Each day this month, an employee at the Atrium Post Acute Care of Matawan nursing home notices fewer workers present to take care of the facility’s nearly 100 patients.
In total, the employee estimates 30 people are absent. Those left are taking on duties beyond their normal roles, while being given one N-95 to use indefinitely, the staff member said.
“I look to my left and I look to my right, and there’s so few of us left, we’re just waiting for us to get it. Jobs are blurred with everyone doing everything to keep the facility functioning. The PPE is less everyday,” said the employee, who wished to remain anonymous for fear of retribution. Multiple patients and staff have tested positive for COVID-19, the employee said, though the facility declined to share that information.
As the pandemic sweeps across New Jersey, understaffing at nursing homes has become an issue statewide, with employees either forced to call out with symptoms or afraid of bringing the virus home. In some facilities, the few workers who remain say they are left juggling multiple responsibilities as communication with families takes the backseat.
The state has said that of New Jersey’s 375 long-term care facilities — a bottom-line figure the state had been referencing during daily press conferences — 231 have at least one resident who has tested positive for the coronavirus. However, on Wednesday, the total number of facilities in the state was changed to include 230 other assisted nursing facilities and congregate homes, for a total of 605.
Now, officials said they are working to identify which facilities were too overwhelmed and need to transfer residents out to slow the spread of the virus.
Massive call outs at long-term care facilities are a deep concern, said Laurie Brewer, New Jersey’s Long-Term Care Ombudsman, who investigates allegations of abuse and neglect at nursing homes. At St. Joseph Senior Home in Woodbridge, residents were evacuated after three nuns were left taking care of nearly 100 patients due to sick employees forced to quarantine.
Since last month, Brewer’s office has fielded about 800 calls from loved ones and staff at nursing homes, a portion related to low staff levels. The situation, she expects, will only get worse as outbreaks among the elderly populations continue.
“We had a report of one nurse who showed up and she was the only person on the unit, so she was doing meals, meds and care by herself for at least some period of time. Call outs are going to happen,” Brewer said. "They are a fact of life pre-COVID. But the ability of the facility to be flexible and adapt is all strained right now. Agency nurses are being used to fill staffing gaps but that is not an infinite resource.”
Over the past month, there have been multiple incidents in which staff say their facilities lack PPE and are not adequately staffed— either because workers are sick themselves, or they were exposed to someone with coronavirus and must quarantine.
At an Essex County nursing home, one asymptomatic employee expressed guilt as she debated whether to call out herself. On one hand, she views the patients as family.
But going to work could also mean bringing the coronavirus home to her own relatives.
“I really want to go because I feel so bad for my residents. It’s making me teary eyed. But I don’t want to expose myself to this or my own family. It’s a difficult decision,” said the Family of Caring at Montclair employee last month, where at least five with coronavirus have died and 10 more were tested.
Elderly patients arrive at CareOne at Hanover in Whippany during coronavirus pandemic.George McNish | For NJ Advance Media
Some nursing homes are relying on staffing agencies to hire much-needed nurses. One nurse who works for such an agency said she filled in at a South Jersey facility before she knew a staff member and residents had coronavirus. That facility, she said, is now offering to pay time-and-a-half to nurses. She spoke anonymously because she fears retaliation.
On her shift last week at Lions Gate Skilled Nursing in Voorhees, her supervisor told her there was only one certified nursing assistant for 39 patients, when a normal night shift would have three.
“I asked him if he could pull [CNAs] from other floors and he said, ‘No one wants to come to the floor.’”
The scarcity of protective equipment has made staff afraid to work, she said.
She wore her own mask and said it was only halfway through her shift that a supply worker found additional PPE supplies so she could wear a gown while near isolated patients awaiting COVID-19 test results.
The nursing home has said that all its staff wear masks, are screened each shift for symptoms and follow infectious disease protocols as directed by the Centers for Disease Control and Prevention and the Department of Health.
Milly Silva, Executive Vice President of 1199SEIU United Healthcare Workers East, said the lack of PPE exacerbates the already high turnover for CNAs.
“Every nursing home worker must be given the appropriate personal protective equipment. This isn’t happening in what is the most extraordinary event of our lives. The job is extremely difficult, both physically and emotionally, and burnout is a very real problem,” Silva said. “Staffing was skeletal to begin with and now it’s at a breaking point in many facilities.”
New Jersey nursing homes have staffing level requirements determined daily by a formula based on the number of residents and type of assistance they need. The type of assistance factored into the formula includes the provision of oxygen and tube feedings, wound care, assistance with eating, bathing, transferring, toileting and dressing. The minimum baseline is 2.5 hours of care for every patient per day.
Late last month, Gov. Phil Murphy issued an order waiving “nursing staff standards” and is instead simply requiring facilities to document attempts to meet the standards.
Silva fears the order could put staff in an unsafe position.
Officials are also allowing the state’s 57,000 home health aides, who perform basic medical tasks for in-home patients, to work in nursing homes as CNAs.
Jonathan Dolan, president & CEO of the Health Care Association of N.J., which represents long-term care providers, said the state’s waivers have helped. Nursing homes are under financial strain now and will also need federal aid as soon as possible, he said.
“Staffing is at an absolute crisis level at many facilities,” Dolan said. “We’re doing more hours and we’re doing more pay and we’re working with more facilities, more agencies to get anyone we can.”
Brewer said the low pay of some nursing home employees has always made retaining them difficult, even before the coronavirus crisis.
According to the Bureau of Labor Statistics, the median pay for nursing assistants in New Jersey is $15 an hour. CNAs handle a significant part of the nursing home workload, including cleaning, changing and regularly checking on patients.
“The people who are showing up for work are overloaded, and the ground is shifting under them every day. Add to that, we are fielding anonymous complaints from nursing home staff who are complaining about a lack of personal protection equipment. They are terrified,” Brewer said.
Dolan said some long-term care facilities are offering staff hazard pay, bonuses for completed shifts and child care as incentives to continue returning to work.
To meet appropriate staffing levels, Atrium Post Acute Care of Matawan has temporarily stopped admitting patients, said Spring Hills Senior Communities, which manages the facility and other nursing homes across New Jersey. The facility normally cares for 120 or more residents, but now has 93 residents.
In a statement, the company said they are also offering bonus pay to all CNAs and associates as “a show of appreciation for their hard work and dedication during these challenging times.”
Dolan said one nursing home administrator is paying for temporary housing for workers, so they don’t spread the virus between family members and nursing home residents.
He said long-term care workers in New Jersey are also on the frontlines of the virus — like hospitals — but nursing homes are "feeling like the forgotten member of the healthcare team.”
“We are praying so hard for our hospital brethren and we want to do our part, but you can’t forget the vulnerable souls we have and that no one has a bigger rate of death than we’re going to have,” he said.
If staffing shortages continue to increase with the virus, Dolan said more relocations like St. Joseph’s Senior Home are likely.
“We’re staying in the fight,” he said. “We need PPE, we need staff and we need prayers.”
Tell us your coronavirus stories, whether it’s a news tip, a topic you want us to cover, or a personal story you want to share.
If you would like updates on New Jersey-specific coronavirus news, subscribe to our Coronavirus in N.J. newsletter.
Avalon Zoppo may be reached at azoppo2@njadvancemedia.com. Follow her on Twitter @AvalonZoppo. Find NJ.com on Facebook.
Rebecca Everett may be reached at reverett@njadvancemedia.com. Follow her on Twitter @rebeccajeverett. Find NJ.com on Facebook.
Get the latest updates right in your inbox. Subscribe to NJ.com’s newsletters.