Death rates higher in nursing homes with COVID-19 patients, newly released documents show

Newly released documents show the death rate in New York nursing homes that admitted or readmitted COVID-19 patients during the height of the pandemic in 2020 was higher than facilities that did not, though the relatively small number of the latter might limit comparisons.

The statewide mortality rate for nursing homes that admitted COVID-19 patients was 8.1%, contrasting with 4.1% for facilities that did not, according to a state Health Department memo released this week as part of a House of Representatives probe into New York’s handling of the pandemic.

But comparisons might have circumspect value in part because relatively few facilities (1 out of every 11, according to the memo) didn't accept infected patients, a health policy expert who worked for Cuomo and other governors said.

At issue is a controversial directive issued by Gov. Andrew M. Cuomo’s administration in March 2020 saying nursing homes had to admit COVID-19 patients if they had the capacity to accommodate them. The policy is a major part of House hearings, which Cuomo has derided as a politically driven, election-year gimmick by the Republican-led chamber of Congress.

The House released a trove of interviews and documents on the eve of Cuomo testifying in Washington on Tuesday.

Among the materials was an internal Health Department memo outlining why the administration always has argued the controversial policy was not a "driver" of nursing home deaths.

In short, the majority of nursing home residents who died had been infected prior to the March 2020 directive, wrote Dr. Eleanor Adams, an agency official, to Health Commissioner Dr. Howard Zucker on June 7, 2020.

"If the March 25 policy had been the driver, the death peak should have been after the peak in admissions, not before," Adams wrote.

However, her memo also contained data showing the death rate was higher in nursing homes that admitted/readmitted COVID-19 patients (8.1%) than facilities that did not (4.1%).

These numbers weren’t made public at the time.

In a separate chart focusing on New York City, the mortality rate was 6.8% for facilities that accepted infected patients compared with 4.3% for those with no admissions, Adams said. However, it noted just four facilities fell into the latter category.

A separate chart noted mortality rates were higher in facilities where COVID-19 patients reflected a higher share of the population.

For example, the rate was 10.2% in homes where admitted COVID-19 patients accounted for 50% or more of a home’s total population; 7.7% if they accounted for 10-20% of a home’s population; and 8.1% if they accounted for less than 10% of a home’s total population.

But some important contingent factors might devalue the comparison of rates, said Paul Francis, a health policy adviser to Cuomo and previous Govs. David Paterson and Eliot Spitzer.

For example, some facilities had COVID-only units, which would drive up their mortality rates as a share of their overall population.

Also, the overall small number of facilities that didn’t receive COVID patients perhaps affects comparisons.

In New York City, just four of 155 facilities didn’t admit/readmit COVID patients, rendering any measure statistically insignificant, Francis said. Outside of the city, just 45 of 375 facilities didn’t admit/readmit COVID patients after the directive was issued.

In addition, Francis said just six of the hundreds of nursing homes in the state had no COVID cases before receiving a COVID patient per the directive.

"If COVID were already in the home, it’s not logical to say there’s a correlation between admissions and deaths," Francis said. He cited studies concluding the nursing home directive might have increased deaths outside of the city by roughly 200-300, not thousands as Cuomo critics claim.

By Yancey Roy

yancey.roy@newsday.com@yanceyroy