The plaudits have pale for New York Gov. Andrew Cuomo. As soon as hailed as a paragon of pandemic governing, he’s since come beneath scorching criticism for undercounting the state’s covid deaths amongst nursing residence residents by as a lot as half. The tallying flap drew consideration to a different misstep: a coverage final March that directed nursing properties to simply accept covid-positive sufferers from hospitals, doubtlessly exposing high-risk, medically weak nursing residence residents to the lethal virus.
Did the governor deliberately fudge nursing residence dying counts to deflect consideration from the influence of an ill-advised directive? That depends upon whom you ask. The governor’s allies say the coverage was a good-faith effort to help hospitals that feared they have been going to be overrun by covid sufferers. The counting snafu, they are saying, arose out of an extra of warning as a result of the administration didn’t need to double depend deaths. Critics, and there are numerous, level to a special motivation. They recommend the governor didn’t need his picture as a reliable pandemic chief to be tarnished by a wrongheaded coverage that the administration withdrew inside weeks.
Curiosity in these points is unlikely to abate anytime quickly. Following the important report by the New York lawyer basic that highlighted the undercounting drawback, the governor’s prime aide got here beneath hearth for admitting to state legislators that the administration withheld full nursing residence covid dying knowledge from them. Now the FBI and the U.S. lawyer’s workplace in Brooklyn have reportedly opened an investigation into the dealing with of long-term care amenities throughout the pandemic.
Judging from the variety of questions and feedback KHN and PolitiFact have fielded on the topic, it’s clear that many readers are confused and anxious. Right here’s a fast information to assist kind it out.
By the numbers
Cuomo continuously touts how nicely New York stacks up in opposition to different states in stopping nursing residence covid deaths. In September, he mentioned New York ranked forty sixth out of fifty states, a declare we examined and located to be Mostly False. A key drawback is that till not too long ago the New York totals didn’t embody deaths of nursing residence residents that occurred in hospitals.
State comparisons are difficult. However most different states, maybe all of them, do embody hospital deaths of their covid nursing residence totals, mentioned Priya Chidambaram, a senior coverage analyst at KFF, the Kaiser Household Basis. (KHN is an editorially impartial program of the muse.)
“New York’s determination to tug out the hospital-based deaths was not primarily based on commonplace observe,” she mentioned, noting that federal rules for reporting covid nursing residence deaths require that states embody off-site deaths in hospitals.
New York’s unorthodox exclusion of hospital deaths was all the time famous within the tremendous print on the information sheets. However the governor didn’t supply a disclaimer when he boasted of the state’s better-than-average efficiency primarily based on an incomplete depend.
Simply how incomplete grew to become evident when New York Legal professional Common Letitia James launched a report in late January that discovered the state’s printed knowledge on nursing residence covid deaths undercounted the full by as much as 50%. The rationale: the exclusion of hospital deaths in addition to underreporting by some nursing properties.
The state quickly launched a revised total of practically 15,000 deaths amongst residents of long-term care amenities, about double the sooner tally of roughly 8,500, as reported by information retailers similar to The New York Times and The Associated Press. The Empire Center set that quantity larger, round 8,940.
Utilizing the up to date, extra complete figures, the state’s covid dying price for nursing properties of roughly 29% remains to be considerably higher than the nationwide common of 37%, mentioned Chidambaram, who tracks covid mortality in long-term care amenities. Final month, we printed a reality test analyzing Cuomo’s current claims about below-average nursing residence covid deaths and located them to be Mostly True.
Advocates and public well being officers agree it’s essential to include hospital covid deaths into the nursing residence mortality figures.
“For those who can’t supply [the infection] again to the place it occurred, you may’t cease it,” mentioned Christopher Laxton, government director of the Society for Put up-Acute and Lengthy-Time period Care Medication, which represents medical personnel who work in these settings.
The New York State Senate handed a bill final month that may require the Division of Well being to document the covid deaths of nursing residence residents who subsequently die in hospitals as nursing residence deaths.
The March 25 Coverage
Final March, New York was the epicenter of a illness outbreak whose scope was nonetheless unknown. Greater than a thousand folks have been being hospitalized on daily basis within the state, and consultants have been genuinely involved that hospitals would run out of area to deal with the inflow of covid sufferers.
Cuomo issued the controversial March directive instructing nursing properties to absorb recovering covid sufferers who’d been hospitalized. There was an nearly fast outcry that the coverage appeared to place frail, aged nursing residence residents, who have been significantly weak to the virus, at huge threat.
The governor mentioned he was merely following Facilities for Illness Management and Prevention steering, a declare we investigated and located to be Mostly False. However was the administration’s coverage accountable for sowing the seeds of an infection that killed 1000’s of nursing residence residents, as a prime Trump administration official claimed? We examined that declare and located it, too, was Mostly False.
On Might 8, the administration amended the March directive and mentioned hospitals couldn’t discharge sufferers to nursing properties with out a damaging covid take a look at.
