Nursing homes across the state — ordered to admit COVID patients from hospitals, told they should not test residents with COVID symptoms and facing severe shortages of protective equipment for their staff — now face scrutiny from state officials over why the outbreak has claimed so many lives in their facilities.
Gov. Andrew Cuomo has begun speaking in harsh terms about holding nursing homes accountable for conditions and practices that may have contributed to the deaths of more than 3,500 long-term care residents statewide.
Nursing homes who fail to protect the health of their residents from the coronavirus will have to answer to state regulators for not providing adequate care, Cuomo said yesterday, suggesting that nursing home operators will find themselves facing citations for violations and even license revocations.
For the first time last week, New York State began disclosing the number of long-term care facility deaths related to coronavirus, which revealed that they accounted for about a quarter of the state’s overall death toll. READ MORE: Nearly half of Suffolk’s coronavirus deaths have been nursing home or adult care facility residents, state data show
The state released the numbers after family members of victims spoke out, questioning practices in place at the facilities, and after reporters began questioning state officials about ways the state’s most vulnerable residents could have been better protected in the pandemic.
The governor made it clear yesterday he does not appreciate the questions.
After a reporter asked him during yesterday’s daily press briefing how the state is helping nursing homes comply with its March 25 directive, which requires nursing homes to admit COVID patients, Cuomo grew defensive.
“The state doesn’t run a nursing home. Your question sounds like the state runs the nursing home,” he answered. “It does not run the nursing home. It’s run by a private corporation. And they get paid for that service,” he added.
“If the private entity is not performing their duty as they should be then the state takes action and they can lose their license,” the governor said. He said the subject of nursing homes violators would be addressed on Thursday.
Several nursing home administrators, along with the statewide organization that represents the facilities, are pushing back against the notion that the care they’ve provided during this health crisis has been inadequate and is responsible for coronavirus infections and deaths in their facilities.
“It absolutely is not a function of the care provided by nursing homes,” said Stephen Hanse, president and CEO of the NYS Health Facilities Association and NYS Center for Assisted Living.
“It’s a function of a predator. The governor himself uses the word ‘insidious’ to describe a virus that preys on vulnerable communities,” Hanse said.
Cuomo has repeatedly called the coronavirus just that: an insidious predator that preys on the most vulnerable members of the population.
Citing the early outbreak in Washington State, where a long-term care facility became the nation’s first coronavirus hot spot, Cuomo has also repeatedly stressed the critical importance of essentially sealing off nursing homes from the outside world in order to prevent the virus from gaining a foothold inside the facilities.
Once inside, Cuomo has compared the virus to “an ember in dry grass.”
‘A sudden sense of urgency’
On March 12 — when there were still only a few hundred confirmed coronavirus cases in New York — the governor announced a ban on all visitors and non-essential personnel from long-term care facilities. He also announced a requirement that all staff at the facilities would be required to wear masks and be monitored for symptoms as they report for work.
The following week, the first long-term care facility deaths made public were announced by Peconic Landing in Greenport; the facility announced on March 20 that three residents there had died of the coronavirus disease and 12 other residents were infected. The Greenport facility has since announced six additional deaths.
It remains unknown whether those infections and deaths were the first in a long-term care facility in New York State.
The state still has not released data on coronavirus infections in long-term care facilities. The state has not released long-term care fatality data by date. It began releasing fatality data by county on April 14. It began releasing partial data on fatalities in individual nursing homes on April 16.
The state was collecting data on nursing home infections long before that, but nursing home administrators say the state did not ask about coronavirus deaths inside nursing homes until last week.
The state health department on March 9 issued an alert to all nursing home and adult care facilities advising them that they would be required to complete a daily survey via the state’s Health Emergency Response Data System “by 3 p.m. daily with no exceptions until further notice.”
The daily survey requires the facilities to report the number of residents with confirmed and suspected COVID-19, residents with negative test results, and residents on isolation, quarantined or hospitalized.
“At no time between March 9 and April 16 were we asked about deaths within our facilities,” said one Suffolk nursing home operator, who spoke to RiverheadLOCAL on the condition of anonymity for fear of retaliation against their facility by state regulators.
“The only question that appeared on the daily survey we were mandated to complete asked, ‘As of today, how many residents of your nursing home facility have been removed from your census due to death from COVID-19 in a hospital.’ That question was very specific to deaths from COVID-19 in a hospital and we answered accordingly,” the administrator said.
