How many Covid-19 deaths in New York nursing homes went underreported? 'As much as 50 percent,' report suggests
A larger number of nursing home residents in the state of New York likely died from coronavirus than data reported by the New York State Department of Health (DOH). According to a report released by the state attorney general’s office, the DOH undercounted the Covid-19 death toll among residents of its nursing homes by approximately 50%.
“Since March, attorney General Letitia James has been investigating nursing homes throughout New York state, based on allegations of patient neglect and other concerning conduct that may have jeopardized the health and safety of residents and employees. Among those findings were that a larger number of nursing home residents died from Covid-19 than the New York State Department of Health’s published nursing home data reflected and may have been undercounted by as much as 50%,” alleged the report.
In early March 2020, the Office of the Attorney General (OAG) received and began to investigate allegations of Covid-19-related neglect of residents in nursing homes. On April 23, OAG set up a hotline to receive complaints relating to communications by nursing homes with family members prohibited from in-person visits to nursing homes. It received 774 complaints on the hotline through August 3, and an additional 179 complaints were received through November 16. OAG also continued to receive allegations of Covid-19-related neglect of residents through pre-existing reporting systems.
During this time, OAG received complaints regarding nursing homes across the state, with a greater volume of complaints regarding nursing homes in geographic areas with higher rates of community-based transmission of coronavirus. Based on this information and subsequent investigation, OAG is currently conducting investigations into more than 20 nursing homes across the state.
“As the pandemic and our investigations continue, it is imperative that we understand why the residents of nursing homes in New York unnecessarily suffered at such an alarming rate. While we cannot bring back the individuals we lost to this crisis, this report seeks to offer transparency that the public deserves and to spur increased action to protect our most vulnerable residents. Nursing home residents and workers deserve to live and work in safe environments, and I will continue to work hard to safeguard this basic right during this precarious time,” said Attorney General James.
The current findings are based on a survey of 62 nursing homes, a roughly 10% sample of total facilities across the state. “Preliminary data obtained by OAG suggests that many nursing home residents died from Covid-19 in hospitals after being transferred from their nursing homes, which is not reflected in DOH’s published total nursing home death data. Preliminary data also reflects apparent underreporting to DOH by some nursing homes of resident deaths occurring in nursing homes,” it noted.
Investigation suggests that lack of compliance with infection control protocols put residents at increased risk of harm. This includes failing to properly isolate residents who tested positive for Covid-19, failing to adequately screen or test employees for Covid-19; demanding that sick employees continue to work and care for residents or face retaliation or termination; failing to train employees in infection control protocols; and failing to obtain, fit, and train caregivers with PPE.
Nursing homes that entered the pandemic with low US Centers for Medicaid and Medicare Services (CMS) staffing ratings had higher Covid-19 fatality rates. Besides, the initial probe also indicates that when there was insufficient staff to care for residents, some nursing homes pressured, knowingly permitted, or incentivized existing employees who were ill or met quarantine criteria to report to work and even work multiple consecutive shifts, in violation of infection control protocols. These policies put both residents and staff at great risk.
“Insufficient personal protective equipment (PPE) for nursing home staff put residents at increased risk of harm. Insufficient Covid-19 testing for residents and staff in the early stages of the pandemic put residents at increased risk of harm. The current state reimbursement model for nursing homes gives a financial incentive to owners of for-profit nursing homes to transfer funds to related parties (ultimately increasing their own profit) instead of investing in higher levels of staffing and PPE,” shows analysis.
The topic of nursing homes has been a sensitive one for New York State Governor Andrew Cuomo, whose office has been previously criticized for not doing enough to protect this vulnerable population. According to the report, government guidance requiring the admission of Covid-19 patients into nursing homes may have put residents at increased risk of harm in some facilities and may have obscured the data available to assess that risk.
The other side
New York State Health Commissioner Dr Howard Zucker issued a statement in which he said that the word ‘undercount’ implies there are more total fatalities than have been reported. “This is factually wrong,” he wrote.
According to Zucker, the OAG’s report is only referring to the count of people who were in nursing homes but transferred to hospitals and later died. “The OAG suggests that all should be counted as nursing home deaths and not hospital deaths even though they died in hospitals. That does not in any way change the total count of deaths but is instead a question of allocating the number of deaths between hospitals and nursing homes,” he noted.
Zucker emphasized that the DOH has always publicly reported the number of fatalities within hospitals irrespective of the residence of the patient, and separately reported the number of fatalities within nursing home facilities and has been clear about the nature of that reporting. He explained that the OAG itself acknowledges in a footnote that DOH was always clear that the data on its website pertains to in-facility fatalities and does not include deaths outside of a facility. “DOH has consistently made clear that our numbers are reported based on the place of death. DOH does not disagree that the number of people transferred from a nursing home to a hospital is an important data point, and is in the midst of auditing this data from nursing homes,” he stated.