More than 9,000 recovering coronavirus patients in New York state were released from hospitals into nursing homes early in the pandemic under a controversial directive that was scrapped amid criticism it accelerated outbreaks, according to new records obtained by the Associated Press.
The new number of 9,056 recovering patients sent to hundreds of nursing homes is more than 40% higher than what the state health department previously released. And it raises new questions as to whether a March 25 directive from Gov. Andrew Cuomo's administration helped spread sickness and death among residents, a charge the state disputes.
"The lack of transparency and the meting out of bits of important data has undermined our ability to both recognize the scope and severity of what's going on" and address it, said Richard Mollot, executive director of the Long Term Care Community Coalition, a residents advocacy group.
The new figures come as the Cuomo administration has been forced in recent weeks to acknowledge it has been underreporting the overall number of COVID-19 deaths among long-term care residents. It is now nearly 15,000, up from the 8,500 previously disclosed.
The Cuomo administration's March 25 directive barred nursing homes from refusing people just because they had COVID-19. It was intended to free up space in hospitals swamped in the early days of the pandemic. It came under criticism from advocates for nursing home residents and their relatives, who said it had the potential to spread the virus in a state that at the time already had the nation's highest nursing home death toll.
In its reply to an AP Freedom of Information request from May, the state health department this week released two figures: a previously disclosed count of 6,327 admissions of patients directly from hospitals and a new count of 2,729 "readmissions" of patients sent back from a hospital to the nursing home where they had lived before.
Before the state released any data, the AP conducted its own survey and found at least 4,500 such patients.
Critics have long argued there were many other places those patients could have been sent, including New York City's Jacob Javits Convention Center, which had been set up as a makeshift hospital, and the USS Comfort military hospital ship. The state contends those facilities were not suitable substitutes for the care of nursing homes.
Cuomo reversed the directive May 10, barring nursing homes from accepting COVID-19 patients without a negative test first.
State health officials contend that asymptomatic nursing home employees, not recovering COVID-19 patients, were the driving factor in nursing home outbreaks. And they have repeatedly noted that by law, nursing homes weren't supposed to accept anyone they couldn't adequately care for.
"At least 98% of nursing home facilities in the state had COVID in their facility before their first admission or readmission, and as we've seen across the nation, the major driver of infections appears to be from asymptomatic staff through no fault of their own," said state Health Commissioner Dr. Howard Zucker in a statement to the AP.
He added that the March 25 directive followed federal guidance, and that the percentage of coronavirus deaths statewide that happened in nursing homes didn't change from the spring to the fall—after the directive was reversed.
A leader of a California group of nursing home clinicians and administrators, however, sees New York officials as seeking to shift blame.
"There has never been any question in my mind that sending COVID-19 patients into completely unprepared, understaffed and underresourced nursing homes both increased transmission and led to a greater number of deaths," said Dr. Michael Wasserman, president of the California Association of Long Term Care Medicine.
New York's health department in July released a 33-page report, heavily criticized by health experts and resident advocates, that said patients sent to homes posed little danger to residents because they had spent an average nine days at the hospitals—consistent with federal guidance at the time about how long it took for people to stop being contagious.
While it may be impossible to know whether the additional 2,729 patients factored in the virus' transmission in nursing homes, "any policy that is implemented that does not do everything it can to safeguard COVID from coming into a healthcare facility has the potential to increase the spread of the virus," said Stephen Hanse, president of a large nursing home group called the New York State Health Facilities Association and the New York State Center for Assisted Living.
The months-later disclosure "further confirms the state's flawed approach in implementing a hospital-centric strategy to combat the COVID-19 pandemic," Hanse said.
Some states, including Connecticut, set up COVID 19-only nursing homes relatively early on.
Zucker told lawmakers in a letter this week that the state started working in November to establish COVID-only nursing homes for some "persistently positive" patients coming out of hospitals. There are now 19 such homes statewide, totaling nearly 2,000 beds.
Cuomo, who wrote a book about his leadership in the virus crisis, has repeatedly downplayed criticism of his administration's handling of nursing homes as a politically motivated "blame game."
But the flurry of new disclosures began last month after state Attorney General Letitia James, a fellow Democrat, issued a blistering report accusing the administration of underreporting its long-term care deaths by more than 50%.
That was consistent with an AP report from August that focused on the fact that New York is one of the only states that counts just those who died on nursing home property and not those who died after being transported to hospitals.
Under heavy pressure to change its methodology, New York began issuing reports in recent weeks that added thousands more to its long-term care death toll since March. The new data also confirmed that COVID-19 deaths at some nursing homes are double or more what had been previously reported.
Overall, New York has lost over 45,000 people to the virus, more than every other state except California, according to figures compiled by Johns Hopkins University.