When New York Governor Andrew Cuomo was first accused of underestimating deaths in Covid-19 nursing homes, his government offered a simple explanation:
The state did not include nursing home residents who died in the hospital in the publicly published count of coronavirus deaths linked to long-term care facilities, officials said, because it wanted to avoid a “double count” of those deaths in the state total.
But New York differentiates itself from other states in taking this approach to counting deaths in nursing homes, experts said – a decision that made the death count in New York’s nursing homes seem lower than it was, and that it is now under federal investigation.
“It is complicated to compare state data, but New York is the only state that explicitly stated that it was excluding hospital deaths,” said Priya Chidambaram, senior policy analyst at the Kaiser Family Foundation, a non-profit research organization.
On the other hand, officials in other states, including Minnesota, Connecticut, Massachusetts and Vermont, said in recent interviews that they found ways to total all deaths in nursing homes, including residents who died in hospitals, without counting them twice, for example. cross-referencing of nursing home reports with other data sources. Research experts, including Chidambaram, said they were unaware of any other state that counted deaths in nursing homes like New York.
This left lawmakers and researchers wondering why New York did not find a similar workaround to avoid excluding thousands of deaths in nursing homes from the reported total.
“New York is kind of an outlier when it comes to this issue,” said David Grabowski, a long-term care specialist and policy professor at Harvard Medical School.
Each state has developed its own method of counting deaths by Covid-19 in nursing homes, as well as the general population. And New York has explicitly said since the early months of the pandemic that its published count of deaths in nursing homes included only those that occurred on the premises, as opposed to a hospital or elsewhere.
The state has taken this approach to avoid including these deaths twice in its total of all New York residents who died from Covid-19, state health commissioner Dr. Howard Zucker told state lawmakers during a hearing in August on nursing care by government households during the pandemic.
“We don’t want to count twice – that person died here and there too,” said Zucker, describing the Cuomo government as being “incredibly transparent in the information.”
New York officials also said that it is important to check the reports of residents who died in hospitals before making these numbers public, as information provided by nursing homes is not always accurate, especially during the chaotic early days of the pandemic.
“It is natural to assume that they may not have as much information as what happened inside their walls,” said Gary Holmes, a spokesman for the state health department.
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This approach, however, has led New York to omit a large number of deaths from its publicly reported total in nursing homes until recently. The state said about 8,500 residents of nursing homes died from Covid-19. But when New York finally included residents who died in hospitals, the total rose to about 15,000 – more than any other state in late January, according to a state-to-state count of long-term deaths compiled by the Kaiser Family Foundation . And the state only released the new total after its own attorney general released a report last month accusing the Cuomo government of underestimating the deaths.
The New York health department said the delay in releasing the death toll from hospitals was due to a lengthy verification process. Covid-19 reports that nursing homes and hospitals send daily include only the initials and the age of residents who died “to protect the patient’s privacy,” said Holmes.
Although more detailed data on hospital deaths are available, the information is entered into a separate system that is often delayed and does not include the name of the patient’s asylum, he added. “Great efforts have been made to ensure the accuracy of data reports from various sources.”
Holmes also said that the recently released figures did not change the overall number of deaths from the virus in New York, since all deaths in nursing homes were included in the state count, regardless of where they occurred.
Officials from other states in the Northeast and elsewhere told NBC News that they took a different approach to compiling a comprehensive resident death count – regardless of whether it occurred in a hospital or facility – to avoid the double counting problem that Nova York officials were concerned.
In Minnesota, for example, “deaths are categorized by place of residence,” said Scott Smith, a spokesman for the state’s department of public health.
The state relies on self-reported data from nursing homes, which are asked to provide demographic information, date and place of death and other information. Minnesota also collects data from hospitals, laboratories, coroners and death certificates to compare reports and exclude duplicate entries to avoid double counting, Smith said.
Likewise, Connecticut uses self-reported data from nursing homes, which are required to report all deaths of residents “whether they occur on their premises or after transfer to a hospital,” said David Dearborn, a spokesman for the department of health at state.
The state also relies on reports from the state medical examiner to avoid double counting the total death toll, Dearborn said. “This process guarantees an accurate total across the state.”
Massachusetts uses a similar approach, crossing reports from nursing homes with death certificates to avoid duplicate entries to capture the total Covid-19 deaths in the state, a state health spokesman said.
While the pandemic is unprecedented in many ways, the data challenges associated with it are not new, said Grabowski, a professor at Harvard Medical School.
“Historically, public health officials have always had to distinguish between the place of death and immediate residence before death,” he said. “I see no reason why other states could classify their previous residence and New York does not.”
Basic data should be readily available to New York officials, said Bill Hammond, a senior health policy researcher at the Empire Center, a right-wing research center that sued the state for failing to disclose its data on deaths in nursing homes. According to the New York data collection form, obtained through the process, nursing homes are specifically asked for “the total number of Covid-19 residents who died outside their facility”, as well as the total number deaths in the facility itself.
“This is not a complicated thing to do,” said Hammond, who believes New York officials should have released hospital and non-hospital death counts immediately, and then checked the information later if they found it necessary.
“They are using the need for maximum precision and the difficulty of reconciling the two sets of data as a justification for postponing” the disclosure of public information, he said.
There are other differences between states, as well as wider inconsistencies in the data. New York and Minnesota, for example, are among the states that include probable cases of Covid-19 in death counts, but some count only laboratory confirmed cases.
Some states included employees in the total number of deaths associated with long-term care facilities, while others did not include or separate them. Some states took months to release detailed information about deaths in nursing homes. And the facilities themselves cannot always report accurate information.
The long-term care industry itself is skeptical that more data would have made a big difference in the overall response to the pandemic.
“It’s just another piece of data that can show something or not,” said James Clyne, CEO and president of LeadingAge New York, which represents long-term nonprofit institutions. “Did anyone look at him and come to any conclusions? It is not as if someone had this epiphany because that information was given. “
But the researchers say complete information from states is important for understanding the full impact of the pandemic on nursing homes. During the worst months of the pandemic, this data can help public health officials decide where to send resources first, advocates said. It could also help researchers identify which factors have made the facility more vulnerable to Covid-19 cases and deaths and which policy decisions appear to help protect residents and employees.
In the early months of the pandemic, for example, the Cuomo government was criticized for demanding that nursing homes accept recovering patients from Covid-19 who were discharged from hospitals – a decision designed to free up much-needed space in hospitals. The guidance was effectively reversed in May, and state officials released an analysis stating that it was not a factor causing outbreaks in nursing homes. But more comprehensive data on resident deaths can help provide more definitive answers, experts and advocates said.
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New York state senator Gustavo Rivera, a Democrat from the Bronx who chairs the health committee, recently introduced a bill requiring the state to disclose the deaths of residents who died after being transferred to the hospital, criticizing the state’s decision to exclude them.
“Families and residents suffered without knowing what was happening on the premises during the Covid pandemic,” said the project.
The federal government did not start collecting national data on Covid-19 cases and deaths in nursing homes until the first week of May, and the facility was not required to provide information about previous months. Thus, state and local governments were the only ones to follow since the start of the pandemic – which is another reason why New York’s nursing home numbers are so important, the researchers said.
“Accurate data is the basis for the policy that meets real needs – which policies were most useful? Which policies were less useful? ”Said Chidambaram, from the Kaiser Family Foundation. “The lack of precise numbers has done a terrible job.”