At the Bergen County nursing home that Carol Silver Elliott runs, last week marked a milestone that speaks volumes to New Jersey’s efforts to recover from the coronavirus pandemic.
For the first time, The Jewish Home at Rockleigh could be declared COVID-19 free — happy news for a nonprofit facility that saw 22 of its residents die and scores more sickened in an outbreak that has devastated nursing homes in the Garden State.
The ubiquitous plastic dividers have been taken down, and the 180-bed home has begun accepting new patients again, even as staff continue to wear protective gear and residents continue to be largely confined to their rooms.
Like nursing homes throughout New Jersey, The Jewish Home saw its population fall significantly amid the outbreak, even beyond the sad toll that coronavirus carried. The low point came in late May, when it had just 111 residents, leaving nearly four of every 10 of its beds empty.
Elliott says her nursing home will recover, and she notes that since it reopened to admissions, its numbers have begun inching up again, rising to 130 last week. But across the industry, that is by no means assured.
Even as coronavirus recedes, nursing homes are facing a difficult financial picture and public scrutiny over a lack of preparedness and transparency. If families continue to fear that facilities will be unable to protect their loved ones, that could reshape what long-term care looks like in New Jersey.
“We hope it does, because we need to do better,” said Evelyn Liebman, AARP New Jersey’s director of advocacy. “If we’ve learned anything from this pandemic, we need to do better and we can do better.”
New data released this month by the federal Centers for Medicare & Medicaid Services shows just how deep of a hole nursing homes have fallen into. More than 35% of beds in New Jersey are unoccupied, nearly double the rate before the pandemic struck, an analysis by NJ Advance Media found.
Out of 325 New Jersey facilities that hold more than 47,000 beds, 30,500 were filled as of May 31, the data said, an occupancy of 64.5%. Before coronavirus hit, prior Medicare data shows, those same nursing homes carried average daily populations of nearly 39,000, an occupancy of 82.5%.
The data is incomplete, with statistics for some of the state’s 370 nursing homes unavailable and others only partially provided. But industry officials said the rates match what they expect across the state.
The reasons for the vacancies are many, even accounting for coronavirus deaths at the facilities, operators and advocates for seniors say.
As the disease raged, some families did anything they could to keep their aging loved ones at home, despite the challenges that caring for them poses. Some nursing homes limited or stopped accepting new patients, even if they came knocking, as they moved to crisis footing as residents and workers were sickened and died. Ten troubled facilities were ordered by the state to cease accepting admissions, and five of those orders continue to be in place, the Department of Health said last week.
Also with the outbreak, another key part of nursing homes’ business vanished. Many facilities take in short-term patients who are recovering from knee and hip replacements or other medical procedures, an important piece of their operations because federal reimbursement rates are greater for those residents. But with elective surgeries canceled in New Jersey until recently, those beds have gone unfilled and many may continue to be, since new patients may elect to rehab at home, rather than risk fears of exposure.
That combines to present daunting financial hurdles at a time when nursing homes have seen their expenses skyrocket, given the price of testing and protective equipment, and overtime and hazard pay to maintain workforces depleted by the virus.
“It’s devastating, not only from the occupancy issue, but from the increased costs of providing services,” said James McCracken, who heads LeadingAge New Jersey & Delaware, which represents nonprofit senior care organizations.
The Health Care Association of New Jersey is pushing for more financial help for nursing homes, beyond the $170 million announced last month by the Trump administration. The trade group notes that New Jersey has not provided direct aid, as some other states have.
Jon Dolan, the Health Care Association’s president and CEO, defends the industry’s performance during the pandemic, saying that nursing homes provide “exceptional care and will continue to do so.”
“We believe that the public understands the unprecedented challenges we faced during the pandemic and the decisions that were outside of our control,” Dolan said in a statement. “It may take a little time, but we know this unprecedented healthcare crisis will not dissuade people from getting the best care for their loved ones.”
About 45% of New Jersey’s lab-confirmed coronavirus deaths — which has topped 12,800 — have been attributed to long-term care facilities, though the state includes more than just nursing homes in that count, with less restrictive settings such as assisted living centers also represented.
The staggering number has raised scrutiny about the adequacy of the state’s response, with a May investigation by NJ Advance Media finding New Jersey failed to react fast enough to slow the disease’s spread among such a vulnerable population. A state-commissioned report, meanwhile, concluded that nursing homes were unprepared and understaffed, and need tougher regulatory oversight.
