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The COVID-19 Crisis at NJ’s Long-Term Care Facilities

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We’d like to thank guest blogger and NJFA friend Laurie Facciarossa Brewer, NJ’s Long-Term Care Ombudsman, for her blog post.

By Laurie Facciarossa Brewer, NJ’s Long-Term Care Ombudsman

The COVID-19 crisis in long-term care facilities is an unprecedented national tragedy. Around the country, tens of thousands of vulnerable residents of nursing homes and assisted living facilities have died.

In fact, as of today in New Jersey, more than 5,400 long-term care residents have lost their lives due to the pandemic. To better put this into perspective, these deaths are more than half of New Jersey’s total cases.

Not only are the numbers themselves horrifying, but the inability of family and friends to physically be there with their loved ones in their final moments-as facilities were locked down to attempt to prevent more infection-makes it all the more painful and traumatic.

I mourn and hold dear the loss of each of these residents and wish peace and healing for their loved ones. And I am deeply concerned about the health and welfare of the long-term care residents who remain, and about the staff who care for them.

As an independent state agency that advocates for long-term care residents by investigating allegations of abuse and mistreatment, the New Jersey Office of the Long-Term Care (NJ LTCO) Ombudsman has been in the forefront in attempting to help residents and families deal with any issues or problems they may be having during this health emergency.

The investigation process

Usually, when we receive a complaint or concern, we make an unannounced visit to the resident in question and obtain consent to do an investigation.

Unfortunately, those visits stopped on March 13 when the federal and state government decided to severely restrict any visits to long-term care facilities, including by state regulators, families and representatives of the Ombudsman program.

The sudden inability to go into the facilities to witness what was happening there–to see firsthand the staffing levels and the physical conditions­­–and to have to rely on phone calls, FaceTime and other technologies to gain insight into what was truly happening, was very jarring and required some out-of-the-box thinking.

Fortunately, the NJ LTCO has highly seasoned and experienced investigators who have deep contacts in, and experience with, long-term care facilities in New Jersey.

In addition, the NJ LTCO has more than 200 highly trained volunteer ombudsmen assigned to an equal number of nursing homes. Under normal circumstances, these volunteers would be in their assigned nursing home every week, speaking with residents and handling their concerns.

So, even though we are not visiting LTC facilities, the NJ LTCO is well-positioned to reach deep into a facility and identify the right person who can solve problems for residents and their families.

Our volunteers continue to keep in contact with residents in nursing homes and have distributed letters reminding residents that the NJ LTCO is still here to assist them with any problems they may be having.

The dramatic increase in calls and cases

Our investigators have never been busier.

During March and April, calls to the NJ LTCO intake line increased by 40 percent, as did the number of cases opened for investigation.

The types of complaints that we have been receiving reflect the deepening crisis in long-term care. Here are some examples:

  • A woman called to tell us that her 56-year-old sister was on a ventilator, fighting for her life after being diagnosed with COVID-19. The long-term care facility in which her sister lived, she alleged, had refused to send her sister to the hospital.
  • A 71-year-old, bed-bound resident called the NJ LTCO to complain that she was not receiving her medication and that she hadn’t been changed–and was sitting in her own urine for more than 24 hours.
  • A nurse called to tell us that she was the only one who showed up to care for more than 60 residents during an evening shift in a nursing home.
  • A man called to see if we could find his mother, who was COVID-19-positive, had a fever and had been hurriedly moved out of her nursing into another one–with no advance notice to the family. He didn’t know if his mother was dead or alive.
  • A family member called to report that he was informed that his father had a fever, that COVID-19 was suspected and that he was fine. He was called 90 minutes later and told that his father had died.
  • Multiple staff members called the NJ LTCO intake line to report that they were not given proper personal protection equipment (PPE) in order to care for residents safely.
  • Dozens of family members called us to state that their loved ones died of COVID-19, alone and without family by their side. Most of these callers alleged care neglect due to poor staffing.

As this crisis unfolds into late spring and early summer, it appears that there is more PPE and more testing available. These are the two things that are absolutely critical to stemming the tide of this horrific virus and getting to a place where our office, state regulators, and families and friends can once again visit long-term care residents.

Stepping up outreach

In the meantime, here at the NJ LTCO, we continue to adapt to this new reality. While we look forward to the day when we can go back into long-term care facilities, we are stepping up our outreach to residents via newsletters, direct phone calls and utilization of tablets and smart phones.

In mid-May, we began to distribute a resident-focused monthly newsletter to residents of long-term care facilities. In the inaugural edition, we remind residents that they have rights and that they can always call us for assistance. In addition, we remind them that most of them will get a $1,200 stimulus payment as a result of the COVID-19-related CARES Act and that this money is theirs-and no one can take it from them.

Conditions at long-term care facilities; hope for the ensuing months

I wish I could say that the tragedy of COVID-19 in our long-term care facilities was totally unforeseeable, but that would not be the whole truth. While the scope and speed at which the COVID-19 tragedy unfolded were certainly new, the conditions in many of our long-term care facilities were ripe to fuel this type of situation.

