LANSING, Mich. – Allegations that New York intentionally manipulated data regarding COVID-19 deaths in nursing homes has led Republicans to demand an investigation in Michigan, where Gov. Gretchen Whitmer — early in the pandemic — told such facilities to admit or readmit COVID-affected residents under certain conditions.
The Democratic governor has said the requirement never took effect, but she has defended allowing recovering coronavirus patients into nursing homes while hospitals faced potentially being overrun last spring. GOP lawmakers, who have long criticized Whitmer's handling of the outbreak, want a review.
A look at the issue:
Long-term care facilities, home to two especially vulnerable groups — older people and those with chronic medical conditions — account for about a third of COVID-19 deaths in the U.S., according to The COVID Tracking Project. Michigan appears to mirror the national rate, though reported data vary by state.
In New York, Gov. Andrew Cuomo's administration was forced to acknowledge a major undercount because it counted just those who died on facility grounds, not later in the hospital. Michigan includes both, and there is no evidence of any similar effort to hide the scope of deaths.
Yet House Oversight Committee Chairman Steven Johnson, a Wayland Republican, said he wants to “trust but verify." He is seeking a breakdown of long-term care residents who died in a facility vs. a hospital, something he said has not been provided.
In a letter to Johnson, state Health and Human Services director Elizabeth Hertel said the federal government requires nursing homes to report the number of residents with a confirmed or suspected COVID-19 case who die in the facility or elsewhere. She defended Michigan's data-collection and validation work as “exemplary.”
The Mackinac Center Legal Foundation filed a public-records lawsuit this past week on behalf of Detroit journalist Charlie LeDuff, who is seeking information on COVID-19 deaths.
Confronted with surging hospitalizations nearly a year ago, Michigan addressed the discharge of patients no longer needing acute care but still in quarantine.
Whitmer, like Cuomo and some other governors in initial hot spots, ordered that nursing homes not prohibit the admission or readmission of a resident based on COVID-19 testing results — in a manner that was inconsistent with relevant guidance from the health department. Her administration has told the Justice Department and legislators, however, that the policy never went into effect because the health department did not issue the guidance due to nursing homes' concerns. She has called allegations that homes were forced to take people “false.”
Her April 15 order also required homes with occupancy below 80% to create a unit dedicated to residents with the virus, including those not sick enough to go to the hospital. Hospitals had to send recovering COVID-19 patients back to their nursing facility — if it had a dedicated unit, protective equipment for staff and enough beds — or to a regional “hub” nursing home with higher care levels.
Critics say it was a mistake that endangered other residents.
“Even if you set up a dedicated unit, if the air is still the same, you're recirculating that through the facility,” said Sen. Jim Runestad, a Republican from Oakland County's White Lake Township.
The governor has said the policy complied with federal guidance.
GOP lawmakers have long argued there were other places patients could have gone, such as makeshift COVID-19 hospitals at two convention centers. The state has contended those facilities were not suitable substitutes for nursing home care.
Whitmer relaxed the order on May 20, saying all homes should make “reasonable efforts” to form a COVID-19 unit unless they could not implement effective infection-control procedures.
Under a policy change and subsequent bipartisan law enacted in October, some nursing homes have been designated as “care and recovery centers” for people with COVID-19, replacing the hub system. Many other nursing homes can still retain or admit infected residents, though, because they have a state-approved designated area for them — typically in the same building.
As of Feb. 14, there had been more than 7,500 admissions or readmissions of COVID-19 patients from hospitals or long-term care facilities to nursing homes, according to data from the Centers for Medicare & Medicaid Services. Direct evidence that they infected other residents is lacking.
The state and long-term care industry have said outside community spread is the strongest predictor of cases inside the facilities. In a December study, the Center for Health Research and Transformation at the University of Michigan said as county COVID-19 infections increased there was a corresponding rise in nursing home infections.
In New York, state Attorney General Letitia James has been investigating nursing homes based on neglect allegations and noncompliance with infection-control protocols. She released a report charging that the death toll could be off by about 50%.
Michigan Attorney General Dana Nessel’s office said it is reviewing GOP lawmakers’ request for an investigation of long-term care policies, data accuracy and adherence to federal guidance.
The Justice Department declined to comment on the status of its evaluation of whether to initiate an investigation of Michigan under a federal law that protects the rights of people in public nursing homes. Most nursing homes are privately owned.
In a September response to a Justice Department fact-finding inquiry, Mark Totten, Whitmer's chief lawyer, said Michigan has two covered facilities — veterans homes. One had a death. He also referenced 34 county-owned nursing homes with 93 COVID-19 deaths.
Macomb County Prosecutor Peter Lucido, a Republican who criticized the governor’s nursing home policies as a senator, plans to review deaths in his jurisdiction outside Detroit. Whitmer’s spokesman called it a “political attack.”
“Our top priority from the start has been protecting Michiganders, especially seniors and our most vulnerable,” spokesman Bobby Leddy said, citing efforts to supply homes with protective equipment, create isolation units and give vaccine priority to residents.