Final summer time, the state well being division put out a self-serving report claiming the timeline of when the 6,327 recovering covid sufferers entered the nursing properties and when nursing residence residents died confirmed that the covid-positive sufferers couldn’t have been a driver of infections or deaths in nursing properties. The report pinned the blame for spreading illness on workers members and guests.
Epidemiologists mentioned the report’s place that the governor’s coverage didn’t open nursing properties to covid infections was nonsense. However they agreed that workers and guests probably performed a bigger function in introducing the virus.
The Empire Heart for Public Coverage, a conservative assume tank, launched a report final month that discovered the March 25 directive was related to 4.2 extra deaths per facility, on common.
Displaying an affiliation is just not the identical as exhibiting that one factor brought on one other, the report notes. And analysts identified different shortcomings within the examine, similar to not incorporating the exact dates when covid-positive sufferers have been admitted, which made any findings of related deaths unreliable.
In an announcement, New York state well being commissioner Dr. Howard Zucker mentioned, “The Empire Heart’s conclusion that ‘the information point out that the March 25 memo was not the only real or major reason for the heavy dying toll in nursing properties’” is according to the well being division’s evaluation that the coverage “was not a driver of COVID infections and fatalities and COVID was launched to nursing properties primarily by workers and guests.”
Invoice Hammond, a senior fellow for well being coverage on the Empire Heart and the examine’s co-author, mentioned he believed that deflecting criticism of the governor’s March coverage was on the root of the administration’s determination to withhold the hospital covid deaths of nursing residence residents. The center sued the state well being division to launch the numbers. The Related Press made a Freedom of Data Act request for the information.
“If it hadn’t been for a courtroom order, they’d nonetheless be hiding this knowledge,” Hammond mentioned.
Past the Numbers
New York’s nursing residence covid controversy goes past whether or not Cuomo deliberately tried to obscure some numbers.
Nationally, fewer than 1% of individuals stay in long-term care amenities however make up 35% of covid deaths, in keeping with the COVID Tracking Project.
The bullet level from the New York lawyer basic’s report that has gotten probably the most consideration was the assertion that nursing residence deaths might have been undercounted.
However different troubling components documented within the report put nursing residence residents in danger, together with poor an infection management practices, inadequate staffing and insufficient private protecting tools and covid testing.
These findings are preliminary and the AG’s workplace continues to analyze.
The report highlighted the “disaster” that many nursing residence residents and their households have skilled, mentioned Richard Mollot, government director of the Lengthy Time period Care Group Coalition, which represents folks in long-term care settings.
“It’s a part of the broader situation that we face, that the lives of nursing residence residents aren’t counted a lot to start with,” Mollot mentioned.
With out a vaccine final 12 months, “it actually laid naked the necessity for higher an infection management: actually good mask-wearing, quite a lot of testing of workers,” mentioned Denis Nash, an epidemiologist on the Metropolis College of New York College of Public Well being.
New York State Division of Well being, Advisory: Hospital Discharges and Admissions to Nursing Homes, March 25, 2020, through Expert Nursing Information
New York State Legal professional Common, Attorney General James Releases Report on Nursing Homes’ Response to COVID-19, Jan. 28, 2021
Instances Union, “FBI, U.S. Attorney in Brooklyn Probing Cuomo Administration on Nursing Homes,” Feb. 17, 2021
Phone interview, Priya Chidambaram, senior coverage analyst, KFF, Feb. 24, 2021
CDC Nationwide Healthcare Security Community, Instructions for Completion of the COVID-19 Long-term Care Facility (LTCF) Resident Impact and Facility Capacity Form (CDC 57.144), March 1, 2021
Phone interview, Christopher Laxton, government director, Society for Put up-Acute and Lengthy-Time period Care Medication, Feb. 23, 2021
New York State Division of Well being, New York State Department of Health Issues Report on COVID-19 in Nursing Homes, July 6, 2020
Empire Heart for Public Coverage, COVID-Positive Admissions Were Correlated With Higher Death Rates in New York Nursing Homes, Feb. 18, 2021
Phone interview, Invoice Hammond, senior fellow for well being coverage, Empire Heart, Feb. 24, 2021
The COVID Monitoring Challenge, COVID deaths in long-term care facilities
Phone interview, Richard Mollot, government director of the Lengthy Time period Care Group Coalition, Feb. 23, 2021
Phone interview, Denis Nash, epidemiologist on the Metropolis College of New York College of Public Well being, Feb. 23, 2021
E-mail interview, Gary Holmes, assistant commissioner, New York State Division of Well being, Feb. 25, 2021
E-mail interview, Dr. Sally Aiken, Spokane County health worker, Feb. 23 and 24, 2021
E-mail interview, Erin Kissane, managing editor, the COVID Monitoring Challenge, Feb. 23, 2021
Phone interview, Dr. James Gill, president, Nationwide Affiliation of Medical Examiners, Feb. 24, 2021
New York Put up, “Melissa DeRosa’s Admission on Nursing Home Coverup Sparks Calls for Probe — And Cuomo’s Prosecution,” Feb. 12, 2021