In the ensuing months, it is my hope that we will see the effects of this terrible virus wane in long-term care facilities. In its wake, I am sure that there will be a clear-eyed assessment of how we, as a society, could have done more to protect vulnerable elderly and disabled people living in residential settings. We have learned much about this virus and the terrible toll it can take in long-term care facilities. My expectation is that we all will apply the lessons we have learned so that we are better prepared for any future outbreaks.

The thousands of souls we have lost and the thousands of vulnerable elderly and disabled people currently living in long-term care facilities deserve at least that much.

For more information on the LTCO, visit nj.gov/ooie/. The LTCO can be reached by calling 1-877-582-6995 or by email at ombudsman@ltco.nj.gov.

Any opinions expressed within guest blogs are those of the author and are not necessarily held by NJ Foundation for Aging.

Are you a Boomer who feels squished like a sandwich?

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If so, you aren’t alone. Many people in the boomer generation (those born between 1946 and 1964) have now been referred to as the Sandwich Generation. That is because this generation that thought their middle years would be full of free time with plenty of time to plan what to do with their retirement benefits is facing a very different reality. Due to the recession, some young adults have had to put off college, or have had difficulty finding a job after completing college. So, for some boomers, they have adult children that have come home and aging parents that may need extra help.

On top of the possibility that some boomers may have lost some of their investments they were relying on for retirement, they also may be spending extra money to help their children get on their feet. Meanwhile their aging parents have also felt the effects of the recession.

This has resulted in two or three generations of a family living under one roof. There are various scenarios, out of work adult children move in with parents due to job loss, sometimes with young adults (college or post-college) in tow. Or young adults come back from college and need to live with mom and dad or even grandpa and grandma. Sometimes the older adult is in need of help so it may work out for both the young adult and the grandparent who needs assistance.

 It’s a fact that is backed up by serious stats, between 2007 and 2009 multigenerational households shot up more than 10 percent, from 46.5 million to 51.4 million. According to the Pew Research Center, that is the largest number of Americans living that way in modern history. Even as the economy recovers, those numbers probably won’t chance much as people are still finding a need to live under one roof.

Sometimes it is due to finances, sometimes it is also due to need for more hands on care. Adult children and grandchildren are finding themselves in caregiver roles more often as the older generation lives longer than it used to. They may have left a job to move in with their parent or grandparent or had them move into their house. Even if mom or dad live in a long term care setting boomers and their children will find that they are juggling their work life, family life, and financial problems all while caring for an elder.

Multigenerational households can be a blessing in disguise. Maybe it means that the child or grandchild doesn’t have to worry about childcare because grandma or grandpa is there. It could mean getting to spend time with a loved one in their last years, providing care for them while you gain comfort in knowing you took care of them they way they did you. Or just the simple fact that saving money by all being together means fewer rent or mortgage payments, utilities, etc. Not to mention sharing cooking and cleaning duties. So while the economy may have hurt your savings, it may just have brought your family together.

 NPR has recently begun a series on this topic called “Family Matters” you can read more facts and hear the stories of three families at http://www.npr.org/2012/04/17/150365158/one-roof-three-generations-many-decisions

 The lesson to be learned? Talk about your plans for the future with your family, many of the families in the stories state this is not where they expected to end up, but we all age and we can all become ill at anytime, so talk to your family and be prepared for what you might do when and if the time comes.

Medicaid Myths in Long Term Care

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You may have heard a friend, family member or neighbor tell a story about an elderly relative that had “all their money taken by a nursing home” or “the state took all their money when they went into the nursing home”.  This is another one of those myths regarding coverage of long term care, like the one we covered in the last blog about Medicare.

Unlike Medicare, Medicaid does cover long term care, but you have to qualify. Medicaid both in the community and in a nursing facility is a program for low-income individuals who must qualify by meeting the income guidelines. When it comes to paying for nursing home care, you have to meet the medical criteria showing that you need the physical assistance, as well as, showing that you have no more than $4,000 is assets and no more than $2,000 in monthly income.

When someone states “the nursing home took all of my mother’s money”, most likely the Medicaid guidelines were not properly explained to them or it was oversimplified by the person explaining it. Often when someone is admitted to a nursing home for long term care, the nursing home must look at their financial records to see how they will pay for the care, they will counsel the person and /or their family on how much care at the facility costs and should help them determine if and when they will need to apply for Medicaid. When a person has enough money to pay, but knows they may run out in six months to a year, they call this a “spend down period” which means you pay the nursing home the monthly rate and when you’ve “spent down” your funds to the Medicaid eligibility level, you can apply for Medicaid.

There may be people who are under the false impression that Medicaid or some other program, will automatically cover you when you need nursing home care, similar to the false belief that Medicare covers long term care costs. We pay for goods and services all the time, but when it comes to long term care there is much confusion and false assumptions.