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New York Has Dramatically Undercounted COVID Nursing Home Deaths, Report Finds

The state's attorney general suggests drastic underreporting by the state health department throughout the pandemic

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The true number of COVID-19 deaths from New York nursing homes during the state's initial surge could be 56 percent more than what the state health department is reporting, according to a report released Thursday by the state's attorney general.

Comparing data collected from 62 of the state's 619 nursing homes and data reported by the New York State Department of Health (DOH) during the same time periods, Attorney General Letitia James found that the facilities recorded 1,914 COVID-19 deaths among residents, while the DOH reported only 1,229 deaths at those same homes.

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The state's official COVID-19 death count in nursing home is roughly 8,700 right now. A 56 percent increase on that count would bring the total deaths to well over 13,000.

The discrepancies between the two data sets stem mainly from the state's decision to omit in-hospital deaths, which occur after a resident is transferred from a nursing home to a hospital, from its official count. That decision has been criticized throughout the pandemic.

"Many residents died from COVID-19 in hospitals after being transferred from their nursing homes,” the report says. By including in-hospital deaths in the count, “a significantly higher number of resident COVID-19 deaths can be identified than is reflected in the deaths publicized by DOH.”

But discrepancies also lie among the on-site deaths reported directly by nursing homes to the attorney general investigators and those publicized by the DOH, the report shows. While the 62 nursing homes surveyed reported 1,266 facility deaths, the DOH publicized only 1,229 for the same homes.

"The bottom line is many more nursing home residents died from COVID-19 than State Department of Health data indicate,” says AARP New York State Director Beth Finkel. “We need more transparency in both the counting of COVID-related nursing home resident deaths, no matter where they occurred, and more accountability by nursing homes to ensure they are following the rules.”

New York State Health Commissioner Howard Zucker defended the state’s figures on Thursday, saying in a statement that his department “has consistently made clear that our numbers are reported based on the place of death.”

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“The word “undercount” implies there are more total fatalities that have been reported; this is factually wrong,” the statement said. But Zucker also acknowledged that the state health department’s own audit of nursing home data shows that more than 3,800 nursing home residents died in hospitals from March 1 of last year to Jan. 19, putting the total number of state COVID-19 deaths tied to nursing homes at almost 13,000.

Nationally, roughly 112,000 nursing home residents have died from COVID-19 throughout the pandemic, according to the federal Centers for Medicare and Medicaid Services. Tallies of long-term care deaths more broadly — including those in assisted living and other long-term care settings — report almost 147,000 resident and staff deaths from COVID-19, or roughly 37 percent of all U.S. coronavirus deaths.

A long list of nursing home problems

The attorney general's report also suggests that many homes lacked compliance with infection control protocols, which “put residents at increased risk of harm during the COVID-19 pandemic in some facilities.” Many homes failed to properly isolate residents who tested positive for the virus, adequately screen and test employees for the virus, train employees in infection control protocols and use of proper personal protective equipment (PPE) use, and cease communal dining.

Many facilities also demanded infected employees continue to come to work or face retaliation or termination, according to the report, which also found that nursing homes that entered the pandemic with lower federal scores for staffing experienced higher COVID-19 death rates than homes with higher ratings.

"Pre-existing low staffing levels decreased further to especially dangerous levels in some homes, even as the need for care increased due to the need to comply with COVID-19 infection control protocols,” the report says, noting that in late March, at a for-profit nursing home in western New York with a one-star (out of five) staffing rating, a worker reported that for at least a few hours there was only one certified nursing assistant in the building with approximately 120 residents.

The attorney general's 76-page report presents preliminary findings from ongoing investigations into COVID-19-related neglect in New York nursing homes. Based on these findings and subsequent investigation, James said in a statement she is conducting ongoing investigations into more than 20 nursing homes whose reported conduct during the first wave of the pandemic presented particular concern.

"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,” she said. “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."

AARP has been calling for better transparency of COVID-19 data and adequate staffing in nursing homes since the early stages of the pandemic. And while the attorney general's report focuses solely on the failures of New York, AARP's Finkel says these findings are part of “a national tragedy.”

"Immediate action is needed,” she adds. “We must make sure it never happens again."

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