COVID cases lurking in vulnerable facilities
Spring outbreak in N.Y. nursing homes likely among worst in nation
Two months ago, a health director in upstate New York received a call from a hotel owner worried that nursing home staffers living at his hotel were spreading COVID -19.
Brought in from other parts of the state or country, some employees of the Grand Rehabilitation and Nursing at Barnwell, a 235-bed nursing home in Valatie, were living at the Comfort Inn and Suites in Castleton while they worked at the facility. Some were sick, but they weren’t isolating, the hotel owner reported.
Then, in May, an outbreak of COVID -19 cases — which appears to have been among the largest nationwide in a nursing home that month — swept through the facility often known locally as Barnwell. That month, 12 staff
members and 20 residents tested positive for the virus, according a Barnwell spokesman, county health officials and data the facility reported to federal regulators. Two residents died in the nursing home and one died later at the hospital, officials said.
“What was going on up in Rensselaer County clearly wasn’t acceptable in terms of the behavior of the staff,” said Jack Mabb, the health director in Columbia County, where the facility is located. “I’m not even sure the Barnwell administration knew about that activity.”
Grand Healthcare System
Vice President Bruce Gendron said by phone Friday he didn’t know what his staff did when they were not working and added, “there’s been obviously a relaxation in visitation procedures and things like that,” but his staff contained the outbreak “pretty quickly.”
“We’re not out of the pandemic,” Gendron said. “We never know exactly where an outbreak may come in.”
At nursing homes across the country, cases and deaths from COVID -19 are down dramatically from peak levels last year. Yet, the virus continues to lurk and, at times flares up locally, in these vulnerable facilities, according to a Times Union review of the Barnwell outbreak as well as data on thousands of other recent COVID -19 infections and hundreds of deaths among nursing home residents nationwide.
More than a year into the pandemic, some facilities continue to struggle to follow basic best practices for preventing spread.
Another concern: Vaccination rates among nursing home staff remain significantly lower than among both the residents they serve and the general population.
And, the Times Union found, there are critical flaws in the data that’s supposed to help health experts track the virus’ spread and prevent outbreaks, even more than a year after the U.S. Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services started collecting these numbers. Inaccuracies in data reported by nursing homes to federal authorities and sparse state information can obscure exactly where nursing home residents and staff are still getting sick and dying.
While the Times Union confirmed the federal data about the Barnwell cases was correct, several other nursing homes around the country that, according to federal data, had the most cases among staff and residents in May, said the CDC/CMS data about infections and deaths at their facilities was wrong — in some instances, very wrong, they said.
For example, Four Seasons Living Center, a 239-bed nursing home in Sedalia, Mo., had the most COVID -19 cases among staff of any nursing home in the country in May with 75 cases, according to federal data. But Four Seasons administrator Kaylon Williams said the nursing home only had one case among staff and zero cases among residents in May. He had no explanation for why the data the nursing home reported to the federal government did not match his records.
The Pearl Nursing Center of Rochester in Monroe County reported to federal authorities it had 19 infections among staff in May — the most of any nursing home in New York and the fifthmost of any nursing home nationwide that month. But administrator John Gagnon said his facility received 19 false positive tests from Quest Diagnostics two months ago due to a lab error and his facility has had no cases among residents or staff since January. He said he thought local or county authorities would correct the data with the feds, while he focused on caring for his residents and staff, and he had no clue how to revise it on his own.
Julie Philipp, chief community engagement officer with the Monroe County Department of Public Health, verified that the Pearl and two other Rochester nursing homes received falsepositive tests in May.
On Long Island, Luxor Nursing and Rehabilitation at Sayville, a 180-bed nursing home, had 10 residents die from COVID -19 in May, according to federal data, the most of any New York nursing home that month. Only six residents had died of COVID -19 at Luxor Sayville up until that point, the data indicated. Federal data also indicated Luxor Sayville accepted nine residents with COVID -19 at the start of May.
Jeff Jacomowitz, director of corporate communications for Centers Health Care, which runs Luxor Sayville, said he could confirm only one death due to COVID -19 at that nursing home in May. He could not explain why their data did not match federal reporting. Data from the New York Department of Health on nursing home resident deaths at Luxor Sayville also did not match the federal information.
Errors were found even among homes that CMS and the CDC said had passed its data quality assurance checks.
“It’s a bit puzzling why the data are still being incorrectly reported a year after data collection started, and it should be within a facility’s control to get the data right,” said R. Tamara Konetzka, a professor in the public health sciences and medicine departments at the University of Chicago. “Maybe it hasn’t been a priority.”
Experts said they believe that along with erroneously high numbers in the federal data, there are examples of underreporting.
Charlene Harrington, professor emeritus in social and behavioral sciences at the University of California San Francisco, said she considers the nursing homes’ reports to CMS and the CDC to be “totally undercounted and inaccurate” because “it is to their advantage in terms of marketing and PR to underreport COVID cases and deaths.”
Hari Sharma, assistant professor of health management and policy at the University of Iowa, said he has refrained from using the federal data because of the errors.
