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N.J. Nursing Home COVID-19 Deaths Speak to National Crisis in Facilities

With thousands dead, a call for greater transparency amid the epidemic

Medical workers load a deceased body into an ambulance while wearing masks and personal protective equipment

Eduardo Munoz Alvarez/Getty Images

Medical workers load a deceased body into an ambulance at Andover Subacute and Rehabilitation Center on April 16, 2020 in Andover, New Jersey.

En español | New Jersey Gov. Phil Murphy has ordered the state's attorney general to investigate the high number of COVID-19 deaths in long-term care facilities following a deadly outbreak and grisly scene at one of the state's largest nursing homes.

Police, acting this week on a tip about a body stored in a shed at a nursing home in Andover, in the northern part of the state, found 17 bodies stored in a makeshift morgue.

Since late March, 57 residents have died at the Andover Subacute and Rehabilitation Center I and II, according to the Sussex County Division of Health. Twenty-six of the victims had tested positive for COVID-19.

The New Jersey nursing home outbreak is just one dramatic example of a trend of infections and death sweeping through nursing homes across the country.

In New York, 19 nursing homes have reported at least 20 deaths each linked to COVID-19, according to a state report released Friday. A single home in Brooklyn reported 55 deaths. Four other homes in New York City reported more than 40. In Massachusetts, half of all COVID-19 deaths have occurred among nursing home residents.

New York Times report Friday found at least 6,900 deaths in U.S. nursing homes.

But the full scale of the outbreak at nursing homes across the country remains unknown, said Elaine Ryan, vice president of government affairs for state advocacy at AARP. “There is little transparency on what is going on,” Ryan said. “It is an outrage."

Ryan said the federal government and many states are not requiring nursing homes to make public the number of COVID-19 deaths and infections at their facilities. Because of that, policy makers and families with loved ones at nursing homes are often learning first of COVID-19 outbreaks at nursing homes from the media, Ryan said. And the lack of reporting has hindered relief efforts and left nursing home residents and their relatives in the dark.

"If we don't know where these cases are happening and who needs help, how can we respond?” Ryan asked.

Staff is overburdened — and often unprotected

In addition to calling for increased transparency by nursing homes and state and federal agencies, Ryan said AARP is advocating for increased COVID-19 testing for nursing home residents and staff, increased access to personal protective equipment for nursing home caregivers, and a solution to the staffing crisis at nursing homes, which were understaffed before the pandemic.

In Maryland, Gov. Larry Hogan has called on “strike teams” of Maryland National Guard members to help overburdened nursing homes. New Hampshire is the first state to implement hazard pay for state health care workers, Ryan said. AARP is pushing for other states and the federal government to help recruit workers to stem the caregiver shortage.

Experts said the coronavirus has spread so quickly in nursing homes for several reasons. First, residents are particularly vulnerable to the virus because they're older and often have multiple underlying health conditions. Residents are often housed as tightly as three to a room, and meals and activities are communal.

And caregivers, who are often paid minimum wage, sometimes work at multiple facilities to increase their income, which has the potential to spread infections.

A lack of communication with families

But many nursing homes had poor records for infection control before the crisis struck, which made them particularly vulnerable to the pandemic, according to Patricia McGinnis, executive director of California Advocates for Nursing Home Reform. In March, for example, the federal Centers for Medicare and Medicaid Services reported that employees at 36 percent of nursing homes it inspected did not follow proper handwashing guidelines, and 25 percent failed to demonstrate the proper use of personal protective equipment.

Nursing homes “couldn't deal with C. diff, sepsis and MRSA,” McGinnis said, referring to a list of infections that swept through nursing homes before the pandemic. “With COVID-19, the spread is just no surprise."

Washington Post analysis of records from the 650 nursing homes that have reported COVID-19 cases found that 40 percent had been cited multiple times for problems with infection control.

Industry officials said that they are doing all they can but that the virus presents a “unique threat.”

"Outbreaks are not the result of inattentiveness or a shortcoming in nursing homes,” said a spokeswoman for the American Health Care Association/National Center for Assisted Living (AHCA/NCAL). “It's the combination of the behavior of this virus and the unique threat it presents to the people we care for — older adults with multiple underlying health conditions. Nursing homes and assisted living communities are doing everything they can with the limited resources they have been given to slow the acceleration of the virus for our residents."

In New Jersey, which is reeling from nursing home deaths, Evelyn Liebman, AARP state director of advocacy, said nursing homes have done poorly at communicating with families since the homes closed to visitors. Nursing homes in the state are required to notify families within 24 hours if a resident has a COVID-19 infection, but that's often not happening, she said.

Laurie Facciarossa Brewer, the New Jersey ombudsman for long-term care facilities, echoed those concerns.

"People are dying in nursing homes, and they are dying in some cases very quickly, and families in some cases are unable to get information or updates on their loved ones,” Facciarossa Brewer said. “It's horrifying."