An executive directive issued by New Jersey Department of Health (DOH) details the criteria long-term care facilities, assisted living residences, comprehensive personal care homes, residential healthcare facilities, and dementia care homes (collectively "LTCFs" or facilities") must meet to proceed through a phased reopening process, which includes mandates concerning infection control.

Among the benchmarks LTCFs must comply with to enter a reopening phase are as follows:

• Contract with an infection control service within two months or hire a full-time infection control employee if they have more than 100 beds or hemodialysis. 

• Develop an updated outbreak plan with lessons learned from the COVID-19 pandemic. This plan must include a communications strategy that outlines regular communication with residents and families about cases and outbreaks or any other emergency and methods for virtual communication in the event of visitation restrictions.

• Implement a respiratory protection program that complies with Occupational Safety and Health Administration (OSHA) standards, including medical screenings and fit testing of employees using respirators (N95 masks), within nine months.

• Must be fully staffed and have a plan in place for additional staffing in the event of an outbreak or emergency. 

• Weekly staff COVID-19 testing.

• Secure enough personal protective equipment (PPE) for present use and a stockpile for emergencies.

• Must not have an active outbreak.

The reopening plan is comprised of four phases, which are tied to the state's planned stages for reopening. All facilities started in Phase 0 on August 10.

The executive directive was issued in conjunction with an announcement that the state is making $155 million available to help LTCFs safely reopen. Of this $155 million, about $25 million will go to assist LTCFs with the weekly testing.

New Medicaid funding worth $130 million will be available to LTCFs beginning in October and running through June 30, 2021. Of that, $52 million is intended to help LTCFs in supporting COVID-19-related infection control and compliance. However, the funding would be subject to recoupment if a facility fails to meet the DOH-specified requirements or is found to have repeated infection control failures. The remaining $78 million will go toward increasing wages for certified nurse aides.

Phenelle Segal, RN, CIC, FAPIC, founder of Infection Control Consulting Services, which provides a range of services to all long-term care facilities, says she expects other states will take a similar approach as New Jersey in supporting LTCFs as they reopen and will also hold these facilities accountable.