Critical state audit may lead to nursing home improvements
ALBANY — A scathing audit of the state’s accounting of nursing home deaths during the worst of the COVID-19 pandemic blames much on the prior Cuomo administration, but the findings also may light a path to improve nursing homes for residents.
State Comptroller Thomas DiNapoli’s audit of the state Health Department found the Cuomo administration undercounted fatalities by more than 50% at times in 2020, at one point failing to count 4,100 additional deaths in public statements.
Tuesday’s audit called the result "thwarted transparency and accountability" from a state Health Department "plagued by a threatening environment of intimidation, closed ranks, and lack of commitment to openness — at the expense of the public’s trust."
In its response to the audit, the Health Department blamed the misleading data on then-Gov. Andrew M. Cuomo’s executive chamber and said health officials provided the governor’s office with accurate numbers. At the time, Cuomo was receiving national attention for his handling of the pandemic and writing a memoir on his leadership under a $5 million book deal.
The audit said the concern, however, extended beyond an inaccurate public count of the deaths, citing a lack of preparation for the pandemic and poor use of health data to combat it.
"Better analysis and data reliability efforts might have allowed the department to more effectively use resources at its disposal for day-to-day operations and in response to public health emergencies," the audit said.
"The department does not routinely analyze the [COVID-19 infection and mortality] data broadly, nor does it take advantage of certain other data sources, to detect inter-facility outbreaks, geographic trends, and emerging infectious diseases or to shape its infection control practices," DiNapoli’s auditors said. Had the department done so, "it would have had greater intelligence at its disposal during the pandemic."
The Health Department said it has accepted many of the auditors’ recommendations to improve the agency, its public reporting of health and death data and its oversight of nursing home care for the next emergency.
"With the direction and strong support of the [Gov. Kathy] Hochul administration, the department has undertaken new initiatives to make more data available so that the Legislature, agency stakeholders, and the public may better understand state’s pandemic response," the Health Department stated.
The initiatives include a new website for COVID-19 data. In addition, other department websites have been revamped to make the information to the public clearer, including hospital admissions by gender and ZIP code, hospital capacity and the share of staff who are vaccinated.
"These efforts have been widely praised and the department expects them to continue going forward," the department stated, noting the culture of the agency has become more open and collaborative since Cuomo resigned in August amid sexual harassment accusations.
Nursing homes, too, found themselves unprepared for the pandemic, the audit noted. Most homes had too little personal protective equipment such as masks and gowns and little if any stockpile; had few or no areas that could be used to keep infected residents from healthier residents; were understaffed even before the pandemic, and had inadequate protocols in place to test staff, residents and their visitors for the virus.
"The entire industry learned some very hard lessons in the pandemic," said Michael Balboni, executive director of Greater New York Health Care Facilities Association, which represents nursing homes and assisted living facilities.
Stephen Hanse, president and CEO of the New York State Health Facilities Association, which represents skilled nursing providers, said many of the needed funding and operational improvements for his nursing home members are part of Hochul’s budget presentation, which is now being negotiated with the State Legislature.
"New York State is absolutely on a better track for nursing homes," Hanse said.
In her budget proposal, Hochul proposes a $10 billion plan over several years to increase the entire health care workforce with higher wages, $3,000 bonuses for full-time workers who remain on the job for a year along with smaller bonuses for the many part-time workers. Nursing homes also could tap into a $1.6 billion capital program for all health care facilities to modernize or expand their facilities.
The comptroller’s office, however, said it can’t yet tell if the Health Department is on track for better performance and public accountability in regulating nursing homes. The department is required by law to update the comptroller on the status of his recommendations within 180 days. The comptroller also plans another full audit in a year to check on progress.
"It’s too early to tell," said DiNapoli spokesman Mark Johnson. But he said a "good first step" is the Health Department’s response to the auditors’ recommendations:
Hochul has already made several changes in the Health Department. On her first day as governor, in August, she released additional COVID-19 data on infections and deaths. In September she appointed a new commissioner, Dr. Mary Bassett, in part to create a new "culture" of openness and cooperation. Hochul also increased access to booster vaccines for nursing homes.
In October, Hochul apologized to several families who blamed the state for the deaths of relatives in nursing homes. Some sought a compensation fund, which still hasn’t been approved.
"I apologized for the pain that those poor families had to endure," Hochul said in October. "It was a very emotional meeting."
Hochul also required mask and booster shots for nursing home staff and eased visiting restrictions that had been imposed to limit the spread of the virus, but which isolated residents from their families. In January she sent National Guard troops to some nursing homes to help the overworked staff still facing shortages in their ranks.
In January, however, Hochul delayed a law that would have required higher staffing in nursing homes and required the facilities to spend at least 70% of their revenue on direct care. She said that requiring nursing homes to meet the higher staffing levels under a threat of fines at a time of a severe shortage of workers would only hurt nursing homes and their residents. Unions representing the workers and many families concerned about the care of their loved ones said Hochul was delaying a critically needed and overdue measure to force better staffing at nursing homes.