Blocked by lobbyists for years, law puts more aides in N.J. nursing homes after 7,400 deaths

They feed, bathe and comfort residents of long-term care facilities, but the thousands of certified nursing aides who work in New Jersey’s nursing homes for little pay have said for years that their workload is often too much to handle.

On Friday, Gov. Phil Murphy signed a bill that will require operators beginning in early 2021 to increase the number of aides in each facility and for the first time set a ratio for the number of residents an aide is asked to handle.

The legislation had been vigorously blocked by industry lobbyists and some lawmakers for five years, but there was a renewed urgency to get the bill passed after the coronavirus pandemic claimed the lives of an estimated 7,400 long-term care residents in New Jersey — more than any other state based on population size.

Compliance will cost the industry $30 million or $5 a day per resident, according to the Health Care Association of New Jersey, a lobbying group for long-term care facilities.

CNA’s, who get paid an average of about $36,000 a year, have long complained they have more responsibilities than they can handle, especially on nights and weekends. The coronavirus outbreak sickened thousands of these workers and killed 121, according to state data, making the CNA shortage worse.

“Sadly, too many nursing homes are run by companies more interested in making money than protecting patients,” Murphy said in a statement after signing the bill Friday morning. “These long-sought reforms will help bring accountability to the industry and protect residents, staff, and family members with a loved one living in a long-term care facility. I am proud to have worked with our partners in organized labor, health care advocates, and legislative sponsors to finally implement safe staffing ratios in our nursing homes, as well as other long overdue reforms.”

The legislation, (S2712) will take effect in Feb. 1, and require long-term care facilities to abide by these staffing ratios:

* One CNA per 8 patients during the day shift;

* One direct care staff member — defined as a certified nurse assistant, a licensed practical nurse or a registered nurse — for every 10 residents during the evening shift, “provided that no fewer than half of all staff members are to be certified nurse aides, and each staff member will sign in to work as a certified nurse aide and will perform certified nurse aide duties,” according to bill;

* One direct care staffer for every 14 residents during the overnight shift, with the same rules that applied during the evening shift.

The law also creates a “Department of Labor and Workforce Development the Special Task Force on Direct Care Workforce Retention and Recruitment.” Long-term care facility operators have said they could not meet any worker-resident ratios without help retaining staff.

The law has been hailed as a victory for nursing home employees led, by 1199SEIU United Healthcare East, but it is a compromise since the union was seeking an even lower ratio of aides to residents.

“Today I care for nearly twice as many residents as I did when I became a CNA seventeen years ago,” said Margaret Boyce, a CNA and 1199SEIU member. “This law means that I will again be able to give my residents the type of care that they deserve. After all they have gone through during this pandemic, no nursing home resident should ever again have to miss a meal, or a shower, or feel lonely because there’s no one available to assist them.”

According to the state Health Department of Health, 6,820 residents of nursing homes, assisted living facilities and other long-term care centers have died from COVID-19. But there are another 627 residents who died who are listed as “probable” COVID-19 deaths by the department. They are not included in the official count because they were not tested before death but probably died from COVID-19 based on autopsy results, or a report or a death certificate indicated they had exhibited telltale symptoms.

These numbers combined, and including the 121 employee deaths, means the virus has claimed 7,568 lives.

Sen. Brian Stack, and Angelica Jimenez, both D-Hudson, were the prime sponsors of the legislation.

“These are our parents and grandparents and soon, they will be us. This law will ensure that every resident in our nursing homes receives the care and attention we all deserve,” Stack said.

Murphy on Friday also signed into law A4007, legislation that requires long-term care facilities to develop an isolation prevention plan for nursing home residents if visitors are barred from the facility.

“Eight months into this crisis, we’ve learned social distancing doesn’t have to mean isolation or loneliness. Whether it be a natural disaster or a public health crisis, we must ensure that residents in these facilities can stay connected to their families and loved ones remotely when in-person visits are not feasible,” Assemblywoman Valerie Vainieri Huttle, D-Bergen, the bill’s prime sponsor, said.

Long-term care reforms are also moving forward in Congress.

Bipartisan legislation has been introduced that would require nursing homes nationwide to maintain a minimum stockpile of personal protection equipment, or PPE, such as masks, gowns, face shields and gloves, to safeguard workers.

On Friday, Rep. Josh Gottheimer, D-5th Dist., who co-chairs the Problem Solvers Caucus, a bipartisan group of 50 moderate House members from both parties, said the pandemic hit the state’s most vulnerable population, killing thousands.

“We can’t allow history to repeat itself,” he said. “We know much more what it takes to stop outbreaks.”

He said the bill he and others are sponsoring, the Nursing Home Pandemic Protection Act of 2020, would require long-term care facilities report communicable diseases, infections, and potential outbreaks to the Centers for Disease Control and Prevention. In addition, it calls for residents and their families to be kept informed of any disease outbreaks.

In a press conference with U.S. Sen. Cory Booker, D-N.J., who is sponsoring similar legislation in the Senate, Gottheimer said too many facilities still have lax infection control and far too many families were kept in the dark about what was going on in the nursing homes where their loved ones were in virtual isolation for months as the virus killed thousands.

“It’s essential we move this legislation in the coming weeks,” he said, noting its protections for workers as well as residents. “It will make sure we have more resources in place.”

Angela Goldman of Paramus, whose mother has Alzheimer’s and is being care for in an assisted living facility in North Jersey, said the pandemic tragically showed weaknesses in the regulation of long-term care facilities involving those who cannot advocate for themselves. She was also critical about how facilities communicated with families about outbreaks.

“Sometimes it would take days for family to reach their loved ones. Days,” Goldman said, recalling how some families resorted to going to first floor windows of nursing facilities to maintain some form of contact with elderly parents or other relatives.

“Staff did not have the necessary PPE. Families donated PPE,” she added.

Booker said the crisis caused by the pandemic in nursing homes across the country was a national shame, exposing just how fragile the system is in a time of stress.

“We have to make sure we make long-term changes in our long-term care facilities,” said Booker.

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Susan K. Livio may be reached at [email protected]. Follow her on Twitter @SusanKLivio.

Ted Sherman may be reached at [email protected]. Follow him on Twitter @TedShermanSL.

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