The following analysis uses information related to coronavirus deaths in long-term care facilities that was recently released by the New York State Department of Health.[i]
The admission of coronavirus-positive patients into New York nursing homes under March 25 guidance from the New York State Department of Health was associated with a statistically significant increase in resident deaths.
The data show that each new admission of a COVID-positive patient correlated with .09 additional deaths, with a margin of error (MOE) of plus or minus 0.05.
Further, admitting any number of new COVID-positive patients was associated with an average of 4.2 additional deaths per facility (MOE plus or minus 1.9).
The effect was more pronounced upstate—possibly because the pandemic was less severe in that region at the time, so that even a single exposure would have had a larger impact on the level of risk.
Among nursing homes outside of New York City and its suburbs, each positive admission was associated with 0.62 additional deaths (MOE plus or minus 0.17), and any number of positive admissions was associated with 9.33 additional deaths per facility (MOE plus or minus 2.6).
Also in the upstate region, facilities that admitted at least one positive patient during this period accounted for 82 percent of coronavirus deaths among nursing home residents, even though they had only 32 percent of the residents.
Statewide, the findings imply that COVID-positive new admissions between late March and early May, which numbered 6,327, were associated with several hundred and possibly more than 1,000 additional resident deaths.
This analysis—based on the limited data available—sheds new light on the Cuomo administration’s much-debated March 25 guidance memo, which instructed nursing homes not to refuse the admission of coronavirus-positive patients being discharged from hospitals.[ii] The policy—inspired by concern about overcrowding of hospitals at the height of New York’s spring wave—was effectively rescinded on May 10.[iii]
The data indicate that the March 25 memo was not the sole or primary cause of the heavy death toll in nursing homes, which stood at approximately 13,200 as of early this month.[iv] At the same time, the findings contradict a central conclusion of the Health Department’s July 6 report on coronavirus in nursing homes, which said, among other things: “Admission policies were not a significant factor in nursing home fatalities” and “The data do not show a consistent relationship between admissions and increased mortality.”[v]
Data & Methodology
This analysis was based on three sources of information:
- A newly released and more complete database of coronavirus deaths in New York’s long-term care facilities by date and location, released by the Health Department under a Feb. 3 court order, which enforced compliance with a Freedom of Information request filed by the Empire Center in August.[vi]
- A newly released and more complete database of coronavirus-positive admissions to nursing homes between March 25 and May 8, recently released by the Health Department under a Freedom of Information request by the Associated Press.[vii] (A copy of this data set was obtained by the New York Post, which shared it with the Empire Center.)
- Nursing home census figures routinely posted by the Health Department on a weekly basis.[viii]
This analysis focused on two key variables: the number of newly admitted COVID-positive patients to each nursing home between March 25 and May 8, which totaled 6,327; and the number of residents in each facility who died between April 12 and June 4, which totaled 5,780.[ix]
The shift in dates reflects the typical delay between exposure to the virus and death, which the Health Department has said ranges from 18 to 25 days.[x] The assumption was that deaths occurring before April 12 or after June 4 were less likely to be related to the admission of positive patients under the March 25 policy.
The admissions figures exclude 2,279 patients who were readmitted to nursing homes where they were already residents. Because such patients were not new to those facilities, they were seen as less likely to be the original cause of an outbreak.
The analysis controlled for the varying size of nursing homes by including each facility’s average resident census during the 12 months before the pandemic. To control for the varying intensity of outbreaks in different parts of the state, the analysis also factored in each facility’s home county.
These variables were then subjected to multiple regression analysis to identify statistical correlations.
As with any such analysis, the results should be viewed with caution. Even a statistically significant correlation between two factors does not necessarily mean that one caused the other. The available data were also limited in potentially important ways—such as the lack of dates for the COVID-positive admissions.
Other possibly relevant factors, such as the relative quality of care provided in the nursing homes and the average acuity of their patients’ condition, were beyond the scope of this review. Moreover, the data do not clarify how many of the patients admitted to a nursing home from a hospital later died in the nursing home, which would add to the home’s death count even if the patient in question did not spread the virus there.
Within the limitations of the available data, the results were robust. The findings were calculated with statistical significance at the 99 percent confidence level. Similar correlations were found across varying approaches, including expanding the pool of admissions data to include readmissions and treating the transfer of hospital patients to nursing homes as a binary outcome (i.e. whether a nursing home received such transfers) or a continuous variable that considers the impact of each additional transfer. When analysis is disaggregated by region (i.e. upstate or downstate), the models indicate that transfers from hospitals to nursing homes were significantly associated with nursing home deaths upstate but not downstate, where the population-wide infection rate was exceptionally high during the period in question.
The coronavirus pandemic wreaked havoc in nursing homes across the country and around the world, including in jurisdictions that did not adopt policies similar to those in the Cuomo administration’s March 25 guidance memo. However, this analysis indicates that the guidance may have made a bad situation worse—and points to the need for further research to determine the best policy before the state faces another pandemic.
[i] The full data set of coronavirus deaths in nursing homes and other long-term care facilities is available at https://www.empirecenter.org/publications/covid-nursing-home-data/
[ii] New York State Department of Health Advisory dated March 25, 2020.
[iii] Executive Order No. 202.3.
[iv] Bill Hammond, “New York Reveals Another 1,516 COVID-19 Deaths in Long-Term Care Facilities,” empirecenter.org, Feb. 7, 2021.
[v] New York State Department of Health, “Factors Associated with Nursing Home Infections and Fatalities in New York State During the COVID-19 Global Health Crisis,” July 6, 2020 (revised July 17, 2020, and February 11, 2021).
[vi] Available at https://www.empirecenter.org/publications/covid-nursing-home-data/.
[vii] Bernard Condon and Jennifer Peltz, “AP: Over 9,000 virus patients sent into NY nursing homes,” February 11, 2021.
[viii] Available at https://health.data.ny.gov/Health/Nursing-Home-Weekly-Bed-Census-Beginning-2009/uhyy-xp9s.
[ix] This nursing home death toll of 5,780 includes residents who died after being transferred to hospitals, a group that was previously omitted from the state’s public reporting and from the Health Department’s July 6 report.
[x] New York State Department of Health’s July 6 report.