Editor’s note: This story was updated at 12:30 p.m., Sept. 11, with additional information about contracts for consultants at the Menlo Park and Paramus veterans homes.

New Jersey officials have promised major changes to improve care at the state-run veterans homes that were the subject of a scathing federal report last week, but what shape that reform will take remains to be seen.

Democratic lawmakers have called for dismantling the department that currently oversees the facilities, in Menlo Park and Paramus, plus a third in Vineland, to create a new state agency focused on veterans services alone. Gov. Phil Murphy pledged to work with them “in any capacity to provide world-class care and services to our heroes,” but offered few other details Friday. Republicans have used the report as a new opportunity to criticize the administration’s role in protecting nursing home residents, an issue that became highly politicized during COVID-19.

While some steps have been taken in recent years, Sen. Joe Cryan (D-Union) said the Department of Justice report released Thursday shows they haven’t been enough. “You need a culture change. You can’t be defensive about the past,” he told NJ Spotlight News. “And quite frankly, I’m not sure we are there yet.”

Sen. Joe Vitale (D-Middlesex) is working with Cryan on a bill that would create a new cabinet-level department or authority focused on “all things veterans,” he said Friday. “We need to have 100% attention paid” to the veterans homes and services, he said, and a dedicated budget.

Murphy’s team is carefully reviewing the report and plans to “coordinate with our partners to determine applicable next steps,” spokesperson Christi Peace said Friday. “The governor takes the health and well-being of our veterans very seriously and will take any action necessary to ensure residents of our veterans homes receive the highest quality of care as we move forward.”

Unacceptable death toll

Problems at the veterans homes in Paramus and Menlo Park were widely reported early in the pandemic after COVID-19 swept through them, killing more than a quarter of each facility’s residents over three weeks. The Justice Department launched an investigation in October 2020 and staff and expert consultants visited the two homes multiple times in 2021 and 2022.

‘The DOJ’s findings should light a fire under all members of the Legislature to pass laws that will serve to protect these honorable men and women.’ — Assemblywoman Aura Dunn (R-Morris)

The resultant report finds the state Department of Military and Veterans Affairs, or DMAVA, failed to provide leadership or be accountable for problems at the facilities, which ranged from communication breakdowns to total failures in infection control. Further, the report concludes that the state violated the constitutional rights of the residents by not providing them access to proper care. It also makes clear the deficiencies are not limited to COVID-19 control, but extend to other aspects of elder care, like fall prevention and proper nutrition.

Mission-critical medical review

Murphy and lawmakers have repeatedly decried the poor treatment of New Jersey veterans and implemented some changes in leadership, including firing the CEOs at both homes and DMAVA officials. The Department of Health deployed its “mission critical strike team” — a group of experts in infection control, nursing care and administration — to  Menlo Park in November and moved to hire outside consultants with expertise in clinical care to provide medical oversight at both homes.

The state contracted with Interim Quality Partners LLC — a subsidiary of East Brunswick’s Honor Aging — to serve as a consultant at the Menlo Park and Vineland nursing homes, according to DMAVA. A temporary CEO was in place at Menlo Park in late December and nursing experts arrived in the spring. Another contract with Care Plus Bergen — which runs New Bridge Medical Center in Paramus — brought several expert advisers to the veterans home in that borough in June.

In April, then-health commissioner Judy Persichilli told the Assembly Budget Committee that while there are “peaks and valleys” in outcomes at any one long-term care facility, “I think DMAVA has turned the corner right now.” Administration officials declined to say if or how this had changed on Friday.

Credit: (U.S. Air National Guard photo by Master Sgt. Matt Hecht)

But the Justice Department report suggested any change at these nursing homes is hard won. When staff from the U.S. Veterans Affairs Department arrived in April 2020 to provide extra hands, expertise and leadership they found a troubling situation at both facilities, the report notes, including major violations of basic infection control practices. When the team’s mission concluded they left detailed recommendations for DMAVA.

State officials said many changes had been made in 2022, according to the Justice Department’s report, but they were ‘silent about what, if any, improvements have resulted.’

“Regrettably, apart from some communication improvements at Menlo Park we saw no evidence that either facility meaningfully implemented these recommendations. To the contrary, both facilities remain beset by structural issues that compromise resident care,” it states.

Justice officials also note that merely training — or retraining — staff is not enough without providing proper oversight or taking responsibility when things go wrong. “This lack of ownership over outcomes — including clinical-care outcomes — undercuts accountability, facilitates dysfunction and places residents at risk of harm,” the report states.

Efforts fall short

In addition, federal officials said a summary of the administration’s efforts to improve care at the two facilities — submitted in June — was “welcome” but “insufficient to improve outcomes for residents … in a systematic or sustainable way.”  These changes “do little to address the dynamic underpinning much of the dysfunction” at the veterans’ homes, the report notes, primarily the lack of accountability or data to track outcomes.

“For instance, while the report lists numerous outside consultants, many of whom will likely share valuable information with Veterans Homes staff, there is no indication of who, if anyone, has ultimate responsibility for implementing the reforms those consultants might suggest, and over the resulting outcomes,” the report states.

State officials said many of the changes had been made in 2022, according to the Justice Department’s report, but they were “silent about what, if any, improvements have resulted.” It is also not clear if the consultants hired to assist each facility have started, the report notes, and state officials declined to clarify the situation Friday. “We commend the State for recognizing the need for outside help, the decision underscores the lack of internal capacity for change,” the report notes.

With lawmakers on break until after the elections in early November, any change will take time.

For these reasons, Cryan and Vitale believe a new oversight structure is needed. Cryan said he would also consider moving the veterans homes under the health department, which regulates nursing homes, although Vitale said as state-run entities they would benefit from a different leadership structure. The Democrats are also sponsors of a bipartisan measure that would require major upgrades to both the Menlo Park and Paramus homes — something Cryan said should be part of any solution — but the bill has been stuck in committee in both houses.

“The DOJ’s findings should light a fire under all members of the Legislature to pass laws that will serve to protect these honorable men and women. Mandating safer facilities for our veterans is a good first step,” said Assemblywoman Aura Dunn (R-Morris), a sponsor of the legislation to address the structural issues at both facilities.

But with lawmakers on break until after the elections in early November, any change will take time.

Ken Hagemann, a retired Marine who leads the nonprofit VFW Department of New Jersey, also favors reforming DMAVA to create a new structure focused on veterans issues. He said the Justice Department report confirms what he and other advocates have been saying all along, that the facilities were failing residents. As to improvements already underway, he said it’s “too early to tell” if they’ll have an impact. The state “assures us some changes were made. We’ll have to see,” he added.