ALBANY — An Albany think tank on Thursday published an analysis stating that the links between for-profit ownership, low staffing and COVID deaths in New York nursing homes are weak at best.
The report comes a little more than a month after an investigation by state Attorney General Letitia James reached nearly the opposite conclusion, and as the state Legislature is moving aggressively to increase oversight and stiffen regulation on staffing and many other aspects of nursing home operation.
The Assembly’s reform package has reportedly grown to a whopping 21 bills, and would prevent new for-profit facilities from being licensed.
Bill Hammond, the Empire Center’s senior fellow for Health Policy, presented the think tank’s new report to reporters Thursday morning. He said it was a mathematical analysis of one aspect of the COVID pandemic in New York nursing homes, with no suggested remedies and no explicit criticism of the reform packages now pushing through the Legislature, aside from the cost.
The report released Jan. 28 by the Attorney General’s Office was a political bombshell, with critics seizing on the concise and mildly stated criticisms of Gov. Andrew Cuomo’s administration by Letitia James, a fellow Democrat.
But more than anything, the report was a scathing indictment of the nursing home industry, particularly its for-profit sector. The report charged that for-profit facilities put profit ahead of patients by not hiring enough workers, violated infection control protocol and didn’t communicate with families enough through the pandemic.
The AG’s report found that the mortality rate at nursing homes was inversely proportional to the federal ratings they had received for their staffing levels — one-star facilities had the worst death rate, followed by two-, three-, four- and five-star facilities, in that order.
“Her conclusion, which is reasonable based on this evidence, is that there was a connection,” Hammond said.
Here’s the catch: Cuomo was withholding much of the data James’ office needed to do a full analysis. Her report is based on 6,645 nursing home resident deaths through Nov. 16. There were actually many more resident deaths before Nov. 16, and have been many more since — 13,621 as of March 2.
The Cuomo administration publicly released most of the data late the same day James released her report, and released more data in early February, when ordered to do so by a judge hearing a lawsuit the Empire Center brought against the state.
So the Empire Center was able to analyze 13,262 deaths from March 2020 to Feb. 9, 2021. Nursing homes with three-star ratings for staffing had the worst death rate, followed in order by two-, one-, four- and five-star-rated facilities.
Also apparent in the Empire Center analysis: The death rates were much closer to each other than those cited in the attorney general’s report.
Statewide, the analysis found government-owned nursing homes had the lowest death rate, 9.4%, followed by non-profit at 12.4% and for-profit at 13.3%.
But downstate, where the bulk of nursing home COVID deaths occurred, for-profit facilities had the lowest death rate, by fractions of a percentage point.
Limited staffing in nursing homes has long been a complaint of residents, their families and employee unions.
The degree of the crisis in the past year — 1 in 3 New Yorkers who died of COVID were nursing home residents but just 1 in 187 New Yorkers lived in a nursing home at the outset of the pandemic — has propelled reforms to near the top of the legislative agenda in Albany.
Cuomo has been a target of criticism almost from the start of the pandemic, as the nursing home death toll soared. In the past several weeks, the attacks have reached critical mass, with the AG’s report, the ruling in the Empire Center lawsuit and revelations that his aides withheld nursing home COVID data from legislators.
On Feb. 19, the 10-year incumbent issued a sweeping set of proposals to reform the pre-existing issues in the nursing home industry, which he said had been exacerbated by the COVID crisis.
The 11-point plan is summarized as increased transparency, accountability for misconduct and prioritizing patient care over profit. It includes fines of up to $25,000 for legal violations, minimum 70% spending levels for direct patient care, and a profit cap.
Cuomo said he would not sign a budget sent to him by the Legislature unless it contained his reform plan.
The Assembly and Senate, meanwhile, are working on their own set of reforms.
Assembly Speaker Carl Heastie and key committee chairs issued an update Thursday, saying the Assembly has begun to pass its reform package.
Provisions include a task force to study the issues and make recommendations, an infection control protocol, limits on resident discharge, provisions for visitation amid health emergencies, a ban on licenses for new for-profit nursing homes, a ban on expansion of existing for-profit facilities, reform of the ombudsman program, increased reporting of facility data, and repeal of immunity from liability for harm incurred during a disaster or emergency.
State Senate Majority Leader Andrea Stewart-Cousins said late last month that the Senate is working on its own package. Many measures are similar to the Assembly package; also included are 70% minimum spending on direct patient care, publication of federal nursing home ratings, greater review of nursing home owners by way of past violations at other facilities they own, and disclosure of violations to potential residents and their families.
Hammond for his part doesn’t offer solutions, only the point that nursing homes’ staffing levels and for-profit status have not been shown to be directly correlated to COVID deaths.
That does not mean that staffing and profit have no impact on overall nursing home quality, he added.
“There is research in those areas and the Legislature should be paying attention to those research,” he said. “But I don’t think they should be presenting these particular proposals as solutions that would have saved people from coronavirus. They may have, but the evidence suggests that these were not significant factors.”
The Empire Center for Public Policy is officially nonpartisan, but its free-market philosophies often place it in opposition to the priorities of the Democrats who control state government. A 2018 report by Hammond for example concluded that opening hospital performance might improve in New York if the state allowed for-profit operations.
But Hammond said the Empire Center isn’t specifically defending for-profit nursing homes with the new report, just pointing out some statistical correlations that had been obscured until recently.
Change is needed, he added.
“I think the quality of our nursing homes is not what it should be,” Hammond said. “I do think the state’s oversight of nursing homes needs a top-to-bottom review. I don’t think anybody would say it’s working well right now.”
He made a key point about all this: “Behind every data point there’s a person,” he said.
The numbers in the report he co-authored equate to more than 1 in 8 nursing home residents in New York being killed by COVID.