NY Nursing Home Coronavirus Deaths Undercounted By 50%: AG Says

An investigation by the New York Attorney General's office into thousands of COVID-19 deaths at nursing homes in 2020 has found the ones with lower staffing ratios had higher fatality rates, and that many lacked basic infection controls, putting residents at increased risk of harm from the coronavirus, AG Letitia James announced Thursday.

Moreover, the extent of the problem has been obscured because nursing home deaths from COVID-19 have been undercounted by more than 50 percent, James said in an interim report on her office's probe of New York nursing homes’ responses to the outbreak.

"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 in an announcement Thursday about the interim report.

She said the preliminary investigations reflect many examples where for-profit nursing homes’ pre-pandemic low staffing model "simply snapped under the stress" of the pandemic, including one based on a complaint from a man concerned that his mother was not receiving proper care because of critically low staffing levels at the nursing home in New York City.

His mother was never tested for COVID-19, but later died while exhibiting COVID-19 symptoms. Between late March and early April, the facility was so understaffed due to staff quarantining, working from home, and pre-existing low staffing, that the onsite management of the entire facility was left in the hands of just two nurse supervisors. During the week of April 5, 33 residents died at that facility, 15 percent of all its residents.

In addition, she pointed to deliberately low-staffed nursing homes. Of the state’s 401 for-profit facilities, more than two-thirds — 280 nursing homes — had the lowest possible staffing ratings before the pandemic began. As of Nov. 16, over half of all nursing home resident COVID-19 deaths occurred in these 280 facilities, the report said.

The investigation found that:

• A larger number of nursing home residents died from COVID-19 than the state Health Department reported.
• Lack of compliance with infection control protocols put residents at increased risk of harm.
• Nursing homes that entered the pandemic with low 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.
• 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.

James said the investigation began after Gov. Andrew Cuomo ordered a hotline set up April 23 for people with complaints and concerns about nursing homes and communication during the pandemic shutdown.

Among those complaints:

• At a for-profit nursing home located north of New York City, residents who tested positive for COVID-19 were intermingled with the general population for several months because the facility had not yet created a “COVID-19 only” unit.
• 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.
• A for-profit nursing home north of New York City failed to consistently conduct coronavirus employee screening. It was reported that some staff avoided having their temperatures taken and answering a coronavirus questionnaire at times when the screening station at the facility’s front entrance had no employees present to take that information or when staff entered the facility through a back entrance, avoiding the screening station altogether.

The AG's office is conducting ongoing investigations into more than 20 nursing homes whose reported conduct during the first wave of the pandemic presented particular concern, she said.

Looking at the discrepancies between the number of deaths being reported by the state's Department of Health, and the number of deaths reported by the homes themselves, her investigators studied a sample of 62 of the state’s roughly 600 nursing homes. They reported 1,914 deaths of residents from COVID-19, while the state Department of Health logged only 1,229 deaths at those same facilities.

If that same pattern exists statewide, James' report said, it would mean the state is underreporting deaths by nearly 56 percent. Part of the gap is explained by a decision by New York's health agency to exclude from its count the number of nursing home patients who died after being transferred to hospitals.

As of Tuesday, the state was reporting 8,711 deaths in nursing homes statewide.

Health Commissioner Howard Zucker has said at times that the state is working on compiling that data. His department has not responded to repeated requests by The Associated Press for that figure in recent weeks.

James asked anyone with information or concerns about nursing home conditions to file confidential complaints online or call 833-249-8499.

"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," she said.

New York State reports these COVID-19 nursing home fatalities in the Hudson Valley and on Long Island by county as of Jan. 27:

• Dutchess - 93 confirmed, 9 suspected
• Nassau - 358 confirmed, 246 suspected
• Orange - 144 confirmed, 24 suspected
• Putnam - 18 confirmed
• Rockland - 44 confirmed, 56 suspected
• Suffolk - 649 confirmed, 230 suspected
• Ulster - 78 confirmed
• Westchester - 291 confirmed, 230 suspected

The Associated Press contributed to this report.