It appears that Michigan wildly under-counts Covid deaths in its long term care facilities.
A joint investigation by the "No BS News Hour" and the Mackinac Center for Public Policy reveals that the Department of Health and Human Services (DHHS) does not do a thorough job of scrubbing vital records to determine whether people who died of Covid were nursing home residents, as its own guidelines require.
Moreover, our investigation found that DHHS did conduct a limited review of those vital records last summer, and found that 44 percent could be traced to nursing homes.
Don't expect the nursing home data to get better or more accurate. DHHS has abandoned the practice of thoroughly scrubbing records because it is considered too “time-consuming.”
Why should it matter? Because we need a clear picture of what happened to our elderly during the pandemic so we can do better next time. Data helps. Unfortunately, it's unclear if even the incomplete and limited numbers have ever been made public.
The true number of pandemic deaths inside Michigan's elder care centers may never be known. But our analysis shows that the Covid death toll may be 100 percent higher than the state reports.
Our findings are based on communications with state health officials as well as material obtained in a Freedom of Information lawsuit settlement with the Attorney General's office.
Long-term care facilities are licensed and regulated by the state. They're required to provide weekly Covid-19 data, including outbreaks and resident deaths, no matter where those people eventually died.
Among these group facilities are: nursing homes, which provide round-the-clock medical attention to residents; homes for the aged, which function like nursing homes but do not offer full-time medical care; adult foster care homes, which function like homes for the aged but house smaller populations of people.
The adult foster homes are broken-down into two categories: those with 13-20 residents, and those that house 12 or fewer people.
Collectively, they are informally known as “nursing homes.”
Just over 19,000 people in Michigan have died from Covid-19, according to daily data posted by DHHS.
We only know for sure that approximately 5,600 people died who were residents of long-term-care facilities. This data is self-reported by those “nursing homes.” This method operates on an honor system.
Another 6,945 deaths among those 19,000 Covid-19 fatalities are classified as “vital records reviews,” according to the attorney general. These are recorded only after health officials and epidemiologists pore through death certificates across the state and determine that the cause of death was indeed Covid-19.
Here is where the problems begin. State health officials do not attempt to determine whether the people in this “vital records” group lived in a nursing home or whether they contracted the disease there, as their own guidelines require.
“Long-term care facility Covid-19 data, which is reported on this web page comes from the facilities themselves, so it doesn’t include any data from Vital Records reviews,” said Bob Wheaton, a spokesman for DHHS.
The Smoking Gun
Steve Delie, a lawyer with the Mackinac Center, and I have learned that the state of Michigan did in fact conduct a study with a limited sample last summer to find out if people on this vital records list were residents of long-term care facilities.
Exactly 1,468 vital records were selected from March through June 2020.
Of those, 648 deaths were traced back to nursing homes and other long-term facilities. That's 44 percent. Nearly half.
Apply 44 percent to the nearly 7,000 vital records and there may be another 3,000 deaths of the institutionalized elderly unaccounted for.
If that is the case, the number of “nursing home” deaths now climbs to 8,900.
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Of course, deaths in nursing homes have dropped dramatically since vaccines became widely available in January. So who knows?
But that's the point -- who knows? Certainly not the state.
Incredibly, the work of tracing those vital records was never institutionalized.
Why? Because it was too hard.
“The 648 deaths came from a vital records review we did for deaths between March and June,” confirmed Wheaton, the DHHS spokesman. “That is not a review that we are able to do regularly due to how time-consuming it is and the amount of resources we need to devote to doing this."
The state claims those 648 deaths were added into the death tally offered daily to the public.
The blame should not lie with state health employees and epidemiologists, said Sam Roosz, CEO and co-founder of Crescendo Health, a data and technology firm in Oakland, Calif, who reviewed our data and materials. Rather, Roosz believes the problems rest on decades of governmental budget cuts, and the current disfunction and division in American politics.
