The death toll inside New York’s nursing homes is perhaps one of the most tragic facets of the coronavirus pandemic: More than 6,400 residents have died in the state’s nursing homes and long-term care facilities, representing more than one-tenth of the reported deaths in such facilities across the country.
What went wrong? The effort to answer that question has become politically charged, with Republican lawmakers using the deaths to try to undermine Gov. Andrew M. Cuomo, a third-term Democrat, who has largely been praised for helping New York State to rein in the outbreak.
At issue is a directive that Mr. Cuomo’s administration delivered in late March, effectively ordering nursing homes to accept coronavirus patients from hospitals.
The goal was to free up hospitals’ beds at a time when those facilities were being overwhelmed by fresh waves of virus patients. But family members and nursing home staff feared that sending those patients to nursing homes may have created a dangerous environment that allowed the virus to quickly spread.
That possibility has fueled calls by lawmakers from Washington to Albany for hearings and independent investigations to determine if the state’s actions played a role in the high death toll.
On Monday, the Cuomo administration fired back: The State Department of Health issued a 33-page report meant to dispel the notion that its March directive fueled the spread of the virus. The report blamed the 37,500 nursing home workers — about a quarter of the state’s total nursing home staff — who became infected since mid-March, unknowingly transmitting the virus to residents.
Across the nation, conflicting narratives have accompanied the virus’s stark death toll in nursing homes and long-term care facilities, both of which often house frail and elderly people more vulnerable to infectious diseases. Some have pointed to shortages of personal protective equipment; others, including Mr. Cuomo, have blamed President Trump’s shifting federal guidelines for nursing homes.
Here’s what we know about New York’s nursing home death toll.
How does New York’s death toll compare with other states?
More than 55,000 people have died in nursing homes and long-term care facilities nationwide, according to a New York Times analysis. Those deaths account for about 40 percent of all coronavirus deaths in the country.
New York ranks second, closely behind New Jersey, among states with the highest number of known deaths in nursing homes and long-term care facilities. The vast majority of those deaths — more than 6,200 people died after being confirmed or suspected of having the virus — happened in nursing homes.
But New York’s numbers do not tell the whole story: The state Health Department only counts residents who physically died within a nursing home, and omits those who contracted the virus and went on to die in a hospital or other facility.
- The C.D.C. announces it will issue new guidelines for reopening schools, hours after Trump assailed its recommendations.
- Pence said the rate of new cases was flattening in hard-hit states. But it remains alarmingly high.
- Protective gear is still in short supply, even as coronavirus cases surge in the U.S.
New York is in the minority in reporting deaths in this way; California’s count, for example, includes most nursing home patients who were transferred to hospitals and died.
It is difficult to do state-by-state comparisons about nursing home cases or deaths because reporting requirements vary widely. Some states report no cases or deaths at all. The federal government publishes some data, but is not requiring nursing homes to report cases or deaths that occurred before May.
When looking at deaths as a share of the total state population, New York has fewer nursing home deaths per capita than neighboring states like Connecticut, Massachusetts or New Jersey.
About 21 percent of all coronavirus deaths in New York occurred in a nursing home or long-term care facility, the lowest rate out of any other state in the country, according to a Times analysis.
But that could be because a staggering number of people — 31,911 — have died in New York, far outpacing the state with the second-highest death toll, New Jersey, where 15,229 people have died.
Did Cuomo’s mandate help spread the virus?
The state Department of Health’s order on March 25 said that nursing homes must readmit residents sent to hospitals with the coronavirus, and accept new patients as long as they are deemed “medically stable.” The homes were also barred from testing new or returning residents for the coronavirus, which might have indicated whether residents were infectious.
Mr. Cuomo and health officials said that under existing regulations, the homes could turn patients away if they were unable to safely care for them. But most home administrators felt they had no choice but to accept them; denying patients could lead to a loss in revenue and invite regulatory scrutiny.
New York’s rule alarmed nursing home workers and residents’ families, who worried it would spark outbreaks among an already high-risk population.
“It makes absolutely no sense,” said Lorry Sullivan, whose mother died in a Long Island nursing home after testing positive for the virus in April. “You lock old people in a nursing home and keep them away from their families, and then you put Covid patients in there?”
Roughly 12 other states, including New Jersey, issued similar guidelines urging nursing homes to accept virus patients from hospitals, according to the Health Department’s report.
