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.
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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.
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.
Gov. Andrew M. Cuomo has said that the state was following federal guidelines when it ordered nursing homes to accept patients who had been hospitalized with Covid-19.Credit...Stefani Reynolds for The New York Times
“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.
