In a long-awaited report obtained by NJ Advance Media, state health officials are calling for a dramatic overhaul of how nursing homes respond to an emergency in the wake of the deadly viral outbreak at a New Jersey pediatric care facility that led to the deaths of 11 children last fall.

The Department of Health is putting forth a litany of requirements for nursing homes, including one that says parents or guardians must be contacted “immediately, following an event of significance.”

Many parents of children being cared for at the Wanaque Center for Nursing and Rehabilitation in Haskell said they did not learn of the outbreak until reading about it in media accounts. And the state itself did not publicly acknowledge there was an outbreak until contacted by NJ Advance Media, nearly two weeks after kids started dying.

Many of the same proposals are reflected in a new bill that will be introduced and discussed on Thursday when the Assembly Health Committee is scheduled to meet.

“Parents weren’t notified until children were very sick and died, and that cannot happen,” said Sen. Joseph Vitale, D-Middlesex, a prime sponsor of the bill with Assemblyman Herb Conaway, D-Burlington, the health committee chairman. “They have to be told as soon as possible.”

The health department report said all long-term care facilities who serve patients with ventilators will need to perform drills and update their and emergency plans in the event of an outbreak.

The report also recommends:

• Making sure that laboratory testing is available to confirm a diagnosis associated with any outbreak.
• Putting rules in place to monitor visitors for illness, as well as establishing procedures to identify and exclude sick staff members from coming to work.
• Implementing strong infection control measures, such as hand-washing policies and the availability of personal protective equipment to all staff entering patient rooms.
• Developing a so-called “cohorting” plan that allows for separation of ill and well patients as quickly as possible, and ensures the space needed to do so, at the onset of an outbreak.

The health department will elaborate on the requirements in a letter sent to nursing homes by September, the report said.

The health department also identified areas in which its own response and that of local health departments could be strengthened.

The report also called for more involvement from local health departments when outbreaks occur. Gov. Phil Murphy’s proposed budget includes $2.5 million in grants for these local offices, according to the report.

“Wanaque needed substantial assistance from the state to conduct public health management of this outbreak, so the state took the primary role,” the report noted. “Local assessment and response is better where possible.”

In addition, the report warned the health department will soon lose federal funding for the health department’s infection control assessment and response team, which works with facilities across New Jersey to help control respiratory virus outbreaks. It proposed $210,000 in additional state funding to maintain the unit.

The department said also gets no funding to track respiratory virus outbreaks, other than for influenza, according to the report. It recommended creating its own unit to monitor respiratory virus outbreaks.

“At this time, any non-influenza respiratory virus surveillance or response is cobbled together from non-dedicated resources that have other primary responsibilities,” the report noted, calling for the addition of additional staff with expertise in respiratory virus disease at an annual cost of $380,345.

When asked whether the number of fatalities and infections could have been contained at Wanaque, Health Commissioner Shereef Elnahal said that was a “tough question.”

“I can’t say for sure how outcomes could have been different, but we have learned from this,” Elnahal said.

In February, the federal Centers for Medicare & Medicaid Services harshly criticized Wanaque, saying it found the facility to be ill-prepared to react to the rapid spread of a deadly strain of adenovirus that swept through its pediatric wards. Its 118-page report cited poor infection controls, delays in seeking treatment of sick kids that led to significant medical complications, as well as inadequate administrative oversight — including a medical director who was rarely there.

The agency has fined Wanaque Center $588,516 for a litany of violations. Attorneys for the Wanaque Center say they are contesting the findings.

It took days to confirm that the respiratory disease killing the kids was the adenovirus. Common symptoms include sore throat, bronchitis, pneumonia, and diarrhea. But the strain of adenovirus that swept through Wanaque was particularly deadly to Wanaque’s children, who needed ventilators to help them breathe were already medically fragile and particularly susceptible to infection.

According to state health officials, the first kids to come down with adenovirus at the Wanaque Center were diagnosed on September 26. In a matter of weeks, 36 had contracted viral infections. Before it ended, 11 children — from toddlers to teens — were dead. One staff member also was diagnosed, but recovered.

State health officials banned new admissions to Wanaque for months after the outbreak, and only recently lifted the last of those restrictions.

In interviews with those who work at the Wanaque Center, many have complained that the facility had long been beset by chronic understaffing that only grew worse after it was sold in 2014. Two pediatric workers who asked not to be identified over fears of retribution told reporters that the lack of adequate help on the pediatric floor often meant kids in soiled diapers, or routinely left unbathed.

Wanaque was just included on a list of nursing homes that may be added to the roster of so-called “Special Focus Facilities” in the country because of repeated and persistent issues with quality, staffing or safety.

Others who spoke with NJ Advance Media on condition of anonymity over fears of retribution charged that administrators delayed sending kids to the hospital to make sure that Medicaid funds were not lost.

Officials at the facility in northern Passaic County have denied the allegations.

A cause of the outbreak has yet to be determined, although Wanaque had been repeatedly cited for deficiencies in hand-washing and infection control, even after the outbreak began, according to state and federal inspection reports.

Original Article