New York health officials have undercounted the number of COVID-19 nursing home deaths by up to 50 percent in some cases, the state’s attorney general has revealed in a bombshell report.
Attorney General Letitia James said the Department of Health’s public data dramatically obscured the true death toll in a state that has already logged more deaths than any other state.
New York was ravaged by the virus early in the pandemic, and its effects were felt most acutely in the state’s nursing homes. More than 42,000 deaths have been recorded, of which 8,500 were nursing home residents.
Gov. Andrew Cuomo has praised his own COVID response to the point of writing a book on it—but he had been sharply criticized for the staggering number of nursing home deaths, even before the attorney general’s report was released on Thursday.
The Democratic governor was lambasted for a health department memo in March that instructed nursing homes to take COVID-positive patients to free up hospital beds.
A DOH report later rejected the claim it had led to outbreaks in nursing homes—but James’ report says it potentially put residents at risk.
“This pandemic has caused great devastation and taken far too many lives,” James said as she released the report, Nursing Home Response to COVID-19 Pandemic, on Thursday. “Nursing homes residents and workers deserve to live and work in safe environments. We’re releasing this report to offer transparency and spur action to protect our most vulnerable.”
From March through August 3, DOH reported a total of 6,423 COVID-19 deaths in nursing homes, including 3,640 confirmed COVID-19 deaths and 2,783 presumed COVID-19 deaths.
These counts were based on data reported by the state’s 619 nursing homes to DOH through its Health Emergency Response Data System.
But, when the Attorney General’s office asked 62 nursing homes to provide information about on-site and in-hospital deaths, it found vast discrepancies—largely because facilities reported the location of the person at the time of death inconsistently.
For example, one nursing home reported five confirmed and six presumed COVID-19 deaths as of August 3 to DOH. But the home reported a total of 27 deaths at the home and 13 hospital deaths to James’ office—a discrepancy of 29 deaths.
The 62 nursing homes reported a total of 1,914 deaths to the Attorney General’s office, compared to the DOH’s publicized total of 1,229.
“The DOH reporting system explicitly requires facilities to correct inaccurate reporting,” the report says. “Either such correction was not made by a number of facilities, or data were not reflected in DOH’s published data for other reasons.”
An undercount of deaths in New York has long been suspected. An Associated Press analysis in August concluded that deaths may have been undercounted by as much as 65 percent.
Cuomo has branded criticism over nursing home deaths as politically motivated or unfair when compared to other states’ death tolls. But, unlike most other states, New York has never included in-hospital deaths of nursing home residents in a home’s overall death toll.
James’ report paints a picture of a nursing home industry that simply buckled under the weight of the pandemic. There was a lack of compliance with infection control protocols, insufficient PPE for staff, insufficient COVID-19 testing for residents and staff in the early stages of the pandemic, and a state reimbursement model that gave for-profit homes a financial disincentive to invest in staff and PPE.
Poor compliance with an executive order requiring communication with family members caused “avoidable pain and distress,” the report adds.
In a 1,600-word response to the report, New York Health Commissioner Dr. Howard Zucker said the report didn’t find an undercount in the overall death toll but, instead, took issue with the state’s classification of hospital deaths as separate to nursing home deaths.
“The word ‘undercount’ implies there are more total fatalities than have been reported; this is factually wrong,” he said. “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.”
He acknowledged that “grave mistakes” were made by underprepared nursing homes, and said reform was needed. But he placed much of the blame at the feet of the Trump administration.
“Ultimately, the OAG’s report demonstrates that the recurring problems in nursing homes and by facility operators resulted from a complete abdication by the Trump administration of its duty to manage this pandemic,” he said. “With no uniform processes or reporting mechanisms, every state reported data in different ways.”