In its January 28 report, the attorney general’s office argued that low staffing levels in nursing homes was associated with higher death rates from the novel coronavirus. As evidence of that connection, the report presented a table (reproduced in Table 1 below) comparing death rates in nursing homes based on their star ratings for staffing from the U.S. Centers for Medicare & Medicaid Services (CMS). It showed that homes with the lowest staffing grade of one star had an aggregate COVID-19 mortality rate of 7.13 percent, compared to 4.94 percent for homes with a five-star rating.
However, that table was based on the limited data available in mid-November, which encompassed 6,645 deaths, only half the number that are documented now.
When that table is brought up to date, it shows no clear association between lower staffing grades and higher coronavirus mortality (see Table 2). Homes with a three-star staff rating showed the largest percentage of deaths, at 13.62, compared to 12.98 for two-star homes and 12.14 for one-star homes.
“The salient policy question isn’t whether the March 25th memo introduced COVID into nursing homes, but whether it contributed to higher infection and mortality rates.
“The department’s comments show that it either doesn’t understand statistics, or is willfully ignoring our findings. Our analysis does, in fact, show a consistent relationship between transfers from hospitals to nursing homes and COVID fatalities. These findings were robust to several statistical assumptions.
“Our report included a statewide statistical analysis, which showed that transfers were associated with deaths at the 99 percent confidence level. Those statewide estimates are the ones we used to estimate that transfers were associated with hundreds of additional deaths. In digging a bit deeper, we hypothesized a differential effect upstate and downstate, which was then corroborated by our analysis.
The admission of coronavirus-positive patients into New York nursing homes under March 25 guidance from the New York State Department of Health was associated with a statistically significant increase in resident deaths.
The data show that each new admission of a COVID-positive patient correlated with .09 additional deaths, with a margin of error (MOE) of plus or minus 0.05.
Further, admitting any number of new COVID-positive patients was associated with an average of 4.2 additional deaths per facility (MOE plus or minus 1.9).
The effect was more pronounced upstate—possibly because the pandemic was less severe in that region at the time, so that even a single exposure would have had a larger impact on the level of risk.
The death toll in New York’s long-term care facilities jumped by another 1,516 this weekend as the Cuomo administration adjusted its reporting on adult-care facilities to include residents who died after being transferred to hospitals.
The newly disclosed deaths represented an almost eight-fold increase for assisted living and other adult-care facilities, which provide non-medical services for their elderly and disabled residents.