NEW YORK CITY – Riverdale Nursing Home in the Bronx appears, on paper, the worst escape from the coronavirus pandemic, with an official state count of just four dead in its 146-bed facility.
The truth is, according to the house, much worse: 21 dead, mostly transported to hospitals before undergoing.
“It was a cascading effect,” recalled manager Emil Fuzayov. “One after the other.”
The death toll from New York’s coronavirus in nursing homes, already among the highest in the nation, could actually be a major undercount. Unlike any other state with major outbreaks, New York only counts residents who died in nursing home ownership and not those who were transported to hospitals and died there.
That statistic could add thousands to the state’s official nursing home death toll of just 6,600. But so far, the administration of Democratic Gov. Andrew Cuomo refused to share the number, leading to speculation that the state is manipulating the figures to show that it is doing better than other states and making a tragic situation less difficult.
“That’s a problem, bro,” Senator Gustavo Rivera, a Democrat, told New York Health Commissioner Howard Zucker during a legislative hearing on nursing homes earlier this month. “It seems, sir, that in this case you are choosing to define it differently, so that you may see better.”
How big a difference could it make? Since May, federal regulators have required nursing homes to send data on coronavirus deaths each week, whether residents died in the facility or in a hospital. Because the demand came after the height of the New York outbreak, the available data are relatively small. According to federal data, roughly one-fifth of the state’s homes reported civilian deaths from early June to mid-July – a number of 323 deaths, 65 percent higher than the state’s 195 count in that time period.
Even if half of this undercount had been true since the beginning of the pandemic, that would translate into thousands more deaths of nursing home residents than the state has acknowledged.
Another group of figures also suggests an undercount. Studies by the state health department show that 21,000 beds in nursing homes are empty this year, 13,000 more than expected – an increase of almost double the official star association for nursing homes. While some of this increase can be attributed to fewer new admissions and people withdrawing their loved ones, it suggests that many others who are no longer there have died.
Although New York’s score is flawed, Cuomo is not ashamed to compare it with tallies in other states.
Almost every time Cuomo is asked about the death toll from New York in the nursing home, he dismisses criticism as politically motivated and notes that his percentage of deaths from nursing homes out of the overall death toll from COVID-19 is about 20%, much less then Pennsylvania’s 68%, Massachusetts ‘64% and New Jersey’s 44%.
“Look at the basic facts where New York is against other states,” Cuomo said during a briefing Monday. “You look at where New York is as a percentage of nursing home deaths, it’s very low on the list.”
In another briefing last month, he ranked New York’s 35th in the nation. ‘Go talk to 34 other states first. Now go talk to the Republican states – Florida, Texas, Arizona – ask them what happens in nursing homes. It’s all politics. ”
Geriatrics expert Thomas Perls of Boston University said it makes no sense that deaths from nursing home residents as a percentage of the total deaths in many neighborhoods are more than three times what was reported in New York.
“Whatever the reason, there’s no way New York could really be at 20%,” Perls said.
A Cuomo spokesman did not respond to repeated requests for comment. The New York Department of Health said in a statement that it has been a leader in providing facility-specific information on nursing home deaths and “no one has been clearer in personalizing the human cost of the pandemic, which is why that we require facilities to notify residents and families within 24 hours of any COVID case being killed. ”
A report by The Associated Press shows that more than 68,200 residents and staff at long-term nursing homes and facilities nationwide have died from coronary heart disease, out of more than 163,000 general deaths.
For all 43 states that release nursing home data, domestic deaths account for 44% of the total COVID deaths in their states, according to Kaiser Family Foundation data. Assuming the same proportion was held in New York, that would translate to more than 11,000 deaths from nursing homes.
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To be sure, comparing coronavirus deaths in nursing homes in different states can be difficult because of the differences in how states perform their counts. New York is among several states that include probable deaths from COVID-19 as those confirmed by a test. Some states do not count deaths from homes where less than five have died. Others do not always give accurate figures, and provide reach instead. And all of them end up relying on the nursing homes themselves to provide the raw data.
‘Everyone does it, however they want to do it. We do not have very good data. It’s just all over the place, all over the country, “said Toby Edelman of the Center for Medicare Advocacy, a nonprofit representing nursing home residents.
Zucker, New York’s health chief, said during the legislative hearing that New York only counts deaths on the premises of the nursing home to prevent “double counting” deaths in both the home and the hospital. And while acknowledging that the state keeps a running count of deaths among nursing home residents at hospitals, he even refused to give a rough estimate to lawmakers.
“I will not provide information that I have not provided is absolutely accurate,” Zucker said. “This is too big a problem and it’s too serious a problem.”
Zucker has promised lawmakers to provide the numbers as soon as double-checking is complete. They are still waiting. The AP has also been denied access to similar data on nursing home deaths despite submitting a request for public records to the state health department nearly three months ago.
Dr. Michael Wasserman, president of the California Association of Medications for Long-Term Care, said it is unethical of New York not to erupt the deaths of nursing home residents at hospitals. “From an epidemiological and scientific perspective, there is absolutely no reason not to count them.”
Nursing homes have become a particular sore point for the Cuomo administration, which has generally been praised for steps that flattened the curve of infections and the highest in New York 32,781 general deaths.
But a controversial March 25 order to send recovering COVID-19 patients from hospitals to nursing homes, designed to free up hospital bed space at the height of the pandemic, has drawn fierce criticism from relatives and advocates of patients who preventing the outbreak of nursing homes from accelerating.
Cuomo returned the order in early May. And his health department later published an internal report that concluded asymptomatic nursing home staff were the real spreaders of the virus, not the 6,300 returning patients released from hospitals to nursing homes.
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But epidemiologists and academics mocked the study for a flawed methodology that sidestepped important questions and relied on selective statistics, including the state’s official figures.
“We’re trying to figure out what worked and what didn’t work, and that means we’re trying to find patterns,” said Bill Hammond, who works on health policy for the nonprofit Empire Center think tank. “You can not do that if you have the wrong data.”