The state didn’t seek data on deaths inside nursing homes of confirmed or presumed COVID-positive residents until April 16, following a “mandatory conference call” the day before with State Health Commissioner Dr. Howard Zucker for all nursing homes in the state during which Zucker informed nursing homes the state health department would be expanding the daily survey, the administrator said.
There was “a sudden sense of urgency on the part of the state,” the administrator said, evidenced by phone calls to nursing home administrators from DOH officials late into the night on Saturday, April 18, to confirm data they had submitted electronically.
The data being released by the state for fatalities at individual facilities represents just over one-third of the total coronavirus deaths of long-term care residents the state has so far reported. Yesterday, the state reported 3,505 deaths in nursing homes and adult care facilities as of April 21. The total number of deaths reported by individual facility was 1,344 as of April 21.
Zucker said the state is not reporting individual nursing homes where fewer than six residents have died “for privacy reasons.”
The Suffolk nursing home administrator said they believe the state is also not reporting long-term care deaths in presumed COVID patients. The administrator said the facility they run has had three confirmed COVID patients die — which keeps the facility under the state’s six-death threshold for reporting. But another 11 residents died who were presumed COVID patients — they had symptoms of the disease but had not been tested.
The administrator’s facility is one of the 32 Suffolk nursing homes not on the state’s list of fatalities by individual facility. There are a total of 42 licensed nursing homes in Suffolk. The state has so far reported COVID deaths in 10 of them. The state’s tally of deaths in Peconic Landing is six, while the facility has publicly reported nine deaths there.
Nursing homes in New York City, Long Island, Westchester and Rockland were told by the State Health Department in a March 21 advisory that “testing of residents and HCWs (health care workers) with suspect COVID-19 is no longer necessary” because of the “sustained community transmission of COVID-19” in those areas of the state.
Since the facilities have been told not to test residents with symptoms, residents who fall ill and die at the nursing homes are “presumed” rather than “confirmed” COVID-19 victims and are not being reflected in the data provided to the public, the administrator said.
Another nursing home administrator, also speaking on the condition of anonymity, agreed with their colleague’s assessment.
“In the beginning, if you got a resident with COVID, you were told to put them in isolation, log everyone in and out, call DOH to transfer them,” the administrator said.
“The March 25 guidance flew in the face of everything else. How could you not expect there wouldn’t be infections and deaths after you required us to admit people with COVID?”
‘Everybody wants a villain’
Nursing homes were not equipped to handle the situation they found themselves in, as the outbreak swept through the region and into their facilities — in some measure as a result of being required to admit COVID patients discharged from hospitals as hospitals scrambled to increase their capacity to care for additional COVID patients.
Nursing homes are typically relied on care for patients who no longer require hospitalization but are not ready to go home. The beds in nursing homes used for this purpose are called “hospital decompression beds,” the administrator said.
“But this is not decompression. This is totally different,” they said.
“This virus isn’t like anything else,” they said. “It’s much, much more contagious than anything we’ve ever had to deal with. It’s like wild fire.” And the facilities are just not equipped to handle it.
“We don’t have negative air pressure rooms,” the administrator said. “We were scrounging to get appropriate PPE.”
“We can’t even buy disinfectants or hand sanitizers anywhere,” one of the administrators said. “There isn’t a nursing home administrator who isn’t willing to pay for it — the problem is you can’t find it.”
Nursing home staff are also dealing with major mental and emotional health issues as a result of this crisis, administrators say.
“These are not numbers. These are not ‘beds.’ These are people we’ve been caring for for a very long time, in some cases years,” one administrator said.
“Our staff becomes like family to them. There’s a bond, an attachment. When one of our residents passes, you’ll usually find their caregivers on our staff at the wake, grieving along with their family. Our people are going through a very rough time right now.”
Watching the community outpouring of love and respect for hospital workers can be difficult sometimes for nursing home staff who are also on the front lines battling the virus yet go largely unrecognized for their efforts, the administrators said.
And now, they say, they see “a shift in the narrative” at the top of state government.
The administrators, as well as the head of their association, worry that nursing homes are going to be scapegoats — and the governor’s remarks yesterday reinforce that fear.
“Everybody wants a villain,” one administrator said. “A virus doesn’t have a face. The villain’s face is going to be the nursing home.”
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