The state Department of Health (DOH) was unprepared to respond to infectious disease outbreaks at nursing homes, even before the COVID-19 pandemic hit New York, an audit released today by New York State Comptroller Thomas P. DiNapoli found. DiNapoli said that a persistent lack of funding for public health over the last decade forced DOH to operate without critical information systems and staff that could have identified and helped limit the spread of COVID-19 at nursing homes.
State auditors also found that DOH did not provide the public with accurate COVID-19 death counts and became entangled in the undercounting of those deaths as the Executive took control of information provided to the public. DOH would not provide auditors with a breakdown by name of the nursing home residents who died from COVID-19, and the actual number of nursing home residents who died is still uncertain. The audit revealed that, on many key indicators, New York significantly trailed other states in surveying nursing homes and developing strategies to stop infections from spreading in facilities.
“The pandemic was devastating and deadly for New Yorkers living in nursing homes. Families have a right to know if their loved one’s COVID-19 death was counted, but many still don’t have answers from the state Department of Health,” DiNapoli said. “Our audit findings are extremely troubling. The public was misled by those at the highest level of state government through distortion and suppression of the facts when New Yorkers deserved the truth. The pandemic is not over, and I am hopeful the current administration will make changes to improve accountability and protect lives. An important step would be for DOH to provide the families who lost loved ones with answers as to the actual number of nursing homes residents who died. These families are still grieving, and they deserve no less.”
Key audit findings:
- DOH understated the number of nursing home deaths due to COVID-19 by at least 4,100, and at times during the pandemic by more than 50%. A timeline included in the audit details the inaccurate death counts reported by DOH. When questioned by auditors, DOH officials could not explain the discrepancies. Auditors found the Executive routinely reported incorrect data, inflating the perception of New York’s performance against other states.
- DOH was slow to respond to a federal directive to conduct surveys of nursing homes for infection control problems, surveying just 20% of facilities between March 23 and May 30, 2020, compared with over 90% for some other states. DOH had to hire temporary employees to conduct nursing home surveys during the pandemic because it was understaffed. DOH issued 602 violations from these surveys; however, for 413 (69%) of them there was no indication that the deficiency was corrected.
- While DOH collects data on a range of issues including infections, DOH does not use it broadly to detect breakouts, geographic trends, and emerging infectious diseases or to shape its infection control policies. It also relies heavily on self-reported data from nursing homes. Auditors found that data from one of DOH’s key informational systems was not complete nor reliable, and found that DOH was aware of this problem long before the pandemic and had committed to resolve it. However, DOH never followed through on the corrective actions, which may have limited its ability to respond to the COVID-19 nursing home crisis.
- DOH imposed impediments on the audit, including delaying requested data, limiting auditors’ contact with program staff, not addressing auditors’ questions during meetings, and not providing supporting documentation. These are not routine actions by state agencies undergoing an Office of the State Comptroller audit and raise serious concerns about the control environment at DOH.
DOH’s inadequate nursing home oversight and low standards for compliance have been long-standing issues. Previous reports issued by DiNapoli’s auditors have taken issue with the department for setting minimum standards for compliance and setting a low bar for accountability for nursing homes. As the Centers for Disease Control cites the workforce as a “first line of defense against disease outbreaks and other health threats,” inadequate support led to some of the major problems that arose during the pandemic and delays in setting up infectious disease control procedures at health facilities.
President Biden in February called on Congress to provide additional funding to support health and safety inspections at nursing homes. The Comptroller urges Congressional support for this initiative as these funds could significantly help DOH improve its data systems and examine workforce needs, which have been limited by underinvestment.
The audit recommended:
- The Executive Chamber assess and improve its internal control environment, including improving cooperation with state oversight inquiries, communication with localities, and external reporting.
- DOH expand its use of infection control data to identify patterns, trends, areas of concern or non-compliance that will help create policy recommendations for infection control practices and nursing home surveys; improve quality of public reported data; and strengthen communication and coordination with localities on collection and reporting and use of infection control data.
- DOH collect supplemental data through other sources, such as the CDC, and incorporate it into its current data sets to establish a foundation to adequately address public health emergencies.
DOH agreed with some of the Comptroller’s recommendations but took exception to some statements in the audit. The response is included in the audit.
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