Protecting Long-term Care Residents in NJ Getting More Complicated
The state Health Department continues to limit indoor visitation at long term care facilities, even if residents and their visitors have been vaccinated against COVID. But during the Wednesday coronavirus update in Trenton, state Health Commissioner Judith Persichilli stressed the need for outdoor visits, compassionate care as well as visitation by appointment for essential caregivers and end of life matters.
Persichilli said COVID-19 continues to infect people across New Jersey including in long-term care facilities, where there are currently 273 active outbreaks. She said continued vigilance is necessary, which is why the Department has developed phases of reopening for all long-term care facilities.
She explained the phase reopening is based on the outbreak status of the facility, the Health Department’s COVID-19 activity level index, how many cases are being reported in the region, and the facility’s ability to meet criteria, including testing of staff and residents, infection control protocols, adequate staffing and PPE.
Persichilli said it is important to keep in mind compassionate care, essential caregiver, end of life visitation can be permitted “even when indoor visitation is otherwise restricted because of the facilities status.”
She said “compassionate care visits are permitted in a wide range of situations including when a resident’s physical or emotional health is significantly deteriorating.”
She said one example of a compassionate care visit is if a long-term care resident had recently been living with other family members before the pandemic began.
“We know that a change in their environment and sudden lack of family can be traumatic,” she said. “Allowing a visit from a family member in this situation would be consistent with the term compassionate care situations.”
She noted a compassionate care visit might also be necessary for a resident “who used to talk and interact with others but is now experiencing emotional distress, seldom speaking or crying more frequently.”
She said if a resident is not doing well, “visitation is permitted in a resident’s room if they are in a single room. If the resident is in a shared room, the facility needs to identify a visitation location that allows for social distancing.”
Persichilli said essential caregivers could include a family member or a close friend who had helped to take care of an elderly resident.
Gov. Phil Murphy pointed out that essential caregivers should be allowed to visit “if a facility goes 14 days without a positive case, and compassionate care visits are allowed even when there is a known case in a facility.”
Murphy said he has enormous concern regarding the emotional distress caused by isolation “and its much broader impact on the overall health and quality of life of residents in our long term care facilities.”
“No facility should place all residents on lockdown in their rooms without taking a full accounting of individual resident needs, staff, PPE capacity," he said.
Persichilli said currently indoor visitations are permitted in Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Hunterdon, Mercer, Salem and Somerset counties.
She also noted 72% of long-term care residents have been fully vaccinated, and 90% of people in assisted living facilities have also been vaccinated, but the total for staff working in both of these types of facilities is only about 50%.
She said there is an ongoing education campaign for those working in long-term care and assisted living facilities.
Murphy said any resident of a loved one experiencing a long term care challenge in navigating a visitation can call the office of the long-term care ombudsman at 1-877-582-6992 or visit nj.gov/ooie.
On Monday afternoon, the Centers for Medicare and Medicaid Services released new guidance for nursing homes, indicating that residents who have been vaccinated should be allowed to have indoor visits.
The guidance stipulates close contact and touch is OK with loved ones who are visiting, but mask-wearing and hand-washing protocols should remain in place.
CMS also said 6 feet of social distancing remains the safest policy, and outdoor visits are always preferable whenever possible.