Families who take their loved ones out of long-term care centers for Thanksgiving should prepare to keep them home longer if the facility does not have enough space to quarantine them for two weeks upon return, State Health Commissioner Judith Persichilli announced Monday.
That said, Persichilli once again strongly advised against taking home residents of long-term care facilities, stressing that gatherings with people they do not live with or see on a regular basis could put residents at risk of contracting the coronavirus.
Instead, Persichilli said, nursing homes, assisted living facilities and other long-term care settings should prepare for outdoor visits, or possibly indoor visits if they meet the department’s safety requirements. Facility operators should also prepare to accommodate more virtual visits, she added.
But if families are intent on bringing home their loved ones, they and facility operators will have to abide by new rules that will undoubtedly complicate — and in some cases possibly delay or even deny — these visits.
“This will not be a normal Thanksgiving,” Persichilli said. “With the alarming surge in our cases, we all need to be vigilant and take all of the public health precautions that helped us to limit the spread of the virus last spring. Our lives—and the lives of our loved ones—depend on it.”
The guidance to cohort residents is not new. Murphy said his administration had advised long-term care operators in March to isolate or “cohort” residents returning home from the hospital, or to notify the Health Department if they couldn’t do so and the state would make other arrangements.
“There was some confusion in the spring and summer, what it means to cohort. Let me blunt: it means keeping folks separated,” Murphy said. “Every single edict, whether it came from me or more importantly or the series of guidance or orders that came from Judy on long-term care was explicit about cohorting residents and staff.”
Based on reports from nursing home employees, union representatives and residents’ relatives, cohorting did not happen consistently and sometimes not at all. Some families, as well as Republican lawmakers, said the Democratic governor’s decision to allow residents who were recovering from coronavirus to return to nursing homes from the hospital cost people their lives, a claim Murphy has bitterly disputed. He has faulted the long-term facilities for not separating the residents.
New Jersey has ranked first or second for most long-term care fatalities per capita throughout the eight-month pandemic.
With New Jersey deep into a second-wave of the coronavirus outbreak, Persichilli noted during Gov. Phil Murphy’s regular pandemic briefing in Trenton, “Small family gatherings are a significant driver of increasing cases.”
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Persichilli listed guidelines for long-term care facilities involving visitation:
* Residents who leave must be quarantined upon their return to the facility for 14 days.
• If the resident has a roommate, the returning resident should be quarantined in a “separate observation room.”
* If a separate room or space to separate returning residents, facility operators must tell families to keep their loved ones home until space is available.
* Facility operators must develop a plan that includes how many residents who plan to leave for the holiday and how much space they have to accommodate returning residents separately from Nov. 25 to Dec. 31. Operators should take “reservations” and create a waiting list, if necessary. Residents and their families should understand if they may not be guaranteed re-admission until a bed is available.
“Reservations should be tied to the number of individuals the facility can quarantine on their return,” she said.
Laurie Brewer, the Long Term Care Ombudsman for New Jersey, said she imagined the holidays posed a “major scheduling challenge.”
“For larger facilities that may be experiencing staff shortages and have limited physical space, quarantining large numbers of people may be extremely difficult,” Brewer said.
Persichilli’s guidelines “strike a necessary balance between the safety of long-term care facility residents and the resident’s desire to salvage some semblance of a normal holiday celebration with their families,” Brewer added.
Visitation has been a tense subject for residents and their families because routine visits halted in mid-March and the isolation and separation has compromised many residents’ mental and physical health. Interim steps like outdoor visits, permitted since June, are usually no more than 15 minutes to 30 minutes, and infrequent because of inclement weather and staff are required to supervise to ensure no hugs, families say. The federal government relaxed visitation guidelines in September, but families continue to complain that facilities have not cooperated.
Bill Borrelle, who founded FACE for Seniors, a Facebook group to advocate for better visitation policies during the pandemic, said he welcomed the commissioner’s guidance.
“I fear that the pent-up demand to see our loved ones due to facilities again in lockdown with no visitation permitted will cause families to remove their loved ones for Thanksgiving,” said Borrelle, whose mother lives in an assisted living facility in south Jersey.
“A holiday like Thanksgiving puts a spotlight on the core issue families with loved ones in long-term care communities face. We want safe, in room visitation to provide caregiving and emotional support on a regular basis, whether or not the facility is locked down. Testing and PPE (personal protective equipment) can make this safe, and our loved ones are deteriorating from isolation,” Borrelle said.
“If one family member was permitted to visit, with PPE and testing, on a regular basis, long-term care residents would be far safer than exposure to an unmasked group around a crowded Thanksgiving table,” he added.
Persichilli said her office has been in “constant communications” with long-term care facility operators, with a focus on improving the availability and frequency of testing. More information about holiday visits was contained in a memo released late Monday.
Even before the state announced the action on Monday, Andrew Aronson, director of Nursing Home Advocates of New Jersey, a coalition of some of the state’s largest nursing home operators, said last week there growing concern over the rising infection rates in New Jersey.
“We see cases going up everywhere and we know that’s going to lead to more cases in nursing homes,” he said. “It’s going to be a very, very difficult season.”
“Every facility is trying to come up with ways to make the holidays as special as they can for the residents,” Aronson said.
But echoing the commissioner, he said those who leave to spend the holiday with families outside the facility “will have to quarantine when they come back.”
After reviewing the health department’s guidance, Arsonson acknowledged the challenge ahead. It’s quite common for nursing home residents to have roommates and less common for assisted living residents. On average, long-term care facilities are about 60% full right now, which gives operators some room to manage the post-quarantine visits, he said.
“If residents want to do that on a large-scale basis, say 25 to 30 residents (from one facility), there won’t be space, ” Arsonson said. “Do you stop them from going or do you stop them from coming back?”
The virus has killed 6,886 long-term care residents in New Jersey, plus an additional 627 probable fatalities that have not been confirmed by a test or autopsy, according to the health department. There are 241 active outbreaks in these centers, up from 188 two weeks ago, according to the state health department website.
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NJ Advance Media Staff Writer Ted Sherman contributed to this story.
Susan K. Livio may be reached at [email protected]. Follow her on Twitter @SusanKLivio.