State identifies 660 more coronavirus deaths
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Nursing homes and other long-term care facilities in Indiana underreported 660 COVID-19 deaths to the state, State Health Commissioner Dr. Kristina Box announced Wednesday.
Box said the deaths had been included in the the state’s total COVID-19 death count, but not on the state’s long-term care dashboard, which serves as Indiana’s official count of nursing home and assisted living deaths from the virus. She said 659 were residents and one was a staff member. Those figures mean that roughly 1 in 10 long-term care deaths went unreported before today’s announcement.
Box said the newly revealed deaths would be added to the state’s dashboard on Thursday. The adjustment should bring the total number of deaths tied to long-term care facilities to nearly 5,900.
It’s the second time this month the state has announced previously unreported long-term care deaths. Box announced 90 additional deaths on Feb. 3 and later increased that figure to 116. The state also made a retrospective adjustment in July that showed previous counts had excluded as much as 22% of long-term care deaths, according to an IndyStar analysis.
Indiana’s nursing home death toll was already well above the national average. An IndyStar investigation published last year found that inadequate staffing, due in part to the shifting of nursing home funds to the county hospitals that own them, likely contributed to hundreds of deaths that may have been prevented with more resources.
Advocates for seniors expressed alarm about Wednesday’s revelations.
Sarah Waddle, state director for senior advocacy group AARP Indiana, said in a statement she was “concerned that facilities are still struggling with basic reporting after nearly a year.”
“Hoosiers deserve access to this information. AARP Indiana will continue to push for transparency, and we are glad that our public health officials were open about this reporting error and that they are taking action to correct it,” she said.
Zach Cattell, president of the Indiana Health Care Association, said in an emailed statement that he was unaware of the data discrepancies before Wednesday’s press conference. His group represents hundreds of nursing homes and assisted living facilities across the state.
“In a brief discussion with the (state health department) since the press conference, it is unclear if the issues regarding allocation of the deaths to the LTC dashboard were a result of reporting issues at the facility level or issues with attribution of already reported data at the state level,” Cattell said.
Reporting requirements not followed
Facilities are required to report long-term cases and deaths directly to the state under an order Box issued in April. She said facilities reported the cases of those who died, but did not report them as deaths through the state’s system.
“It wasn’t until we reviewed cases and cross referenced them with our death records that we determined that they had not been included in the long-term care dashboard,” Box said Wednesday.
The 660 deaths occurred from April to January and were associated with 273 different facilities. Box said most facilities appear to have underreported one or two deaths; 32 underreported six to ten deaths; and “a handful” of facilities appear to have underreported more than 10 deaths.
Box said that some facilities that failed to report deaths to the state successfully reported them to the federal Centers for Medicare and Medicaid Services.
Facilities must report deaths to the state and federal governments in different systems, making data reporting a “complex” issue, Cattell said.
Other states raise issues.
Underreporting of nursing home deaths has been a topic of national discussion after revelations that New York’s Governor Andrew Cuomo and his administration delayed releasing the state’s data. Cuomo has faced scrutiny over the state’s decision to only count deaths of nursing home residents that happened in the facilities and not those who were transported to the hospital and later died.
It’s unclear if a similar phenomenon may have contributed to the underreporting in Indiana. A state department of health spokeswoman did not immediately respond to questions about the count on Wednesday. IndyStar has asked the state for a list of facilities that failed to report.
The accuracy of the death count came up Tuesday at a meeting of the Marion County Health & Hospital Corp.’s long term care committee. The public agency is the state’s largest nursing home owner, with 78 facilities across the state.
Chairman Gregory S. Fehribach questioned the nursing home system’s private operator, American Senior Communities, about reporting issues given the controversy in New York.
“How are we doing on our accountability as far as numbers of folks that have had the virus, folks that we’ve lost from the virus, etc?” he asked. “Are we comfortable with those numbers being correct and accurate?”
David Stordy, COO of American Senior Communities, said the homes have lost “just over 1,000 people over the course of the pandemic” and more than 4,500 have recovered. He said he was very comfortable with the numbers and said staff is going to great lengths to account for all COVID-19 deaths.
But he said he is not so certain about the reliability of the statewide fatality numbers.
“The guidance is if you have a long term care facility person who either has COVID, or perhaps is suspected of having COVID, and they go to the hospital even for a non-COVID related condition, or changing condition, if they pass away in the hospital the skilled nursing facility is supposed to count those people,” Stordy told the committee. “We have been doing that. So we’ve not only been capturing deaths in skilled nursing facilities but also our residents that have passed away in the hospital. We have no way to really verify if the other providers have been doing that. But we’re not certain of the high level of credibility to all the reporting in the state.”
Disproportionate impact
Indiana’s long-term care residents have been disproportionately impacted by the pandemic. They represent less than 1.5% of the state’s population but approximately 50% of coronavirus deaths as of Feb. 10, including the newly announced deaths.
“Our long-term care residents have borne the heaviest burden of this pandemic,” Box said. “And it’s simply heartbreaking to see the percentage of our deaths that are attributable to these residents.”
Even if nursing homes were properly reporting resident and staff deaths, the way Indiana reports them can make the percentage of Indiana’s deaths involving long-term care residents seem lower than it actually is. That’s because state health officials report long-term care cases and deaths a week behind their reporting of all state cases, effectively reducing the percentage of deaths tied to nursing homes and assisted living facilities.
IndyStar calculates the percentage using the long-term care data and the total data as reported on the same date.
Emily Hopkins is a data reporter for IndyStar’s investigative team. Reach them at 317-444-6409 or emily.hopkins@indystar.com.
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