A new investigation by ProPublica examines the effects of New York Governor Andrew Cuomo’s March 25, 2020 order that nursing homes must admit medically stable patients discharged from hospitals that determined they required nursing home care, even if those patients had been treated for COVID-19. The order also prevented nursing homes from testing such prospective residents to determine whether they had either become newly infected with COVID-19 or remained contagious from an earlier infection. According to ProPublica, the disease “tore through New York state’s nursing facilities, killing more than 6,000 people” in the weeks after the order was implemented. Those deaths comprised roughly 6% of the 100,000+ nursing home residents in the state.
ProPublica notes that states with comparable orders suffered comparable outcomes: Michigan, for instance, suffered a death rate of about 5% of its 38,000 nursing home residents, while New Jersey suffered a rate of 12% of its 43,000+ residents. Meanwhile in Florida, which prevented such transfers from hospitals to nursing homes, 1.6% of the state’s 73,000 died as a result of COVID-19. And in California, which “quickly revised” a policy comparable to New York’s, 2% of the state’s 103,000 nursing home residents died.
The investigation states that the policy implemented by Cuomo and New York health commissioner Howard Zucker was condemned, when it was announced, by “medical experts, nursing home operators and the families of residents.” One New York county executive “viewed the state’s directive as madness and chose to defy it, refusing to allow any COVID-19 patients to be returned to, or placed in, the one nursing home run by the county.” That nursing home “has not seen a single COVID-19 death, according to ProPublica. The policy was defended by Cuomo, as well as New Jersey Governor Phil Murphy, as a means of keeping hospital beds open at a time when it seemed they may be overwhelmed by COVID-19 patients. Charles Branas, an epidemiologist at Columbia, told ProPublica that while he appreciates the idea, it may have drastically increased New York’s COVID-19 death toll. “If you introduce 4,500 people sick with a potentially lethal disease into a vulnerable and notoriously imperfectly monitored population, people are apt to die,” he said.
The order was revoked on May 10, “after escalating criticism,” but the governor’s administration “would not say who conceived of the order or answer the question of whether it believed the order had led to additional deaths.” It has said that the order “was based on federal guidance,” and that the state’s Health Department is reviewing the disease’s toll in nursing home facilities. Efforts are complicated by the fact that the Health Department “did not track in real time what happened when COVID-19 patients were transferred from hospitals to nursing homes,” according to ProPublica, citing one official in the nursing home industry who said the state “didn’t even begin comprehensively counting COVID-19 deaths in these facilities until well into April.” The state has “disputed” this, ProPublica says.
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