When the federal data on COVID -19 cases and deaths in nursing homes was first released in June 2020, many reporters and health experts found inaccuracies in the data, especially when comparing it to state numbers.
The inspector general that oversees CMS last year launched an audit of the federal nursing home COVID -19 data, which is due out later this year, said Katherine Harris, spokeswoman with the inspector general’s office.
CMS referred most questions on the data to the CDC, but pointed to its quality assurance checks as its primary way to avoid inaccuracies. The agency said it has overseen nursing homes during the pandemic by directing state agencies to increase inspections, increasing penalties for nursing home infection control violations and providing guidance.
The CDC conducts weekly reviews of data submitted for potential errors that require review and possible revision, spokeswoman Jade Fulce said. Nursing homes are alerted to data flagged by their quality assurance checks. Nursing homes can correct their data at any time through the module used to report the data, Fulce said.
“CDC has provided several resources to assist facilities in reporting accurate data,” Fulce said. “Facilities have ownership of their data. Therefore, it is the responsibility of reporting facilities to correct data entry errors. CDC does not change or revise data entries.”
The federal data suggest the recent outbreak at Barnwell was among the worst in the nation at that time. Barnwell had the eighth-highest number of cases among residents in May and the 13th most cases among staff. But because of the flaws in the federal data it remains unclear exactly how the Barnwell outbreak stacks up.
The Times Union was able to verify other outbreaks spotted in the CMS data.
For example, Baptist Health Nursing and Rehabilitation Center in Scotia had 17 infections and three deaths among residents as well as 13 cases among staff in May, according to CMS data and the Schenectady County Department of Health.
Baptist Health did not respond to a request for comment.
Statewide, 811 New York nurs
ing home staff had confirmed COVID -19 cases in May, according to federal data. That month, 431 residents tested positive for coronavirus. Eightythree residents and three staff died from the virus.
The state Department Health, through a spokesman, declined to verify any data regarding COVID -19 cases among New York nursing homes published by federal authorities. When asked to confirm specific case data, a spokesman pointed to publicly available nursing home data on the Health Department’s website, but it does not include detailed data on COVID -19 cases.
The department, which regulates nursing homes in the state and is responsible for ensuring they follow COVID -19 protocols, publishes only cumulative data on nursing home resident deaths, not historical data showing when deaths occurred.
The agency does not publish data on COVID -19 cases in nursing homes among residents or staff.
Gov. Andrew M. Cuomo and the state Health Department have come under intense scrutiny for their oversight of nursing homes during the pandemic, especially after a February report from state Attorney General Letitia James’ office found the state underreported the deaths of nursing home residents during the pandemic by as much as 50 percent, including labeling some as hospital deaths based on where the person later died. The governor and agency also took heat for a directive early in the pandemic that caused some nursing homes to take COVID -19 positive patients from hospitals when they were ill-equipped to care for them.
In response to questions from the Times Union about recent outbreaks in New York nursing homes that are highlighted in the federal data, state Health Department officials pointed to evidence that COVID -19 cases in nursing homes have declined sharply in recent months.
The department attributed continued COVID -19 cases in nursing homes to some facilities not following proper infection-control protocols and low vaccination rates among residents and staff.
Nationwide, more staff tested positive for COVID -19 in April and May than residents, federal data shows, as staff vaccination rates against COVID -19 trail resident vaccination rates.
In New York nursing homes, 86 percent of residents and 65 percent of staff had received at least one dose of a coronavirus vaccine as of Tuesday, the Health Department reported. In comparison, 72 percent of the New Yorkers 18 and older had at least one dose of a vaccine, although most of the general public got access to the shot months after nursing home residents and staff.
The department added that it has conducted thousands of on-site inspections, visiting every nursing home at least once, and has issued $1.5 million in fines for violations against more than 150 nursing homes during the pandemic. The department said it is seeking to levy fines against more facilities.
“The New York state Department of Health will continue to protect the health of the residents who call these facilities home,” spokesman Jeffrey Hammond said. “The department continues to make it clear to nursing homes that they have an obligation to vaccinate residents and staff going forward and offered to set aside specific allocations for them.”
At Barnwell, 85 percent of residents and 53 percent of staff were fully vaccinated as of Tuesday, according to state data.
Harrington said a vaccination rate that low among staff is “highly dangerous” and puts all the residents at risk of getting sick. She said facilities with similar vaccination rates must continue to test staff frequently to catch cases before they spread.
Gendron said the Grand encourages staff to get vaccinated, but whether they do or not is a “personal choice.”
Cheryl Ronsani, a county communicable disease nurse, said most residents involved in the May outbreak were asymptomatic for the virus. Two of the residents who died refused the COVID -19 vaccine, were very elderly and had other health conditions, Ronsani said. The third resident who died had one dose of a COVID -19 vaccine.
Gendron said his staff “quickly quelled” the outbreak when it occurred.
“It’s a pandemic. It spread throughout the world,” Gendron said. “There’s not the opportunity every time to prevent it from spreading.”
Nationwide, more staff tested positive for COVID-19 in April and May than residents, federal data shows, as staff vaccination rates against COVID-19 trail resident vaccination rates.