DiNapoli: State’s pandemic response to nursing homes hampered by ill-prepared state agency

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The state Department of Health (DOH) was unprepared to respond to infectious disease outbreaks in nursing homes even before the COVID-19 pandemic hit New York, an audit released today found. today by New York State Comptroller Thomas P. DiNapoli. DiNapoli said a persistent lack of public health funding over the past decade has forced the DOH to operate without critical information systems and personnel who could have identified and helped limit the spread of COVID-19 in retirement homes.

State auditors also found that the DOH failed to provide the public with the exact number of COVID-19 deaths and became entangled in undercounting those deaths as the executive branch took control. information provided to the public. The DOH would not provide auditors with a breakdown by name of nursing home residents who died of COVID-19, and the actual number of nursing home residents who died is still uncertain. The audit found that on many key indicators, New York lags significantly behind other states in investigating nursing homes and developing strategies to prevent infections from spreading in facilities. .

“The pandemic has been devastating and deadly for New Yorkers living in nursing homes. Families have a right to know if their loved one’s death from COVID-19 has been counted, but many still don’t have an answer from the state Department of Health,” DiNapoli said. “The findings of our audit are extremely troubling. The public has been deceived by those at the highest levels of state government by twisting and suppressing the facts when New Yorkers deserve the truth. The pandemic is not over and I hope the current administration will make changes to improve accountability and protect lives. An important step would be for the DOH to provide families who have lost loved ones with answers as to the actual number of nursing home residents who have died. These families are still grieving and they deserve nothing less.

Main results of the audit:

  • The DOH has underestimated the number of nursing home deaths from COVID-19 by at least 4,100, and sometimes during the pandemic by more than 50%. A timeline included in the audit details inaccurate death counts reported by the DOH. When questioned by auditors, DOH officials could not explain the discrepancies. Auditors found that the executive regularly reported incorrect data, inflating perceptions of New York’s performance relative to other states.
  • The DOH was slow to respond to a federal directive to survey nursing homes for infection control issues, surveying only 20% of facilities between March 23 and May 30, 2020, compared to more 90% for some other states. The DOH had to hire temporary employees to conduct nursing home investigations during the pandemic because it was understaffed. The DOH issued 602 violations from these investigations; however, for 413 (69%) of them, there was no indication that the impairment had been corrected.
  • While the DOH collects data on a range of issues, including infections, the DOH does not use it generally to detect outbreaks, 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 major information systems was not complete or reliable, and found that DOH was aware of this issue long before the pandemic and was committed to addressing it. . However, the DOH never acted on the corrective actions, which may have limited its ability to respond to the COVID-19 nursing home crisis.
  • The DOH imposed audit hurdles, including delaying requested data, limiting auditor contact with program staff, not answering auditor questions at meetings, and not providing supporting documentation. These are not routine actions by state agencies subject to audit by the Office of the State Comptroller and they raise serious concerns about the control environment at DOH.

Inadequate DOH nursing home oversight and low compliance standards are long-standing issues. Previous reports released by DiNapoli auditors have challenged the department for setting minimum standards for compliance and setting a low bar for nursing home accountability. While the Centers for Disease Control cites the workforce as the “first line of defense against disease outbreaks and other health threats,” inadequate support has led to some of the major issues during the pandemic and delays in implementation. put in place procedures for the control of infectious diseases at the health level. facilities.

In February, President Biden called on Congress to provide additional funding to support health and safety inspections at nursing homes. The Comptroller urges Congress to support this initiative, as these funds could significantly help DOH improve its data systems and address labor needs, which have been constrained by underinvestment.

The audit recommended:

  • The Executive Chamber assesses and improves its internal control environment, including improving cooperation with state oversight investigations, communication with localities, and external reporting.
  • DOH is expanding 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 investigations ; improve the quality of public data communicated; and strengthen communication and coordination with localities on the collection, reporting and use of infection control data.
  • The DOH collects additional data through other sources, such as the CDC, and incorporates it into its current datasets to establish a baseline to adequately respond to public health emergencies.

The Department of Health accepted some of the comptroller’s recommendations, but disagreed with some of the audit statements. The response is included in the audit.

Audits:
Department of Health: Use, Collection and Reporting of Infection Control Data

Prior audits:
Nursing Home Monitoring and Tracking Audit
Monitoring of medical equipment related to resident care in nursing homes


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