When New York Governor Andrew Cuomo was first accused of failing to report deaths in a nursing home from Covid-19, his administration offered a simple explanation:
The state did not include residents living in the homes of the elderly who died in hospital in a publicly published aggregation of coronavirus deaths related to long-term care facilities, officials said, because they wanted to avoid “double counting” of these deaths across the country.
However, New York differs from other states in that it takes this approach to counting deaths in a nursing home, research experts say – a decision that compares deaths in a nursing home in New York seems lower than it was, and it is now federal. under investigation.
“It’s hard to compare state-level data, but New York is the only state that has explicitly stated that it excludes hospital deaths,” said Priya Chidambaram, a senior policy analyst at the nonprofit research organization Kaiser Family Foundation.
In contrast, officials from other states, including Minnesota, Connecticut, Massachusetts and Vermont, said in recent interviews that they had found a way to kill all seniors at home, including residents who died in hospitals, without double counting, with cross-references to reports. from nursing homes with other data sources. Research experts, including Chidambaram, have said they have no knowledge of states that, like New York, count deaths in a nursing home.
Both policymakers and researchers have wondered why New York did not find a similar solution to avoid counting the thousands who died in nursing homes from the reported amount.
“New York is different when it comes to this issue,” said David Grabowski, a long-term care expert and professor at Harvard Medical School.
Each state has developed its own method for counting Covid-19 deaths in nursing homes as well as the entire population. And New York has explicitly said from the early months of the pandemic that the publicly reported number of deaths in nursing homes includes only those that occurred on the spot, as opposed to being hospitalized or elsewhere.
The state has taken this approach to avoid these deaths twice in all New York residents who have died from Covid-19, state health commissioner Dr. Howard Zucker told state representatives at an August hearing on treating administration care. during an epidemic.
“We don’t want to double it – this person died here and died there,” Zucker said, describing the Cuomo administration as “incredibly transparent.”
New York officials also considered it important to check reports of residents who died in hospitals before releasing these numbers, as the information provided by nursing homes was not always accurate, especially in the chaotic early days of the pandemic.
“It’s natural to assume they may not have as much information as what happened within their villages,” said Gary Holmes, a spokesman for the state health department.
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However, this approach has led New York to leave the myriad deaths in its recently publicly announced nursing home. The state said about 8,500 residents of nursing homes died in Covid-19. But when New York finally included hospital-died residents, the total number shot at about 15,000 – more than in any other state at the end of January – was revealed by the Kaiser Family Foundation’s count of long-term deaths per state. . And the state only released the new amount after its own attorney general released a report last month accusing the Cuomo administration of not counting the deaths.
According to the New York Department of Health, the delay in disclosing the number of hospital deaths is due to a time-consuming review process. Covid-19 reports that nursing homes and hospitals contain only the initials and age of residents who have died “to protect patients’ privacy, ”Holmes said.
While more detailed data on hospital deaths are available, the information will be entered into a separate system, which is often left behind and does not include the name of the sick nursing home, he added. “We have taken great care to ensure the accuracy of data from multiple sources.”
Holmes also said the newly released numbers did not change the number of deaths in New York from the virus, as all deaths in nursing homes were included in the nationwide census, regardless of where they occurred.
Officials in other states in the Northeast and elsewhere told NBC News that a different approach was taken to compile the overall number of deaths of residents — whether in a hospital or facility — to avoid the double-counting problem in New York. officials were worried.
In Minnesota, for example, “deaths are classified by place of residence,” said Scott Smith, a spokesman for the state’s public health department.
The state relies on nursing home self-declarations and requests demographic information, date and place of death, and other information. Minnesota also collects data from hospitals, laboratories, medical examiners and death certificates to comply with reports and exclude duplicate entries to avoid double counting, Smith said.
Similarly, Connecticut uses self-reported data from nursing homes that must report the deaths of all residents, “whether they occur at their facility or after being transferred to a hospital,” said David Dearborn, a spokesman for the state health department.
The state also relies on reports from the state medical examiner to prevent double counting in all deaths, Dearborn said. “This process ensures an accurate amount for the entire state.”
Massachusetts takes a similar approach, looking at reports of a nursing home with cross-references and death certificates to avoid duplicate entries to record the entire Covid-19 deaths in the state, a state health spokesman said.
Although the epidemic was unprecedented in many ways, the data challenges associated with it are not new, said Grabowski, a professor at Harvard Medical University.
“Historically, public health officials have often had to distinguish between the place of death and the place of immediate residence before death,” he said. “I see no reason why other states could have classified pre-stay and New York could not.”
The basic data should have been readily available to New York officials, said Bill Hammond, a health policy officer at the Empire Center, a right-wing think tank that sued the state for failing to provide data on elderly home deaths. According to the New York data collection form received during the lawsuit, nursing homes are specifically asked to “the total number of Covid-19 residents who died outside your facility,” as well as the number that died in the facility itself.
“It’s not a complicated thing,” said Hammond, who believes New York officials should have released both hospital and non-hospital deaths immediately and then checked the information later if deemed necessary.
“The need for maximum accuracy and the difficulty of reconciling the two sets of data are used as a justification for postponing the release of public information,” he said.
There are other differences between states, as well as wider inconsistencies in the data. For example, New York and Minnesota are among the states that are likely to include Covid-19 cases in the death census, but some only count laboratory-confirmed cases.
Some states included staff members in the total number of deaths associated with long-term care facilities, while others did not take them into account or segregated them. It took months for some states to provide detailed information on deaths in nursing homes. And the facilities themselves do not always provide accurate information.
The long-term care industry itself is skeptical that more data would have made a big difference in the overall response to a pandemic.
“This is just another piece of data that may show something or not,” said James Clyne, CEO and president of LeadingAge New York, representing nonprofit long-term care institutions. “Did anyone look at it and come to any conclusions? It’s not as if anyone had this epiphany because this information was released.
But researchers say full information from the states is important to understand the full impact of the epidemic on nursing homes. In the worst months of the pandemic, the data could help public health officials decide where to send funds first, lawyers said. It can also help researchers determine which factors have left facilities most vulnerable to Covid-19 cases and deaths, and which policy decisions seem to be helping to protect residents and staff.
In the first months of the pandemic, for example, the Cuomo administration came under fire because nursing homes had to demand recovering Covid-19 patients discharged from hospitals – a decision aimed to clean up a much-needed place in hospitals. The guideline was virtually reversed by May, and government officials issued an analysis that it was not the driving force behind home epidemics in the elderly. But more comprehensive data on population mortality could help provide more definitive answers, experts and advocates said.
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Gustavo Rivera, New York State Senate, Bronx Democrat Democrat, chairman of the health committee, recently introduced a bill requiring the state to disclose the deaths of residents who died after being transferred to hospital, and criticized the state exclusion decision.
“Families and residents alike suffered because they didn’t know what was happening at the facilities during the Covid epidemic,” the bill says.
The federal government did not begin collecting nationwide data on Covid-19 cases and nursing home deaths until the first week of May, and facilities were not required to provide information from previous months. So the state and local governments were the only ones to follow up since the start of the pandemic – another reason why the number of New York nursing homes has such significance, the researchers said.
“Accurate data is the foundation of a policy that meets actual needs – which guidelines were most helpful? Which guidelines were the least useful? Said Chidambaram of the Kaiser Family Foundation. “Still, the lack of exact numbers did something wrong.”