New York's coronavirus death toll in long-term care homes could be a significant undercount

New York's coronavirus death toll in nursing homes, already among the highest in the nation, could actually be a significant undercount. Unlike every other state with major outbreaks, New York only counts residents who died on nursing home property and not those who were taken to hospitals and died there.

That statistic could add thousands to the state's official care home death toll of just over 6,600, from the over 25,200 COVID-19 deaths the state has recorded overall. But so far the administration of Democratic Gov. Andrew Cuomo has refused to divulge the number.

"That's a problem, bro," state Sen. 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 can look better."

A controversial March 25 order in New York to send recovering COVID-19 patients from hospitals into nursing homes that was designed to free up hospital bed space at the height of the pandemic has drawn withering criticism from relatives and patient advocates who contend it accelerated nursing home outbreaks.

Cuomo reversed the order under pressure in early May. And his health department later released an internal report that concluded asymptomatic nursing home staffers were the real spreaders of the virus, not the 6,300 recovering patients released from hospitals into nursing homes.

The explanations have not satisfied many relatives of those who died, with some testifying this week to New York lawmakers in hearings on the state's response to the pandemic.

Since May, federal regulators have required nursing homes to submit data on coronavirus deaths each week, whether or not residents died in the facility or at a hospital. 

State health department surveys show 21,000 nursing home beds are lying empty this year, 13,000 more than expected — an increase of almost double the official state nursing home death tally.

While some of that increase can be attributed to fewer new admissions and people pulling their loved ones out, it suggests that many others who aren't there anymore died.

However flawed New York's count, Cuomo has not been shy about comparing it to tallies in other states.

Cuomo touts state's lower percentage of nursing home deaths

Nearly every time Cuomo is questioned about New York's nursing home death toll, he brushes off criticism as politically motivated and notes that his state's percentage of nursing home deaths out of its overall COVID-19 death toll is around 20 per cent, far less than Pennsylvania's 68 per cent, Massachusetts' 64 per cent and New Jersey's 44 per cent.

"Look at the basic facts where New York is versus other states," Cuomo said during a briefing Monday. "You look at where New York is as a percentage of nursing home deaths, it's all the way at the bottom of the list."

In another briefing last month, he touted New York's percentage ranking as 35th in the nation.

"Go talk to 34 other states first. Go talk to the Republican states now — Florida, Texas, Arizona — ask them what is happening in nursing homes. It's all politics."

Boston University geriatrics expert Thomas Perls said it doesn't make sense that nursing home resident deaths as a percentage of total deaths in many nearby states are more than triple what was reported in New York.

"Whatever the cause, there is no way New York could be truly at 20 per cent," Perls said.

A running tally by The Associated Press shows that more than 68,200 residents and staff at nursing homes and long-term care facilities across the nation have died from the coronarivus, out of more than 163,000 overall deaths.

For all 43 states that break out nursing home data, resident deaths make up 44 per cent of total COVID deaths in their states, according to data from the Kaiser Family Foundation. Assuming the same proportion held in New York, that would translate to more than 11,000 nursing home deaths.

Data collection inconsistent across U.S.

To be sure, comparing coronavirus deaths in nursing homes across states can be difficult because of the differences in how states conduct their counts.

New York is among several states that include probable COVID-19 deaths as well as those confirmed by a test. Some states don't count deaths from homes where fewer than five have died. Others don't always give precise numbers, providing ranges instead. And all ultimately rely on the nursing homes themselves to provide the raw data.

"Everybody is doing it however they feel like doing it. We don't 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.

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New York health chief Zucker explained during the legislative hearing that New York only counts deaths on the nursing home property to avoid "double-counting" deaths in both the home and the hospital.

And while he acknowledged the state keeps a running count of nursing home resident deaths at hospitals, he declined to provide even a rough estimate to lawmakers.

"I will not provide information that I have not ensured is absolutely accurate," Zucker said. "This is too big an issue and it's too serious an issue."

Zucker promised to provide lawmakers the numbers as soon as that double-checking is complete.

Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine, said it is unethical of New York to not break out the deaths of nursing home residents at hospitals.

"From an epidemiological and scientific perspective, there is absolutely no reason not to count them," he said.