NJDOH Offers Guidance for Holiday Visitation at Long-term Care Facilities

Even as the state’s health commissioner is warning against removing family members from nursing homes, New Jersey’s Department of Health (NJDOH) provided guidelines to long-term care facilities on visitation policies for the holidays.

“The department strongly recommends against families taking residents out of the facilities for holiday celebration or gatherings,” said Health Commissioner Judith Persichilli. “Individuals at increased risk of severe illness from COVID-19 should avoid gatherings with individuals that they don’t live with.”

“We cannot let our guard down because we know the gatherings provide an opportunity for COVID-19 to spread,” continued Persichilli. “Small family gatherings are a significant driver of increasing cases.”

Long-term Problems

Gov. Phil Murphy and health officials have faced criticism from state Republicans and Democrats due to their handling of long-term care facilities in the first months of the pandemic, where nearly half of the deaths the state has confirmed are based. Detractors have blamed the decision to return long-term residents who were COVID-19 positive to nursing homes after hospital stays caused the virus to spread needlessly at nursing homes.

State officials have defended their actions, placing the blame on operators for failing to follow guidelines given in March about cohorting those who had the infection from those that didn’t.    

For the holiday season, NJDOH is recommending instead of family visits where the resident leaves the facility, visitation take place outdoors at the facilities or be held indoors in accordance with safety protocols. Additionally, long-term care facilities are being asked to plan to accommodate increased virtual communications for residents. 

Return Protocols

If a resident does leave a long-term care facility, operators are required to place them in quarantine when they return. If a resident lives in a private residence or room, the resident may be quarantined in place. 

If the resident has a roommate, the resident is to be quarantined in a separate observation room for 14 days. If an observation room is not available in the facility, the facility must notify the rest of the family that the resident will not be permitted back until the room is available, or until the facility is otherwise able to cohort returning residents in compliance with current CDC and NJDOH guidance and directives.

Plan Details

Long-term care facilities are being mandated to develop a plan for holiday visits, according to Persichilli. Operators are required to estimate how many residents can be cohorted for a 14-day quarantine period, based on their current census from Nov. 25 through to Dec. 31. 

The plan is to include:

  • Facilities creating a reservation process for residents who want to leave and visit families. 
  • Reservations should be tied to the number of individuals the facility can quarantine on their return.
  • Reservations and any changes to reservations must be confirmed 36 hours before the resident leaves the facility. 
  • The facility creating a waiting list for residents who request a reservation after the established limit has been reached. Operators are to inform families of the possibility that if a resident leaves without a reservation or on the waiting list, that may not be guaranteed readmission to the facility until the bed is available.

Visitors are to follow coronavirus protocols when they visit a facility, including wearing a face mask, social distancing, and hand hygiene. Facilities are to be notified if anyone present at the holiday gathering tests positive for COVID-19 or exhibits symptoms of COVID-19 within 14 days of the residents’ visit. 

New Outbreaks

“We are still very concerned about the outbreaks we are seeing in long-term care, so we need to be especially vigilant to protect this population,” said Persichilli. “We continue to partner with the industry to improve quality and infection prevention in these facilities.”

To that end, NJDOH began a series of educational sessions as part of the National Nursing Home COVID-19 Action Network Training Program. The first session topic was understanding the strategies to prevent the spread of COVID-19. 

“We know that the virus is coming into long-term care because the residents, in most cases, are not going out,” said Persichilli. “We’re looking at that pretty critically right now.”

Daily Data

As of Nov. 17, the cumulative number of coronavirus cases in New Jersey reached 285,519 with 4,060 total new cases reported and 38 new deaths, bringing that total to 14,817. The state listed probable deaths at 1,801, bringing the overall total to 16,618.

For North Jersey counties, Bergen had a total of 413 new cases, Essex 355 new cases, Passaic 334 new cases, Hudson 320 new cases, Morris 155 new cases, Sussex 162 new cases and Warren 159 new cases.

State officials noted 26 deaths occurred in the last 24 hours of reporting that have not yet been lab confirmed.  

Of the total confirmed deaths in North Jersey, Essex County has the most with 1,955, followed by Bergen at 1,841, Hudson with 1,391, Passaic at 1,142, Morris at 705, Sussex at 162 and Warren with 159.

In regards to probable deaths, Bergen has 246, Essex has 230, Hudson has 158, Morris at 146, Passaic at 141, Sussex has 36 and Warren has 13.

State Testing 

The daily rate of infections from those tested as of Nov. 11 was 9.4%. By region, the North has a rate of 10.3%, Central at 7.4% and the South at 10.7%. The state is no longer using serology tests as health officials explained those results show a past presence of the disease as well as a current one. 

As for the rate of transmission, it increased to 1.42 from 1.40 the day before. Officials have continually cited transmission rate and positivity rate as health data they rely on to track how the coronavirus is being contained in New Jersey, guiding them in determining when restrictions have to be tightened or lifted.

Officials reported 2,320 patients are hospitalized; by region, there were 1,121 in the North, 638 in the Central and 561 in the South.

Of those hospitalized, 458 are in intensive care units and 155 on ventilators, while 154 patients were discharged.

Essex Tops County Count

Essex has the most cumulative cases in the state with 30,780, followed by Bergen at 29,800, Hudson at 27,372, Middlesex at 26,354, Passaic at 25,324, Union at 24,626, Ocean at 18,954, Monmouth at 17,157, Camden at 15,295, Morris at 11,428, Mercer at 11,409, Burlington at 10,849, Somerset at 7,843, Gloucester at 7,321, Atlantic at 6,728, Cumberland at 4,522, Sussex at 2,123, Warren at 2,079, Hunterdon at 2,049, Cape May at 1,406 and Salem at 1,376.

Another 706 cases are still under investigation to determine where the person resides.

In regards to cases related to in-school transmissions, a total of 51 outbreaks involving 192 cases have been reported in 18 of the 21 counties in the Garden State, with 15 new outbreaks involving 46 cases recorded. For North Jersey, Bergen County has six confirmed outbreaks with 17 cases, Sussex County has three confirmed outbreaks with seven cases, Warren County has three confirmed outbreaks with seven cases, Hudson County has two confirmed outbreaks with eight cases and Passaic County has one confirmed outbreak with nine cases. 

Long-term Care Facilities

Health officials noted 250 long-term care facilities are currently reporting at least one case of COVID-19, accounting for a total of 5,033 of the cases, broken down between 2,570 residents and 2,463 staff. 

Cumulatively, 921 long-term care facilities reported a case infecting 26,172 residents and 14,896 staff, for a total of 41,068 cases. 

The state’s official death total will now be reported as those that are lab confirmed, sits at 7,260 on Nov. 16. The facilities are reporting to the state 6,889 residents deaths and 122 staff deaths.

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