Case and death counts off by hundreds in some states
By: Jill Riepenhoff, Jamie Grey, Daniela Molina and Lee Zurik
Originally Published: June 5, 2020
(InvestigateTV) – According to newly released federal data, a 96-bed nursing home in New Jersey has had a staggering 753 COVID-19 deaths among its residents since January.
That means that the Dellridge Health & Rehabilitation Center in Paramus has had more deaths caused by the coronavirus than any other nursing home in the country.
But it’s not true.
The nursing home has recorded just 16 deaths, according to state data and the nursing home itself.
An employee at the nursing home called the death numbers released June 4 by the Centers for Medicare and Medicaid Services “laughable.” The facility was unaware that it had hundreds of COVID-19 deaths listed in the CMS data until InvestigateTV called them to ask them about them.
Another nursing home owned by the same company, Advanced Subacute Care of Sewell, showed 396 COVID-19 deaths in CMS data. The state says it has had 28.
On the flip side, the CMS data shows that Life Care Centers of Kirkland in the state of Washington recorded zero COVID-19 deaths. The nursing home, however, was the epicenter of the outbreak in Washington where coronavirus led to the deaths of at least three dozen residents.
“There are a lot of inconsistencies, a lot of flaws. It’s pretty bad,” said Brian Lee, executive director of Families for Better Care, a Texas-based group that advocates nationally for the rights of nursing home residents and their families.
In April, CMS announced that it was requiring nursing homes to report COVID-19 cases and deaths among residents and staff weekly to the Centers for Disease Control and Prevention. The first batch of data was released by CMS June 4.
“This is part of the Trump Administration’s historic transparency efforts to ensure residents, families and the general public have information about COVID-19 in nursing homes,” CMS said on June 5 announcing the release of the data.
But it is woefully inaccurate, and the reasons why are unclear.
CMS and the CDC did not respond to requests for comment but cautioned in a disclaimer on the CMS website, where the data is publicly available, that it could be inaccurate.
InvestigateTV compared the CMS data to state data in six states and found disparities between the two sets of numbers. Both are reported by the nursing homes themselves.
- Among 146 nursing homes compared in Louisiana, the state reported that there were 621 deaths. CMS showed only 520.
- In Georgia, CMS reported just 2,979 COVID-19 cases among residents in 246 nursing homes while the state said there were 5,115 in those facilities.
- In New Jersey, while Dellridge’s numbers came in much higher than even possible in the CMS data, overall, the CMS data showed far fewer cases than state data. In the 112 facilities InvestigateTV compared, the state reported 1,496 COVID-19 deaths; CMS reported 1,084.
- Another New Jersey facility, Lincoln Park Care Center, showed a discrepancy of 56 deaths when comparing the datasets – CMS only had eight deaths even as the state reported 64. But another of the ownership group’s facilities, Lincoln Park Renaissance Rehab and Nursing showed the CMS data 48 additional deaths that weren’t counted in the state’s tally.If the CMS data reported was accurate, deaths in 67 nursing homes in New Jersey would account for nearly 15 percent of all COVID-19 deaths in long-term care facilities nationally.
- In hard-hit Dougherty County Georgia, PruittHealth-Palmyra has had 22 deaths, according to the state. CMS shows none. After hearing about the discrepancy from InvestigateTV, Pruitt Health started to dig into the data to help understand what went wrong but didn’t have answers yet, a spokeswoman for the nursing home said.
It is unclear if the errors are coming from data entry at the nursing home level, collection at the CDC or reporting from CMS. The reporting involves a computer system with fillable forms, according to an online tutorial.
One explanation that could account for some undercounts that InvestigateTV found buried in the rules: CMS is only requiring facilities to report cases after May 8, when the reporting rules went into effect. Facilities can voluntarily report back to January 1. That date variable, however, is not easily found in the CMS public data portal cannot explain some of the overcounts and wide variations.
For nursing homes using the May 8 option, their numbers could disguise the true nature of the outbreak because for some, their cases and deaths had leveled off by then. The Life Care Center in Kirkland could be one such example where CMS shows zero deaths when most occurred early in the pandemic.
On its website, CMS said it performed quality checks on the data and eliminated any that did not meet its standards. But somehow Dellridge – and it’s 753 deaths – slipped through as did other obvious errors.
In one of its data summary graphics, CMS stated: “Due to how some facilities submitted data, and since this is a new program, some data limitations exist and we caution users to consider these limitations when analyzing the data.”
InvestigateTV identified Dellridge only by sorting the total number of COVID-19 deaths in a spreadsheet.
Lee calls the inconsistencies and inaccuracies shocking but says that at least the dataset is a step toward pulling back the curtain on the coronavirus in long-term care facilities.
Secrecy has surrounded COVID-19 cases in nursing homes since the outbreak of the pandemic, InvestigateTV reported in mid-April. Some states didn’t release any data. Others release only aggregate numbers but don’t identify the facility. Some name the facility and positive cases among residents but not the number of deaths.
The data was shrouded by state officials and nursing homes hiding behind the federal health privacy law, which prevents the release of individuals’ health records.
An aggregate number of positive COVID-19 cases or the number of deaths, however, does not lead to disclosure, advocates for transparency have argued.
Until now, there has been no official tally of the number of patients and staff members who have been infected or how many of them have died of COVID-19. Most of the reporting about the coronavirus’ wrath on nursing homes has come from media organizations.
“This has been the biggest coverup of my 20 years of advocacy,” Wes Bledsoe, founder of A Perfect Cause, a nursing home reform organization based in Oklahoma, told InvestigateTV in April. “State government does not want to admit what’s going on in these nursing homes.”
For months, the federal government wouldn’t say either. The CDC and CMS each kept a list of impacted nursing homes but refused to make it public.
Two senators wrote to those agencies in early April urging transparency.
“While the privacy of individual residents must be protected, (it) is imperative that the names of facilities with a positive COVID-19 case be made available to help prevent further spread of this terrible virus,” wrote Robert P. Casey and Ron Wyden, Democratic senators from Pennsylvania and Oregon, respectively.
The April 19 CMS rule was intended to remedy that.
“Nursing homes have been ground zero for COVID-19. Today’s action supports CMS’ longstanding commitment to providing transparent and timely information to residents and their families,” CMS Administrator Seema Verma said on the day the new rule was announced. “Nursing home reporting to the CDC is a critical component of the go-forward national COVID-19 surveillance system and to efforts to reopen America.”
12% of the nation’s 15,300 nursing homes did not report in the first round.
CMS warned nursing homes administrators that they face enforcement actions if they failed to report. After June 7, facilities can be fined hundreds or even thousands of dollars for each week they fail to report.
The data is supposed to be updated weekly by the nursing homes. CMS said facilities may correct data, which could cause fluctuations in future reports.
Lee hopes that going forward that either nursing homes will get their data right and complete or that CMS will sanction them.
“We know more today about what’s happening in nursing homes than we did yesterday,” Lee said. “But were not getting a complete picture.”
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