What to make of NY saying admission policy wasn’t to blame for nursing home COVID-19 deaths?

Jul 7, 2020

New York state has been criticized for previously mandating that nursing homes take in COVID-19 patients from hospitals. But on Monday the state Department of Health issued a report saying the policy was not the major driver of nursing home deaths, and that it was instead nursing home workers unknowingly bringing the virus into facilities. WBFO’s Older Adults Reporter Tom Dinki spoke with Dr. Nancy Nielsen from the University at Buffalo to discuss the report and what it does — and does not — confirm about the state’s more than 6,000 nursing home deaths.


Dr. Nancy Nielsen

Tom Dinki: What was your initial reaction to the report's findings, essentially saying that staff unknowingly brought COVID-19 into their nursing homes, and that this was the major reason COVID spread through nursing homes, not necessarily the state's former policy of discharging COVID hospital patients into nursing homes? What was just your reaction to reading that?

Nancy Nielsen: My reaction was that this is true in large part, but it's not the only factor. From a reality standpoint, we know that nursing homes got coronavirus via staff or visitors — they had to because it was a new virus nobody in this country had ever seen. So somebody from the outside brought it into a nursing home. But once in a nursing home, it spreads like wildfire. So once it was introduced, then there's no question that it was going to spread. My concern about the report is that it says it's the major driver, it was a driver and clearly was the initial driver. But whether it was the only driver I think is really not so clear.


TD: The report notes that the peak number of staff reporting COVID symptoms was March 16. That was 23 days before we had our peak nursing home deaths on April 8. The report notes that the peak number of COVID patients being discharged into nursing homes wasn't until April 14. If all that's true, does it make sense then that the origin of the virus in nursing homes, and what really caused the deaths here, was more staff as opposed to COVID patients. I mean, on the surface, does that make sense that the state came to that conclusion? 


NN: I would say that looking just at the peaks is not the whole story. You have to look at all the people who died thereafter who were nursing home residents. And I think just to say this peak came before the peak of nursing home deaths, and therefore it had to be due to that. That may be true of the peak, but what about all the other 6,000 patients who died? I really think there are multiple factors involved.


TD: Should we be skeptical at all of this report and its findings? Just considering that the state received so much criticism for discharging COVID patients into nursing homes and now we have this report today that essentially in some way seems like it's trying to exonerate the state for having that policy. Can we take this report at face value?


NN: I would always say that when somebody has something to gain by the conclusions of a report, that the report up to be very carefully analyzed by independent observers, and I would certainly say that here. I think we can accept the data, but the conclusions may need some amendment.


TD: So the state ultimately did rescind this policy back in May. But now they have a report saying the policy wasn't the major cause of infection in nursing homes. If there is indeed a second wave in New York state this fall, does the state go back to this policy of discharging COVID patients into nursing homes in order to free up hospital beds?


NN: I doubt it. I seriously doubt that that would ever happen in any state given what's happened in nursing homes, because it is such an incubator, as I mentioned before, for transmission of an infectious disease. So no, I don't think they will do that. I think what probably might happen is patients would be cohorted, meaning positive patients would be roomed with other positive patients. And for example, a nursing home could become a COVID nursing home, as happened I believe that happened with one of the nursing homes here in the Buffalo area. So I think that's what you would see now that we know as much as we know.