State reclassifies 1,000 virus deaths
Long-term care facilities now own 45% of fatalities
In the last two weeks, Wisconsin health officials have attributed nearly 1,000 more COVID-19 deaths to longterm care facilities, people that for months had been marked as having died in an “unknown” housing setting.
The state is now reporting 45% of the people who died from COVID-19 were in long-term care facilities, when for months the state had only linked between 26% and 30% of COVID-19 fatalities to long-term care.
Those earlier percentages were much lower than in most other states, including many neighboring ones, and the differences raised questions about the accuracy and timeliness of Wisconsin’s count of long-term care deaths.
Until recently, the state was missing information in about half of all COVID-19 deaths and could not say whether those people were long-term care residents. They were listed as COVID-19 deaths with an “unknown” housing setting.
Now, many of them have been reclassified as long-term care residents, a category that covers nursing homes and assisted living centers.
Gov. Tony Evers’ administration said the change is part of the normal process of updating the state’s health data, including about COVID-19 deaths, and ensuring data quality. They said the state’s decentralized system — with data gathered at local health departments — makes data difficult to collect, and said that without an extra step they took, the 1,000 deaths might never have been
correctly tied to long-term care facilities.
However, his administration did not answer questions about why it took months to update the data and how long ago the reclassified deaths occurred.
The new information is providing a clearer picture of the extent of the pandemic’s toll in long-term care. But even as new deaths fall thanks to vaccinations, it is unclear just how many people in long-term care died from the virus.
While Wisconsin’s nursing homes are required to report to federal regulators how many of their residents die from COVID-19, there is no similar requirement for assisted living facilities, which are state-regulated and which house more people than the state’s nursing homes.
Wisconsin gives a single total for the number of people in long-term care who have died from COVID-19, without breaking out how many were in nursing homes and how many in assisted living facilities.
David Grabowski, a professor of health care policy at Harvard Medical School whose research focuses on longterm care, said the delay ended up making the situation in Wisconsin’s longterm care facilities appear less dire than it was.
“This is not something that you should have to go back and correct after the fact,” he said. “You can look at 40some (other) states that seem to be able to do this in real-time.”
Wisconsin health officials did not return the Milwaukee Journal Sentinel’s emails earlier this week asking for an explanation.
Julie Willems Van Dijk, deputy secretary of the state Department of Health Services, told the Associated Press that the state recently ramped up its overall data verification efforts as it prepares to finalize numbers for 2020 and submit them to the U.S. Centers for Disease Control and Prevention.
As of Wednesday, the state reported at least 2,927 of the people who died from COVID-19, or 45%, were in longterm care. Earlier this month, the state had counted only 1,956 deaths as related to long-term care.
The new data does not mean that 1,000 long-term care residents have died in the last two weeks. Nor does it mean that 1,000 people have been added to the state’s total death toll; rather, the state is only now counting them as long-term care residents, even though many of them likely died months ago.
The new numbers led a Republican senator to call for an investigation by the Legislative Audit Committee into the way DHS has handled the data.
“Their severe underreporting and lack of transparency put more lives at risk and diverted attention from the crisis in our long-term care facilities,” said state Sen. Alberta Darling, R-River Hills.
Expert: Data is vital to understanding
State health officials did not answer the Journal Sentinel’s questions about how the state determines if someone who died from COVID-19 was a longterm care resident, or why it took the state months to count some of the longterm care residents who died in its numbers. Nor did state officials answer why it is only now updating its data to reflect so many more deaths in long-term care.
But in a media briefing Thursday, Willems Van Dijk said that over the last week, state regulators used COVID-19 death data reported to the state and addresses of Wisconsin’s long-term care facilities to match some people with an “unknown” housing setting to longterm care facilities.
“As a result we have been able to significantly reduce the number of deaths in the unknown housing setting,” she said.
The Journal Sentinel made a public records request for all data on coronavirus cases and deaths in long-term care facilities, including facility name, on June 5.
After months without a response, DHS officials said in December that they were unable to release the records due to an ongoing lawsuit over a separate records request over coronavirus outbreaks linked to Wisconsin businesses, and said the matter had been referred to the state Department of Justice.
On Wednesday, the state was still missing information on 26% of deaths and could not say whether those 1,726 people who died were long-term care residents. With information missing in so many cases, it’s still unclear exactly how high the death toll was in such facilities in the state.
Willems Van Dijk said on Thursday that at this time, she did not anticipate being able to determine the housing setting of those remaining people.
Grabowski said the lack of real-time data may have hurt the response to long-term care facilities that needed help.
“In the middle of a public health emergency, data is king,” he said. “When you delay that kind of data and make the nursing home problem or the long-term care problem look better than it actually is, you delay the response by policymakers to direct resources there. ... You’re basically flying blind.”
State officials pushed back on that view, noting that the department responded quickly to positive COVID-19 tests in facilities, and treated any single case an outbreak.
The Journal Sentinel found earlier that Wisconsin was one of the last states to start vaccinating assisted living residents in earnest, even though it had the opportunity to start giving shots earlier.
Other states have been accused of undercounting the number of people who died in long-term care.
New York Gov. Andrew Cuomo’s administration is under federal investigation after it underreported deaths in nursing homes, many of which had experienced COVID-19 outbreaks before the federal government started requiring them to report cases and deaths.
The Cuomo administration only publicly reported COVID-19 deaths of residents inside nursing homes and did not include nursing home residents who died in hospitals in its tally of nursing home resident deaths, an investigation by the state’s attorney general found.
Long-term care facilities were the epicenter of the COVID-19 pandemic. Less than 1% of the U.S. population lives in long-term care facilities, but they make up more than a third of the fatalities from COVID-19, according to the COVID Tracking Project.
Daphne Chen of the Journal Sentinel staff contributed to this report.
Sarah Volpenhein is a Report for America corps reporter who focuses on news of value to underserved communities for the Milwaukee Journal Sentinel. Email her at svolpenhei@gannett.com. Please consider supporting journalism that informs our democracy with a taxdeductible gift to this reporting effort at JSOnline.com/RFA.