New York AG: Nursing Home COVID Deaths Undercounted by 50%, ‘Low Staffing Model Simply Snapped’

The attorney general of New York State on Thursday released a blistering report suggesting that COVID-19 deaths in the state’s nursing homes may have been undercounted by as much as 50%, while also describing an already insufficient staffing model collapsing under the pressure of the pandemic.

A sample of 62 Empire State facilities showed that official numbers may not have included a substantial portion of nursing home residents who died at hospitals after transfers, obscuring the true toll of the coronavirus in long-term care, the office of AG Letitia James announced.

“As the pandemic and our investigations continue, it is imperative that we understand why the residents of nursing homes in New York unnecessarily suffered at such an alarming rate,” James said in a statement. “While we cannot bring back the individuals we lost to this crisis, this report seeks to offer transparency that the public deserves and to spur increased action to protect our most vulnerable residents. Nursing homes [sic] residents and workers deserve to live and work in safe environments, and I will continue to work hard to safeguard this basic right during this precarious time.”


James’s office is actively investigating more than 20 facilities as a result of the investigation.

The report in particular called out for-profit facilities for maintaining low staffing levels prior to the pandemic, noting that 280 of the 401 for-profit facilities in the state had the lowest possible staffing ratings from the Centers for Medicare & Medicaid Services (CMS) — with those facilities accounting for more than half of COVID-19 resident deaths through mid-November.

“Already-low staffing levels decreased even further, to especially dangerous levels in some homes, even as the need for care increased due to the need to comply with COVID-19 infection control protocols and the loss of assistance from family visitors,” the office observed. “OAG’s preliminary investigations reflect many examples where for-profit nursing homes’ pre-pandemic low staffing model simply snapped under the stress of the pandemic.”


James’s office also criticized the sector for either pressuring or allowing employees with COVID-19 symptoms to continue to working during the pandemic; the industry and government have faced scrutiny from the other angle, with the Center for Medicare Advocacy (CMA) last summer calling on CMS to reverse emergency flexibilities that relaxed nurse-aide training requirements in order to fill staffing gaps caused by COVID-related guidelines.

Nursing home deaths in New York have consistently made national news, both due to the devastation in the pandemic’s early months and the political wrangling over Gov. Andrew Cuomo’s handling of the crisis.

Cuomo has faced sharp criticism, some of it politically motivated during the 2020 election cycle, for requiring nursing homes to continue accepting COVID-19 patients even as the danger became clear. The governor and former CMS administrator Seema Verma sparred publicly over who exactly was to blame for that policy — which also became a political hot potato for the Democratic governors of several other states, including Pennsylvania and Michigan, with similar policies.

James’s report did not spare Cuomo from blame.

“Government guidance requiring the admission of COVID-19 patients into nursing homes may have put residents at increased risk of harm in some facilities and may have obscured the data available to assess that risk,” the report concluded.

But industry practices were at the center of the AG’s criticism, with James accusing providers of putting profits over patients and pointing to previous investigations into the complex web of related-party entities that are common in nursing home operation and ownership.

“The current state reimbursement model for nursing homes gives a financial incentive to owners of for-profit nursing homes to transfer funds to related parties (ultimately increasing their own profit) instead of investing in higher levels of staffing and PPE,” the report found.

James additionally blamed operators for lapses in infection control and the proper use of personal protective equipment (PPE), as well as communication breakdowns with family, during the pandemic.

“Lack of nursing home compliance with the executive order requiring communication with family members caused avoidable pain and distress,” James’s office concluded.