"The U.S. has paid a heavy price this year for its chronic underinvestment in public health infrastructure,” said Roosz.
“History will repeat itself unless we learn from this lesson and modernize health data systems, invest in public health departments, and increase data transparency.”
Still, Whitmer may have a Cuomo problem
So what about those 6,500 remaining Covid deaths in the state's list of 19,000?
Where did those people live?
Is anybody asking?
Remember, Andrew Cuomo's administration in New York tried to fob off 4,000 nursing home deaths as hospital deaths because that's where those people actually died. But that's not where the people lived, or where they contracted Covid, as reporting guidelines require.
And the Cuomo cronies knew it. They kept it quiet because it was an election year and the Trump Justice Department had opened an investigation. “We froze,” said Melissa DeRosa, a top Cuomo aide, to a group of Democratic lawmakers. There have since been calls for Cuomo's impeachment.
Nonetheless, New York officials did keep count – secretly.
Not so in Michigan.
“Even when we do the manual review that is needed to link hospital deaths to long-term-care facility residents, the results are still substantially incomplete,” admitted Wheaton in an email. “If the facility resident is transferred to a hospital and subsequently dies, it can be difficult to tie that death back to a specific facility, or to the fact that the individual was even a resident of a facility. Death certificates have a field for type of place of death (such as home, inpatient, outpatient/ER, hospice, nursing home, long-term care facility, other). We also capture the name of the facility if the death occurred in a facility. The challenge has been identifying long-term-care facility residents who are transferred to, and die in hospitals since the death certificate lists where they actually died.”
While it is true that a person's place of death is listed on his death certificate, a person's place of residence is also listed, usually beneath the place of death.
That's how it is for Clarence, an 86-year-old military veteran and ward of the state.
Clarence died in a Detroit hospital last year, according to his death certificate. His residence is listed on East Grand Boulevard. An eight-second Google search confirms it to be a nursing home.
New York is able to track this data.
Michigan? Not so much. Why?
And remember, the reporting is done on an honor system. Multiple nurses and executives in these facilities have told me they dumped their death on the hospitals' tab.
Foster Homes Are Not Family Homes
What is more, the state doesn't monitor or record Covid cases emanating from the smaller adult foster care homes (those with fewer than 12 people) even though they account for 25 percent of all beds and 75 percent of all elderly congregant facilities.
So why does the state not monitor these foster homes? Because they're a lot like family homes, said Wheaton.
“There are privacy concerns associated with publicly reporting information related to small adult foster care facilities. Many of the small adult foster care facilities really aren’t a lot different than a family’s household because of the small number of people, and we don’t report Covid-19 cases by the address of families,” he said. “It’s important to note that the smaller adult foster care facilities are still responsible for reporting directly to their local health department when they have a resident or staff member who tests positive for Covid-19.
"We continue to work closely with the local health departments to be sure we have a pulse on what is happening in these settings even when they aren’t included in the state’s LTC data set.”
Nobody was asking for an address. What we were asking for was someone to look out for the old and infirm. To be sure they were safe and well-kept.
Why This Matters
Go. Gretchen Whitmer crows that Michigan (29%) has done better than national average (32%) when it comes to Covid deaths in long-term-care facilities.
Cuomo was braying the same line until called out by his own attorney general for faking the data.
As for the controversial comingling of positive people with healthy people in these facilities, as was done in Michigan as well as New York? The Empire Center for Public Policy showed a 9 percent rise in deaths in those New York facilities where the elderly were comingled.
Nursing homes and other elder facilities were at the epicenter of the entire Covid crisis. So, it is stunning to learn that the data used to make decisions on all human activity in Michigan did not exist.
Attorney General Dana Nessel said in March there were no grounds to investigate the Whitmer administration's handling of the nursing homes.
There seems to be now.
In the meantime, the governor and Republican-controlled legislature need to come together and fashion a plan to fix it.
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