"Over the past five months, COVID-19 has greatly impacted our long-term care facilities," Governor Phil Murphy said Monday during his coronavirus briefing. "This is not a New Jersey-specific tragedy, but we are determined to be a leader in showing a better way forward. We engaged Manatt Health to help us determine a course of action."
The governor said the NJ Department of Health will release a directive setting mandatory benchmarks for the state's long-term care facilities as they look to reopen to visitors and resume normal operations.
"This directive will establish phases for reopening based on the time since a last outbreak," Murphy said. "This directive will also establish strong baseline infection-control measures, requirements for PPE stockpiling, requirements for resident and staff testing - including weekly coronavirus tests for all staff."
The state is planning to direct $25 million in CDC Epidemiology and Laboratory Capacity Funding through the New Jersey Department of Health to support their new staff testing program.
Murphy said New Jersey Department of Human Services Commissioner Carole Johnson is working with their legislative partners on a $130 million plan to stabilize and support the state's long-term care facility workforce. He says it will enable them to increase wages, while ensuring that their long-term care facilities can continue to fully support their current staffs.
"60% of this funding must flow directly to our nursing home workforce," Murphy said. "The remainder will only go to facilities when they attest that they have met critical benchmark requirements outlined in this directive."
Acting Commissioner of Health Judith Persichelli said there will be a new category of essential caregivers for all residents and proper precautions such as screening and the use of PP will apply.
She added to also keep in mind the facilities may need time to provide the test stations.
"We must proceed with caution as we reopen these facilities," Persichelli said. "There are still more than 260 active COVID-19 outbreaks at long-term care facilities in our state, and we know that the virus is still circulating in our communities. It is essential that there are safeguards in place to keep this virus from entering a nursing home."
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.
Hundreds of nursing homes still aren't allowing visitation amid coronavirus pandemic
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