Murphy introduces reopening guidelines for long-term care facilities (including increased pay for employees), fires back at critics (especially Christie)

Gov. Phil Murphy talks with Health Commissioner Judith Persichilli before a COVID-19 briefing. (File photo)

On a day in which he vigorously defended the actions his administration took in the past toward long-term care facilities, Gov. Phil Murphy announced what it will take moving forward — most notably $155 million in additional funding that will allow for the implementation of safe reopening.

The Department of Human Services also unveiled a proposal to provide increases in Medicaid funding to nursing facilities to support wage enhancements for the front-line certified nurse aide workforce and to support compliance with Department of Health infection control directives.

Murphy said the funding — which will be a mix of state and federal cash — will allow for the implementation of a new DOH directive for the safe reopening of long-term care facilities for indoor visitation by appointment and other activities if the facilities have no COVID-19 cases among residents or staff. Before reopening, facilities must meet certain public health benchmarks including adequate infection control, staff and personal protective equipment to ensure preparedness, he said.

The funding was announced Monday during Murphy’s COVID-19 briefing and came with remarks from Health Commissioner Judith Persichilli and Human Services Commissioner Carole Johnson.

“Today’s announcement will allow facilities to meet the ongoing challenges created by the COVID-19 pandemic, while also ensuring both high-quality care and the health and safety of residents and staff going forward,” Murphy said. “And, most importantly, it will allow for residents to safely reunite with loved ones.”

He left his stronger comments for critics, most notably, former Gov. Chris Christie, who specifically challenged the administration’s efforts with long-term care facilities, saying it forced COVID-19 positive cases back into the facilities.

Murphy challenged that — and did so while firing a shot back.

“There’s a talking point, which sounds really good,” Murphy said. “I would just suggest to him, I know he’s doing really well lobbying on behalf of coronavirus clients, it’s really important to know what the facts are. Don’t let the facts get in the way, God forbid.”

Murphy said Persichilli’s instructions were precise.

“Judy was crystal clear explicit about any reintroduction of COVID positive residents into long-term care facilities,” he said. “Could not have been (more clear) and that was cohort, separate into different floors, including staff, different buildings, different wings.

“And by the way, if you do it against our directives, you will pay a price. And by the way, if you can’t do it, and many came to us and said, ‘Listen we can’t do that, can you help us find a place for these COVID-positive patients?’ We did exactly that.

“So, that talking point is myth. It may have happened, but it was completely against our and Judy’s directive.”

Persichilli’s directives Monday also were spelled out. Facilities will be able to reopen in phases.

The phased-in reopening is based on the outbreak status of a facility, its ability to meet criteria including, but not limited to, testing of staff and residents, infection control protocols, adequate staffing and PPE, and is tied to the timing of the state’s reopening plan, she said.

Under the DOH directive, when a facility is permitted to enter a reopening phase depends on compliance with the following benchmarks:

  • Must not have an active outbreak. An outbreak is considered concluded when a facility has no cases for 28 days — two incubation periods with no new positive staff or residents — and, if a CMS-certified facility, a DOH survey inspection;
  • 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;
  • Have enough PPE for present use in addition to a stockpile for emergencies;
  • Have an updated outbreak plan with lessons learned from the 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; methods for virtual communication in the event of visitation restrictions; and must be posted on its website;
  • Must contract with an infection control service within two months or hire a full-time employee in the infection control role if it has 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 Monday.

In order to assist facilities with the cost of testing benchmarks, the health department also announced $25 million in funding to assist long-term care facilities with the cost of weekly testing for all staff. These facilities will have priority access to the Rutgers University saliva test.

Under the department of human services proposal, new Medicaid funding of $130 million — $62 million in state funding and the remainder in federal matching funds — would be available to nursing facilities for the next fiscal year from Oct. 1 to June 30. This funding would increase a nursing facility’s Medicaid rates by 10%, Johnson said. Of the proposed $130 million, $78 million must be used to increase wages for certified nurse aides, or CNAs. On average, this funding will support a 20% hourly wage increase for CNAs depending on a facility’s current wage rates. The remaining $52 million would assist facilities in supporting COVID-19-related infection control and compliance with specifics in DOH directives, including infection control, PPE, cleaning, other staffing needs and more. Funding would be subject to recoupment if a facility failed to meet DOH-specified requirements or is found to have repeat infection control failures.

The proposed legislation would give DHS the authority to require facility reporting of the relevant wage data to ensure compliance and be subject to recoupment for noncompliance. Facilities that fail to pass-through the funding to wages or fail to comply with specific DOH infection control requirements and/or are found to have repeat infection control violations would be subject to recoupment of funds by the DHS. The Department of Human Services proposal requires legislative approval and approval from the federal Centers for Medicare and Medicaid Services.

Johnson said the state is working with the Legislature on a shared goal of supporting Medicaid recipients and the staff who work tirelessly to care for them.

“Wage enhancements will help support the critical front-line certified nurse aide workforce and help contribute to decreasing the risk of exposure for staff and residents,” she said. “Funding for enhanced infection control — that is tied to clear accountability measures and compliance with health and safety requirements — will further help to increase facilities’ tools to support residents. We look forward to enactment of this proposal.”

Assemblywoman Valerie Vainieri Huttle, chair of the Assembly Human Services Committee, said the new guidelines are essential.

“The COVID-19 pandemic has exposed numerous issues within our long-term care industry,” she said. “I share the administration’s commitment to enact legislation that supports our CNA workforce and achieves the broader recommendations set forth in the nursing home review conducted by Manatt Health. With this funding, we now have an opportunity to take meaningful action to create more resilient, transparent long-term care facilities.”

Senator Joe Vitale, chair of the Senate Health, Human Services and Senior Citizens Committee, said a commitment to increase pay is key.

“To provide the highest quality of care possible, we must recruit, train, and pay our workforce well,” he said. “I look forward to continuing our partnership with the administration and legislative leaders to deliver reforms that will help ensure New Jersey has the resources in place to weather the ongoing impact of COVID-19 and improve the future of the long-term care industry.”