But in Connecticut and Massachusetts,coronavirus patients were sent to facilities that were reserved for those with Covid-19, a strategy considered to be the safest way to halt the contagion.
In early April, Mr. Cuomo also signed legislation that shielded nursing homes from most lawsuits over their handling of the coronavirus — a measure pushed for by industry representatives.
Politicians across the political spectrum criticized Mr. Cuomo’s nursing home policies.
In May, amid mounting pressure, the governor amended the directive, saying hospital patients had to test negative for the virus before being discharged to nursing homes.
What does the state’s report say?
New York’s report on Monday made two key assertions: The influx of about 6,326 coronavirus patients to nursing homes from hospitals did not cause the virus’s spread; the more likely source was the tens of thousands of workers who tested positive or were presumed to be infected who brought the virus into the facilities between March and June.
More than 6,850 workers likely had the virus in March alone, the report found. But, at the time, the report said, the Centers for Disease Control and Prevention did not believe asymptomatic individuals were likely to spread the disease. The C.D.C.’s guidance evolved by April as more was learned about the virus, but by then it was too late.
“It is likely that a significant percentage of both mildly symptomatic and asymptomatic employees were advised to continue working during March and April and thus unknowingly spread the disease within the facility,” the report said.
The report, which was done in collaboration with McKinsey & Company, a consulting firm, said it was likely that family and friends of nursing home residents also spread the virus before the state banned visits on March 13.
Using self-reported data from nursing homes, the report cited data that showed that the deaths in nursing homes peaked on April 8 — a week before nursing homes admitted most of their infected patients from hospitals.
The patients transferred to nursing homes following their hospital stay, the report said, were likely no longer contagious because health experts believe infected individuals likely stop being contagious nine days after showing symptoms.
Dr. Howard A. Zucker, the state’s health commissioner, said nursing homes were not at fault for the deaths. “If you’re going to place blame, I would blame the coronavirus, Covid-19,” he said on Monday.
Mr. Cuomo laid the blame on the C.D.C. and the federal government’s marred efforts ramping up testing capacity to detect the virus early on.
“Nobody knew what they were talking about for a long time,” he said on Monday. “That’s the bottom line here, and the federal government was just plain wrong.”
In a statement, a spokesman for the U.S. Department of Health and Human Services, the agency that houses the C.D.C., dismissed New York’s findings.
“Governor Cuomo’s handpicked investigators are bending the truth to try to absolve him, but the fact remains that no one is to blame for the Covid-19 deaths in New York nursing homes but him,” said Michael Caputo, assistant secretary for public affairs. “Cuomo did not follow sound, science-based federal guidance and he made a grave mistake.”
What do nursing homes say about the report?
Nursing home administrators said the report confirmed what they had been saying all along: Despite their best efforts, they were largely powerless to contain the virus. Early on, many homes struggled to get enough personal protective equipment or testing for residents and staff.
“In an area with widespread outbreaks, it was already in every facility,” said Jim Clyne, chief executive of LeadingAge New York, a group that represents nonprofit nursing homes. “And if it wasn’t, you were just lucky.”
The report found nursing home quality had little to do with fatalities; in fact, nursing homes with high Medicare quality ratings had higher mortality rates than those with lower quality ratings. Location, and the rate of community spread, were the more likely predictor of deaths, the report said.
Some advocates for nursing home residents questioned that finding, saying that true quality indicators, like staffing levels and a facility’s infection control policies, matter immensely.
“It’s frankly troubling that the Health Department would go out of their way to protect the industry that has showed that it fails residents on a day-to-day basis,” said Richard Mollot, executive director of the Long Term Care Community Coalition. “These deaths were not inevitable.”
What’s next?
Legislators in Albany are planning to soon hold wide-ranging public hearings on the nursing home situation in New York, including Mr. Cuomo’s handling of the crisis. They have pressed for an independent probe into the governor’s response, and many have dismissed the Cuomo administration’s report as not truly independent, reliable or far-reaching enough.
Assemblyman Richard N. Gottfried, a Democrat and the chair of the Assembly health committee, said an outside entity should investigate the situation in nursing homes, not the Health Department or the state attorney general, as Mr. Cuomo recently directed them to do.
“The problems in our nursing homes were there long before Covid-19 — problems like inadequate staffing, inadequate enforcement,” he said. “To me that’s what we need to be focusing on, not whether the March 25 order was the right thing, but what are the conditions in our nursing homes.”
Danielle Ivory contributed reporting.
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