Update: James Challenges Cuomo on Count of Covid-19 Nursing Home Deaths

Updated: General Letitia James Thursday accused the Cuomo administration of undercounting the number of Covid-19 deaths of patients at nursing homes.

State Health Commissioner Dr. Howard Zucker replied that the state numbers were not an undercount of the total number of the deaths but rather a question of how to count the people who were in nursing homes but transferred to hospitals and later died.

Since March, James has been investigating nursing homes based on allegations of patient neglect and other concerning conduct that may have jeopardized the health and safety of residents and employees.

In a report released Thursday, James said that a larger number of nursing home residents died from COVID-19 than the New York State Department of Health’s (DOH) reported, and may have been undercounted by as much as 50 percent. The investigations also said nursing homes put residents at risk by failing to comply with infection control protocols put residents at increased risk of harm, and facilities that had lower pre-pandemic staffing ratings had higher COVID-19 fatality rates.

She is investigating more than 20 nursing homes.

“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,” James 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. Nursing homes 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.”

In early March, the attorney general’s office received and began to investigate allegations and indications of COVID-19-related neglect of residents in nursing homes. At the direction of Cuomo, on April 23, the office set up a hotline to receive complaints relating to communications by nursing homes with family members prohibited from in-person visits to nursing homes, and formally initiated a large-scale investigation of nursing homes’ responses to the pandemic. It received more than 770 complaints on the hotline through Aug. 3,  and an additional 179 complaints through Nov. 16. The office also continued to receive allegations of COVID-19-related neglect of residents through pre-existing reporting systems.

The report’s preliminary findings include:

  • A larger number of nursing home residents died from COVID-19 than DOH data reflected;
  • Lack of compliance with infection control protocols put residents at increased risk of harm;
  • Nursing homes that entered the pandemic with low U.S. Centers for Medicaid and Medicare Services (CMS) Staffing ratings had higher COVID-19 fatality rates;
  • 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;
  • Lack of nursing home compliance with the executive order requiring communication with family members caused avoidable pain and distress; and
  • 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.

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. In fact, the OAG found that nursing home resident deaths appear to be undercounted by DOH by approximately 50 percent.

OAG asked 62 nursing homes (10 percent of the total facilities in New York) for information about on-site and in-hospital deaths from COVID-19. Using the data from these 62 nursing homes, OAG compared: (1) in-facility deaths reported to OAG compared to in-facility deaths publicized by DOH, and (2) total deaths reported to OAG compared to total deaths publicized by DOH.

“In one example, a facility reported five confirmed and six presumed COVID-19 deaths at the facility as of August 3 to DOH. However, the facility reported to OAG a total of 27 COVID-19 deaths at the facility and 13 hospital deaths — a discrepancy of 29 deaths,” James’ office said.

The office also said that it received numerous complaints that some nursing homes failed to implement proper infection controls to prevent or mitigate the transmission of COVID-19 to vulnerable residents. Among those reports were allegations that several nursing homes around the state failed to plan and take proper infection control measures, including:

  • 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.

At a for-profit facility on Long Island, COVID-19 patients who were transferred to the facility after a hospital stay and were supposed to be placed in a separate COVID-19 unit in the nursing home were, in fact, scattered throughout the facility despite available beds in the COVID-19 unit. “This situation was allegedly resolved only after someone at the facility learned of an impending DOH infection control visit scheduled for the next day, before which those residents were hurriedly transferred to the appropriate designated unit,” the report says.

Anyone with information or concerns about nursing home conditions to file confidential complaints online or by calling 833-249-8499.

State Investigating Deaths at Nursing Homes

 

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