David Robinson

The state Department of Health’s own analysis of COVID-19 nursing home deaths has renewed politically the charged debate over how and why coronavirus ravaged the most vulnerable New Yorkers.

Central to the discourse is a controversial March 25 Health Department order directing nursing homes to accept COVID-19 infected patients from hospitals, if medically stable.

The agency’s report, which was not independently crafted, asserted its March 25 order and facility admission policies “were not a significant factor in nursing home fatalities.”

Instead, the report contended COVID-19 infected nursing home workers and visitors unknowingly introduced the deadly virus into many facilities, where it spread rapidly among frail and elderly residents most susceptible to the respiratory disease.

Meanwhile, a resident advocate as well as executives of several medical providers and trade groups, have described the Health Department’s analysis of the March 25 order as scientifically sound, citing various data included in the 33-page report.

The key reasons that the March 25 order had limited impact on deaths included that a majority of nursing homes already had COVID-19 infections, and many of the hospital discharges involved patients who were no longer contagious, the report contended.

A USA TODAY Network analysis of data in the report, however, suggested that the Health Department downplayed the potential that the order helped spark or fuel the spread of coronavirus in some nursing homes.

Some advocates and lawmakers have continued to seek an independent investigation of the more than 6,280 COVID-19 deaths in New York nursing homes.

The Health Department report does not reduce the need for additional analysis of everything from infection-control practices and staffing levels to COVID-19 data self-reported by nursing homes, said Richard Mollot, executive director of the Long-Term Care Community Coalition.

The complex web of circumstances involved in the deaths required “independent assessments of the conditions that led to the tragedies that unfolded in so many of our nursing homes,” he added.

Why COVID-19 nursing home data in NY requires further scrutiny

Many of the key unresolved questions hinge on the fact that New York nursing home data only reflects residents who died inside the facilities, as opposed to those transferred to hospitals.

In other words, incomplete COVID-19 fatality rates and statistics in the Health Department report could skew its findings and comparisons with other states.

The COVID-19 death toll among nursing home residents may be thousands higher than the official state tally, according to the Empire Center, an Albany-based think tank, which cited how the nursing home vacancy rate more than doubled during the pandemic.

Further, nursing homes self-reported the COVID-19 infection and death statistics to the Health Department, which raises questions about potential conflicts of interest.

To seemingly address the concern, the report noted nursing homes submitted COVID-19 data in many cases under penalty of perjury.

How many COVID-19 nursing home deaths are connected to admissions

While the Health Department report concluded the March 25 order was not a significant factor in COVID-19 nursing home deaths, it lacked details necessary to connect specific cases to outbreak clusters.

For example, the report revealed 6,326 COVID-19 positive hospital patients were discharged to nursing homes between March 25 and May 8, but it disputed the discharges caused infections and deaths for several reasons.

First, nursing home deaths peaked April 8 while hospital discharges of infected patients peaked on April 14, the report said, suggesting the spike in deaths stemmed from earlier exposures linked to thousands of infected nursing home staff and visitors in February and March.

Additionally, 81% of nursing homes had at least one confirmed or suspected COVID-19 case prior to the March 25 order, the report noted.

Second, the COVID-19 positive residents were admitted to nursing homes a median of nine days after hospital admission, but people are most infectious two days before symptoms appear and likely no longer infectious “nine days after symptom onset,” the report noted.

In other words, the report contended that many hospital discharges were no longer contagious by the time they reached nursing homes.

But a USA TODAY Network review of the data suggested some discharges may have contributed to infections and deaths.

For example, 1,338 of the hospital discharges of infected patients to nursing homes occurred from March 25 through April 8.

That suggested potentially contagious cases preceded the daily fatality peak in nursing homes, but it is difficult to make connections because the report did not provide names of the 19% of nursing homes that were free of COVID-19 prior to March 25.

Further, nearly 5,000 additional hospital discharges of COVID-positive patients to nursing homes came after April 8, including some potentially transferred while still contagious and capable of fueling existing outbreaks at facilities.

Meanwhile, health experts and state officials in New York, including Gov. Andrew Cuomo, have said all it takes is one contagious case to cause hundreds of additional COVID-19 infections.

The Department of Health on Tuesday said it would take up to 20 days to fulfill a Freedom of Information Law request for the underlying nursing home data and survey responses involved in the report.

How nursing homes admitted COVID-19 infected hospital patients

The Health Department report also defended its March 25 order by saying officials in New York and several other states followed guidance issued by the federal Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention.

It noted state and federal laws only allow nursing homes to admit residents if they’re capable of providing adequate care, suggesting the March 25 order did not direct nursing homes to admit COVID-19-infected patients.

Cuomo has repeatedly made similar statements, which the independent fact-checking website PolitiFact deemed “Mostly False,” citing in part how nursing home operators felt pressured to admit the infected patients.

The Health Department report, however, expanded on the issue by noting nursing homes that could not provide adequate care could have moved infected residents to alternative sites.

The report added New York state created COVID-positive exclusive facilities for nursing home residents statewide.

It listed two sites in New York City, as well as one in Buffalo, the Father Baker Manor Home. Surplus capacity was also available at SUNY Downstate Hospital in Brooklyn and SUNY Upstate Hospital in Syracuse.

The Health Department and state Attorney General’s Office are investigating if any nursing homes violated the law by accepting COVID-19 patients without the ability to provide adequate care, the report noted.

The Health Department is also probing potential profit motivation by some nursing homes to evict certain low-income patients to be able to accept COVID-positive patients as the reimbursement for treatment is higher than that for traditional Medicaid patients, the report said, citing New York Times reporting.

Ultimately, Cuomo reversed the March 25 order under pressure from advocates and relatives. On May 10, he issued an executive order that required one negative COVID-19 test result for hospital patient discharges to nursing homes in New York.

© 2020 Lohud