
Fourteen residents of United Methodist Communities at Collingswood died of coronavirus in the initial months of the disease, according to the state. But when one staffer and one resident became infected in late July, they recovered and the Camden County facility is now COVID-19 free.
Robbie Voloshin, a spokeswoman for United Methodist Communities, said that speaks to the efforts they’ve made to hold the disease at bay, which include portable negative air pressure machines, ultra-violet sanitation equipment and electro-static disinfectant sprayers.
“I would love to say there’s no cases ever, but as we’ve recently seen, COVID is an indiscriminate [illness],” Voloshin said.
She added: “I know we’re prepared. Now that we are however many months into this, we’ve put a lot of measures in place.”
Coronavirus is particularly fraught for the elderly. People of 80 years and older represent 48% of New Jersey’s deaths, according to the Department of Health. Those ages 65 to 79 make up 32% of deaths.
That comes as New Jersey has gradually reopened as new deaths, hospitalizations and infection rates plummeted, leading the state to lift restrictions on social life. But many of those trend lines have begun inching upward again, and officials are expressing concerns about several hotspot counties, particularly Ocean and Monmouth.
Whether the state is prepared for a second wave has long been a question in the forefront, even before surging caseloads thrust it there. More than a month ago, Murphy was asked about preparedness during one of his regular coronavirus briefings.
“I think we’re probably as prepared as any American state, but I would say nobody’s going to pat themselves on the back or do any celebrations,” Murphy said Sept. 2. “We’re all going through this together, and God willing, we’ll be fortified enough to be able to push back, if there is a second wave, successfully.”
The progress nursing homes have seen had Jon Dolan, the chief executive of the Health Care Association of New Jersey, also invoking a higher power.
“We are in an entirely different world, thank God,” Dolan said.
While every death is one too many, long-term care facilities have been able to avoid the sweeping outbreaks they once saw, Dolan said.
“So far, fingers crossed, so good,” Dolan said.
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Riley Yates may be reached at firstname.lastname@example.org.