While COVID-19 continued to haunt New Jersey throughout 2022, case numbers fell to far more manageable levels, pandemic health restrictions were largely abandoned and much of the public clearly moved on.

But it also left some cautionary lessons that could inform how the state responds to COVID-19 in 2023 — including the results of the state’s own “after-action” report on New Jersey’s handling of the pandemic.

State Department of Health Commissioner Judy Persichilli said her department remains focused on the coronavirus, and she is urging the public to continue their viral vigilance too, wearing masks when in crowds, testing before gathering for holiday events, washing hands regularly and staying home if they feel sick.

Most important, she said, is to get a flu shot and stay up to date on COVID-19 vaccines, including the new bivalent booster, a message she and Gov. Phil Murphy have frequently repeated.

“I think we’re all weary of COVID, and we do want to get on with our lives,” Persichilli told NJ Spotlight News’ David Cruz on Dec. 15. “The pandemic is not over, and the way to get on with our lives is to get boosted.”

‘What we have learned and seen this year is that what continues to happen in New Jersey’s nursing homes and other long-term care facilities through this pandemic is an unacceptable tragedy.’ — Evelyn Liebman, AARP New Jersey

New COVID-19 diagnoses have been increasing in New Jersey since mid-November, a trend Persichilli said was due partly to Thanksgiving gatherings. And the rate of transmission, or RT — a critical measure of spread — leapt in early December to a point not recorded since last winter’s viral surge.

Hospitalizations have also remained stubbornly high for months, although a fraction of what they were last winter. But acute care facilities are also battling the usual winter wave of influenza and other respiratory viruses.

“We don’t expect it to be as bad as it was a year ago, but we are seeing an increase in our (COVID-19) hospitalizations,” Persichilli, a nurse and former hospital administrator who became the public face of New Jersey’s pandemic response alongside the governor, told Cruz.

Persichilli’s request

“We’re just asking everyone to start internalizing how they can protect themselves, first and foremost,” she said, “and that they’re not passing on COVID to those who could perhaps result in hospitalizations and unfortunately deaths.”

While New Jerseyans may be eager to put the pandemic behind them, nursing homes continue to deal with COVID-19 every day. These facilities were hard-hit early on by COVID-19, which takes an extreme toll on frail older adults and those with weak immune systems.

Death rates at nursing homes have plummeted since the early days of the public health crisis, but residents and staff account for more than 110,000 infections and 9,000 deaths, or one out of four COVID-19 fatalities in New Jersey. In all, more than 2.9 million cases have been reported in the state since March 2020.

‘This is still a virus that preys on elderly individuals and eighty percent of our deaths are in this category.’ — New Jersey Department of Health Commissioner Judy Persichilli

“What we have learned and seen [in 2022] is that what continues to happen in New Jersey’s nursing homes and other long-term care facilities through this pandemic is an unacceptable tragedy,” said Evelyn Liebman, advocacy director for AARP New Jersey and a leading voice for reform. “There are chronic, ongoing issues in New Jersey’s nursing homes that emphasize the urgent need for reform.”

Persichilli has continued to stress the importance of protecting older residents, including those in nursing homes, hundreds of which were reporting active COVID-19 outbreaks as of mid-December.

“Unfortunately, we are seeing increasing deaths,” she  said. “And the deaths we are seeing are in individuals 65 years and older. This is still a virus that preys on elderly individuals and eighty percent of our deaths are in this category.”

Problematic nursing homes

Two New Jersey nursing homes attracted extensive public attention this year for their particularly problematic COVID-19 response. The state took unprecedented steps starting in the spring to close Woodland Behavioral and Nursing Center, in Sussex County, claiming it was putting the life and health of hundreds of residents in jeopardy. It is now seeking an outside expert to run the Veterans Memorial Home in Menlo Park, in Middlesex County, following a growing list of regulatory violations, many of which involved failures to protect people against COVID-19.

Woodland was closed over the summer after a coordinated effort to resettle 350 poor, elderly and disabled residents at other facilities. The facility — formerly known as Andover Subacute and Rehabilitation Center and the state’s largest — first made national news early in the pandemic when 17 bodies were discovered in a shed on Easter weekend, stored there because the building’s morgue was already full.

The state has suspended the nursing home license held by Woodland’s owners and the health department said it has not received any new requests to operate a health care facility at that location.

By spring 2022, state and federal regulators had amassed a long list of violations and assessed hefty fines before the federal Medicare program — which contributed 92% of its revenue — said it would stop paying for residents to live there. A representative for the state health department said the bankruptcy attorney appointed to oversee the closure was dismissed by the court in early December and the role of Atlantic Health System, which had been tapped to oversee clinical operations there, has also wrapped up.

Credit: (AP Photo/Ted Shaffrey)

It is not clear what will happen to the Andover Township building, an aging 450-bed behemoth with few single rooms and that experts consider an infection risk. The state has suspended the nursing home license held by Woodland’s owners — Chaim Scheinbaum, Louis Schwartz and Menachem Spiegel, all of Lakewood — and the health department said it has not received any new requests to operate a health care facility at that location.

