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New York May Have Underreported COVID Deaths at Nursing Homes by 50 Percent

New York reports nursing home deaths differently than other states, which may be obscuring the actual death count.

Emergency Medical Service workers unload a patient out of their ambulance at the Cobble Hill Health Center on April 18, 2020, in the Cobble Hill neighborhood of the Brooklyn borough of New York City.

A new report headed by New York Attorney General Letitia James has found that the New York Department of Health underreported deaths due to COVID-19 in the state’s nursing homes by approximately 50 percent. The state health department has reported over 8,600 nursing home deaths due to COVID so far.

The 76-page report, released on Thursday, is the product of an ongoing investigation into allegations of neglect of coronavirus protocols in nursing homes. The report says that lack of compliance with COVID-19 safety guidelines, understaffing and poor government guidance may have contributed to high death counts as well as underreporting.

The report is preliminary and so far is only reflective of a fraction of the nursing homes in the state. However, James’s office finds that, in many cases, there is a discrepancy between what the state health department and nursing homes reported and what the attorney general’s office found in surveys. Because of the way that Gov. Andrew Cuomo and the state chose to report nursing home deaths, the data published by the state health department may have been skewed.

Cuomo came under fire last year for obscuring nursing home COVID death tolls by reporting them differently from many other states with major outbreaks. New York only counted a nursing home death as such if it occurred at the facility — if the nursing home resident died after being transported to the hospital, the state did not count it as a nursing home death.

Some have speculated that the deaths were reported this way in order to make it seem like the state — and Gov. Cuomo — was doing better than it was during New York’s historic COVID outbreak last year. A similar investigation by the Associated Press found that between June and July last year, the state may have underreported nursing home deaths by as much as 65 percent.

To make matters more complicated, Cuomo’s record on nursing homes during the pandemic has already been tainted by a controversial decision he made last March, which effectively forced nursing homes to accept COVID patients from hospitals after they had supposedly recovered. A ProPublica investigation found that the decision likely caused more deaths than would have occurred had the facilities been allowed to not accept these patients.

James’s report further found that state laws on reimbursement may have also allowed for-profit nursing home owners to line their own pockets instead of buying needed medical equipment for their facilities, even as understaffed facilities struggled to care for patients, which may have led to more deaths due to failures in the care provided.

“Through a variety of related party transactions and relationships, owners and investors of for-profit nursing homes can exert control over the facility’s operations in a manner that extracts significant profit for them, while leaving the facility with insufficient staffing and resources to provide the care that residents deserve,” the report reads.

Now, after nearly a full year since the pandemic hit the U.S., nursing homes across the country are facing a financial crisis. A new report by the American Health Care Association and the National Center for Assisted Living finds that over 65 percent of nursing homes have said that they are at risk of closing within the year due to costs brought on by the pandemic. The pandemic has also taken a huge mental toll on many nursing home residents, which James’s report says is reflective of poor compliance with government guidance in some nursing homes.

“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,” said James in a statement. “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.”

But the problem is not just the potential underreporting of COVID-related deaths at nursing homes — inconsistent reporting and a dearth of testing in some places means that it will likely take years, if ever, to understand the full death toll that COVID has taken across the country. An excess death tracker by The Economist, which compares deaths during COVID with previous pandemic-free baselines, finds that there may be up to 85,000 deaths due to COVID that have not been counted as such in the U.S.

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