How a small Montclair nursing home is beating the coronavirus odds

From the outside, you'd never guess that the tidy white-shingled house, its inviting front porch framed by shrubbery, is a long-term care facility.

The homey facade of the Little Nursing Home, which is nestled into a tree-lined residential street in Montclair, isn't the only sign it's an outlier. At the height of a crisis for the state's long-term care facilities, it is so far beating the deadly odds of the coronavirus pandemic. It has had no deaths from complications of COVID-19 and just reported its first infected patient on April 24, well after many nursing homes had reported dozens of cases.

In New Jersey, nearly 4,900 residents of long-term care facilities have died from the virus, about 53% of all COVID-19-related deaths statewide. There have been more than 26,200 coronavirus cases at 515 long-term-care facilities in the state so far.

Michael Cummiskey, who runs the Little Nursing Home along with his father, Brian, is quick to acknowledge that the size of the facility — with just 29 beds, it is one of the smallest in the state — has helped them respond nimbly to the pandemic.

Still, the low infection rate is noteworthy, considering the enormous challenges facing nursing homes, where COVID-19 can spread like wildfire among a highly vulnerable population even before symptoms appear. Getting enough tests and personal protective equipment, nearly impossible early on, has remained difficult.

What's more, the facility is in North Jersey, a nexus for COVID-19 cases, and there is a strong correlation between outbreaks in nursing homes and their location near hotspots. There were more than 1,000 COVID cases each in Bergen and Essex counties in the last week of April.

In stark contrast to the Little Nursing Home is Montclair Family of Caring, just over a mile away. The 69-bed long-term care facility has recorded 38 cases of the virus and 15 deaths, including that of its administrator.

“Nursing homes were given a very challenging task," said Jonathan Dolan of the Health Care Association of New Jersey. “The Little Nursing Home has gone above and beyond to keep its residents safe from the virus despite these universal challenges.”

According to its administrator, the Little Nursing Home employed a simple strategy: Be proactive and don't wait for government mandates. 

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"When the government said to close to visitors on March 15, we were already two weeks into being closed to visitation," Cummiskey said. "I admit I didn't like doing it; it's good for residents to see family members, but it's important to keep residents safe, and the family members understood." 

A day or so later, all staff members were wearing surgical masks, and a few days later, KN95 masks. "We thought we'd rather be overprepared and look a little foolish with some extra masks than be under-protected and have everyone infected with COVID," he said. 

Each KN95 mask is disposed of at the end of the day and new ones put on each morning. "I know not everyone can do this, but that's what we do," he said. With a staff of 31, he said, economies of scale work in his favor.

Cummiskey's grandfather opened the Little Nursing Home in 1960, and the family's experience helped them get ahead of the curve. "Early on, my father kept saying that he hadn't seen anything like this in his entire career," Cummiskey said. "We were proactive because we knew it was a big deal. And it got more and more serious, which led us to be more and more proactive."

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Nurses who care for the one patient with COVID-19, who is isolated in a rear addition of the building, wear a surgical mask over their KN95 mask and a face shield over that, along with two pairs of gloves and a bonnet and gown.

"I know it sounds like overkill, and it's a little harder to breathe, but we are trying to be as careful and safe as we can," Cummiskey said.

He has had to "work round the clock" to meet the facility's PPE needs, he said. Masks come from a hodgepodge of sources, including Amazon, Alibaba, local restaurant supply chains and hardware stores. The town of Montclair donated three or four days' worth.

As manufacturers pivot to mask-making, the difficulty has switched to finding gowns, he said. And it's a constant battle to get a fair price for PPE; masks, for example, can run anywhere from $4 to $10 each. "Some vendors will be more than happy to gouge you," he said. "You don't want to get ripped off, but sometimes you just have to bite the bullet."

Besides curbing virus transmission, providing enough PPE has an unexpected benefit: It boosts staff morale, Cummiskey said. 

"Imagine how upsetting it would be to have to go into a room with someone who is sick and there is no protective gear," he said. "The staff has really stepped up, and I know having adequate PPE to make them feel safe has something do to with it."

Temperature checks and symptom questionnaires for staff each morning before entering the building are another safeguard instituted early on. Such a questionnaire was key in pinpointing the only staff member at the facility who tested positive for the virus, a woman who had no fever and only one symptom: the loss of taste and smell. "Part of the danger of COVID is that symptoms aren't the same for everyone," Cummiskey said.

Upon reporting the symptom, the staff member was tested and self-quarantined until the results came back. Two and a half weeks later she was healthy and back at work. 

Despite his success, Cummiskey isn't letting his guard down. "Infection will continue to be a real thing to worry about, especially for the vulnerable population," he said. "Even after the epidemic is over, I am very confident that myself and my staff will still be wearing these masks." 

Julia Martin covers Montclair for NorthJersey.com. For unlimited access to the most important news from your local community, please subscribe or activate your digital account today.

Email: jmartin@gannettnj.com Twitter: @TheWriteJulia