When New York Governor Andrew Cuomo was first accused of underestimating the number of deaths in nursing homes caused by Covid-19, his government provided a simple explanation:
Officials said the state does not include nursing home residents who died in public reports of coronavirus deaths related to long-term care facilities in hospitals because the state wants to avoid “double counting” of these deaths statewide.
However, research experts said that New York is different from other states in using this method to calculate the number of deaths in nursing homes. This decision makes New York̵
Priya Chidambaram, a senior policy analyst at the Kaiser Family Foundation, a nonprofit research organization, said: “Comparing state-level data is tricky, but New York is the only state that explicitly states that they do not include hospital deaths.”
In contrast, officials in other states, including Minnesota, Connecticut, Massachusetts, and Vermont, stated in recent interviews that they had cross-referenced reports to find a way to total all nursing home deaths, including deaths in hospitals. Of residents without counting twice. Obtain other data sources from nursing homes. Research experts, including Chidambaram, said they did not know of any other state that counts nursing home deaths like New York.
This makes policymakers and researchers alike wonder why New York has not found a similar solution to avoid omitting thousands of nursing home deaths from the reported total.
David Grabowski, a long-term care expert and policy professor at Harvard Medical School, said: “On this issue, New York is an outlier.”
Each state has developed its own method to calculate the number of Covid-19 deaths in nursing homes and the general population. From the first few months of the influenza pandemic, New York has made it clear that its publicly announced nursing home deaths only include deaths that occurred in that place, not in hospitals or other places.
New York State Health Commissioner Dr. Howard Zucker said at the hearing in August that New York State took this approach to avoid dying from homes during the pandemic that doubled the total number of New York residents who died of Covid-19.
Zach said: “We don’t want to double counting. This person died here and died there.” He described the Cuomo government as “very transparent in terms of information.”
New York officials also said that it is important to verify the reports of residents who died in hospitals before the death toll is announced, because the information provided by nursing homes is not always accurate, especially in the early stages of the pandemic.
State Health Department spokesperson Gary Holmes (Gary Holmes) said: “It is natural to think that they may not have as much information as what is happening inside the wall.”
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However, this approach resulted in New York State having only recently omitted a large number of deaths from its publicly reported total number of nursing homes. The state said about 8,500 nursing home residents have died of Covid-19. However, according to the New York State Kaiser Family Foundation’s long-term death toll statistics in each state, when New York finally included residents who died in hospitals, the total surged to about 15,000, more than any other state in late January. Last month, the state’s attorney general issued a report accusing the Cuomo government of underestimating the death toll, and the state only released a new total.
The New York Department of Health said the delay in publishing the number of hospital deaths was due to time-consuming verification procedures. Holmes said the Covid-19 report stated that the daily information submitted by nursing homes and hospitals included only the initials and ages of residents who died to protect the privacy of patients.
He added that although more detailed data on hospital deaths are available, this information is entered into a separate system that often lags behind and does not include the name of the patient’s nursing home. “Every effort has been made to ensure the accuracy of data reports from multiple sources.”
Holmes also said that the newly released figures did not change the overall number of deaths from the virus in New York, because all deaths in nursing homes are included statewide, no matter where they occur.
Officials in other states in the Northeast and elsewhere told NBC News that they used different methods to aggregate the total number of deaths (whether in hospitals or facilities) to avoid double counting problems in New York. Officials expressed concern about this. .
For example, in Minnesota, “deaths are classified by residence,” said Scott Smith, a spokesperson for the state’s public health department.
The state relies on self-reported data from nursing homes, asking them to provide demographic information, date and location of death, and other information. Smith said Minnesota also collects data from hospitals, laboratories, physical examiners, and death certificates to match reports and exclude duplicate entries to avoid double counting.
Similarly, Connecticut uses self-reported data from nursing homes to require the state to report deaths of all residents “whether it occurs in its facilities or after being transferred to a hospital,” said State Health Department spokesperson David Dearborn (David Dearborn) .
Dearborn said the state also relies on reports from state medical inspectors to avoid double counting the total death toll. “This process ensures accurate totals across the state.”
The state health spokesperson said that Massachusetts uses a similar method to cross-reference nursing home reports with death certificates to avoid duplication of inputs to capture the state’s total number of Covid-19 deaths.
Harvard Medical School Professor Grabowski said that although the pandemic is unprecedented in many respects, the data challenges associated with this are not new.
He said: “Historically, public health officials have often had to distinguish between the place of death and the immediate place of residence before death.” “I don’t see any other reason to classify other states, but New York State cannot.”
Bill Hammond, a senior researcher for health policy at the Empire Center, said basic data should already be available to New York officials. The Empire Center is a right-leaning think tank that has sued the state for failing to release its data on the number of deaths in nursing homes. According to the New York data collection form obtained through the lawsuit, nursing homes are specifically asked to provide “the total number of Covid-19 residents who died outside your institution” and the total number of deaths in the institution itself.
Hammond said: “This is not a complicated thing.” Hammond believes that New York officials should have announced the number of hospital and non-hospital deaths immediately, and then cross-check the information when they deemed it necessary.
He said: “They used the need for maximum accuracy and the difficulty of reconciling these two data sets as reasons for postponing the public release of information.”
There are other differences between states, as well as wider inconsistencies in the data. Take New York and Minnesota as examples. The death toll in these states may include Covid-19 cases, but some states only count laboratory confirmed cases.
Some states include workers in the total number of deaths associated with long-term care facilities, while others do not include them or isolate them. It took several months for some states to release detailed information about deaths in nursing homes. And the facility itself may not always report accurate information.
The long-term care industry itself is skeptical, because more data will have a major impact on the overall pandemic response.
James Clyne, CEO and President of LeadingAge New York, which represents a non-profit long-term care organization, said: “This is just another piece of data that may show some content or may not show anything.” Have you ever come to any conclusions? This is not an epiphany that everyone has, because this information has been made public. “
But the researchers say that complete information from each state is important to understand the full impact of the pandemic on nursing homes. Advocates say that such data can help public health officials decide where to send resources first during the worst months of the pandemic. It can also help researchers determine which factors make facilities most vulnerable to Covid-19 cases and deaths, and which policy decisions seem to help protect residents and staff.
For example, in the first few months of the pandemic, the Cuomo government came under fire for requiring nursing homes to accept recovered Covid-19 patients discharged from the hospital-a decision aimed at clearing the hospital’s much-needed space. By May, the guidelines had been effectively revoked, and state officials issued an analysis report stating that this was not the cause of the outbreak in nursing homes. Experts and supporters say, but more comprehensive data on residents’ deaths may help provide clearer answers.
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Senator Gustavo Rivera from New York State (Gustavo Rivera), a Democrat from the Bronx City, serves as chairman of the health committee. The bill recently introduced a bill requiring New York State to disclose the deaths of residents who died after being transferred to hospitals, and criticized the state’s decision to exclude them.
The bill says: “Families and residents have suffered from not knowing what is happening in the facility during the Covid pandemic.”
It wasn’t until the first week of May that the federal government began collecting national data on Covid-19 cases and nursing home deaths, and facilities were not required to provide information about previous months. Therefore, state and local governments are the only people who have been tracking since the pandemic began, which is another reason why the number of nursing homes in New York is so important.
“Accurate data is the basis of policies that meet actual needs-which policies are the most helpful? Which policies are the least helpful?” said Chidambaram of the Kaiser Family Foundation. “The lack of accurate numbers is really bad for us.”