“In the industry going forward, there’s a fair amount of question marks,” said James McGregor, the director of research for SEIU 1199, a union that represents nursing home employees. “I think the coronavirus crisis really drives home the need for the state and federal government to take a look at the industry.”
For families with loved ones in long-term care, the past three months have been harrowing.
As coronavirus leveled the state, Mary Sisler said she feared for her 93-year-old mother, Therese Pounds, who had moved into assisted living in West Orange late last year after deciding she was too weak to continue at her home of 56 years in Montclair.
Sisler, a professor at Hamilton College in Upstate New York, decided to remove her mother from Green Hill, the senior living community, after receiving an April 3 notice that a resident had died and had tested positive for COVID-19. Sisler said Pounds was initially reluctant to go.
But then her mother looked out the window as a body bag was carried away, Sisler said.
“She saw that and she said, ‘I think this is a sign that I should get out,’” Sisler remembered.
Sisler said that days later, she drove 3 1/2 hours from her home to pick up her mother. As she waited for Pounds, a hearse pulled up alongside her car to pick up a body, she said.
“I said, ‘Ma, what car do you want to be taken out of, theirs or mine?‘” Sisler said.
Sisler and her mother rented a suite at a Marriott extended stay hotel in West Orange, where Sisler paid $139 a day for two rooms and a kitchenette. They lived there for two months, allowing Sisler to continue to teach her college classes remotely, while caring for Pounds, who has COPD and uses a walker.
On Sunday, Sisler moved her mother into an apartment in Essex County, where she has arranged for a home health care aide to serve as caregiver. Sisler plans to stay with Pounds through the summer.
Despite the challenges and the expense, Sisler said she is convinced she made the right decision.
“I didn’t want my mom to die this way,” Sisler said. “I was really afraid.”
Federal and state data give conflicting numbers of coronavirus-confirmed deaths at Green Hill. According to the state, two residents and one worker died of COVID-19. The Centers for Medicare & Medicaid Services list six resident deaths and two staff deaths from the disease.
The facility did not return a phone call seeking comment.
As fear of coronavirus racketed up, some families made decisions like Sisler’s, said Laurie Facciarossa Brewer, New Jersey’s long-term care ombudsman, which advocates for seniors in the system. But Brewer said she believes that was uncommon, given the difficulties families face in caring at home for loved ones with chronic illnesses such as dementia.
There’s a reason people end up in institutional care to begin with, Brewer said. It’s a choice that is “generally not something that people make, unless they have no alternative.”
Marc Zimmet, a longtime nursing home consultant based in Marlboro Township, said that reality will allow nursing homes to recover more quickly than some assume. Despite the crisis, America remains an increasingly aging population that will continue to need services, he said.
“They don’t want to put their parents in a nursing home, but there’s not much choice,” Zimmet said. “With the demographics and the return to elective surgeries, I think it will be one of the first to bounce back.”
Some advocates are pressing New Jersey to expand its investment in community-based services that allow seniors to age at home. Those efforts were underway even before coronavirus, said Linda Schwimmer, who heads the New Jersey Health Care Quality Institute.
“Given COVID-19 and its attendant risks to the elderly and those living in congregant housing, we think the move toward home-based care will accelerate and become even more of a priority,” Schwimmer said.
Given the contagion’s sweep, many people are trying to delay sending their relatives into the system as long as possible, and looking for any alternatives they can find, said Farron Blanc, the CEO of Gerry, a New York-based company that helps seniors find facilities suitable for their needs.
Before the outbreak, his company was placing about 200 seniors a month in New Jersey. Now, that number has dwindled to less than 10 a month, with families “trying to scrape the bottom of the barrel to find other options,” Blanc said.
He predicts that some nursing homes will fail financially and that there will be a shakeup in the industry.
Elliott, who leads The Jewish Home at Rockleigh, said that wouldn’t necessarily be a bad outcome. She said she worries that “nursing home” has become a pejorative term because of poor performing facilities that haven’t been held accountable.
“Do I think that people are going to have hesitation about putting loved ones in nursing homes in general? Absolutely,” Elliott said. “Do I think they will have hesitation in putting them in The Jewish Home? No, I do not.”