The building itself is owned by a separate out-of-state entity that has stopped paying property taxes to the township, a loss of $1.4 million annually, according to U.S. Rep. Josh Gottheimer (D-5th), who asked the state to help cover the loss in October. Gottheimer’s office did not respond to requests for an update last week.

Menlo Park

The veterans home in Menlo Park — one of three state-run facilities for former service members — continues to care for residents, thanks to a “mission critical” team of experts the state health department dispatched to the Edison site in late November.

Multiple problems, including potential abuse, were identified by state regulators during an extended site visit in late summer, according to many reports, and a follow-up inspection in November found staff failed to properly use testing, contact tracing and other infection-control measures to halt the spread of COVID-19. The federal Medicare program also stopped paying for new admissions in the fall and threatened to withhold all payments next spring if changes were not made.

A report identified 15 long-term care facilities that receive more than $100 million in state taxpayer dollars annually through Medicaid, despite receiving only one of five stars in a federal quality-of-care review. 

Persichilli told NJ Spotlight News in early December that the bulk of these problems have now been resolved and Medicare funding is no longer in jeopardy as a result. Days earlier, the governor’s office announced its intention to hire an outside entity to “manage systemic change and provide qualified, administrative staff to help lead these initiatives.” Murphy’s office said the state will soon issue a public request for proposals to identify the right person or group for this job.

“We are in a daily battle with COVID-19 and our team welcomes this anticipated support,” said Brig. Gen. Lisa J. Hou, who oversees these facilities in her role as Adjutant General of the New Jersey National Guard and commissioner of the state’s Department of Military and Veterans Affairs, in a statement when the plan was announced.

“As a physician and a combat veteran, I have known no greater mission than the one we face in this fight to protect our heroes,” said Hou, a doctor of osteopathic medicine.

Fifteen one-star facilities

While Woodland and Menlo Park have received most of the media attention, experts note they are not the only nursing homes with problems. A report released in February by the Office of the State Comptroller, in conjunction with the state’s Long-Term Care Ombudsman, identified 15 facilities — including Woodland — that receive more than $100 million in state taxpayer dollars annually through Medicaid, despite receiving only one of five stars in a federal quality-of-care review.

Efforts to improve care at the state’s 370 nursing homes have remained a stated priority for Murphy. He’s signed bills to increase staffing levels, improve communication between regulators and nursing home operators, and strengthen state oversight of the industry, while providing millions of dollars for hazard pay and other pandemic-related benefits.

‘It’s time to hold nursing homes and other long-term care facilities accountable for providing safe environments and high-quality care for residents.’ — Evelyn Liebman, AARP New Jersey

Many of these reforms were recommended by Manatt Health, consultants the state hired in May 2020 to examine nursing homes and assess their COVID-19 response. State lawmakers are also considering further changes to boost transparency around corporate ownership structures, like at Woodland, and facility sales, based in part on problems identified in the state comptroller’s report.

Liebman of the AARP applauds these changes but said much more needs to be done to truly protect older New Jerseyans in institutional care. “Our most vulnerable residents who live in nursing homes and other long term care facilities deserve better than subpar conditions and we need to accelerate the pace of change. It’s time to hold nursing homes and other long-term care facilities accountable for providing safe environments and high-quality care for residents,” she said in an email.

Republican criticism

Additional developments could stem from an independent analysis Murphy recently announced, to be conducted over the next year by Paul Zoubek, an attorney who has worked at the U.S. Attorney’s Office and the state Attorney General’s Office, along with global management experts from the Boston Consulting Group. The findings are due late next year, more than three years after Murphy first called for an “after-action” report on his administration’s response to COVID-19.

Public health leaders have welcomed this review and urged Zoubek’s team to coordinate with other analyses now being done in New Jersey. But Republican lawmakers — who have long pushed for a full study of Murphy’s pandemic-related policies — insist it is too little, too late, with results delayed until after the 2023 election cycle to avoid impacting the campaigns of Democrats in the Legislature. Some insist the Legislature should do its own review, using subpoena power, but Democratic leaders said any hearings should wait until Murphy’s study is done.

Murphy stressed that political calculations had nothing to do with the timing of the review and said the delay in getting it started reflected the administration’s dedication to selecting the right team, which was chosen by his office without a public process. The governor pledged not to interfere with the process. Murphy compared it to the critique done by the Manatt group in 2020, which he said was “pretty much holding up a tough mirror on our activities then and I think we should expect a very similar reality this time.”

“This is not just a look back on what we did right, wrong or otherwise, but we want to develop a playbook for the next governors down the road, the next administration who may have to do something — please God they won’t — but if they have to, that this is going to be a relevant document for the future, not just the past,” Murphy told reporters when announcing the probe in late November.