A US House subcommittee hearing Tuesday examining former New York Gov. Andrew Cuomo’s culpability for mandating nursing home acceptance of COVID-positive patients in 2020 devolved into expected political finger-pointing but also left room to blame facility staff for spreading the virus to residents.
The focus of the hearing was a March 25, 2020, directive that came to be known as the “must-admit” order. It prohibited nursing homes from denying admission or readmission to COVID patients and also prohibited facilities from testing patients prior to admission.
Throughout the hearing, a combative Cuomo (D) insisted that New York nursing homes had retained their ability to deny admission or readmission to patients all along.
“It was just an advisory,” he said, under a barrage of questions from panel members. “The advisory does not supersede the law. A nursing home can only accept people for whom they can provide adequate care. … The attorney general said it followed [Centers for Disease Control] guidance and is consistent with [Centers for Medicare & Medicaid Services] guidance. … You would think if they had a problem with the directive, they would have called.”
In the early days of the pandemic, the CDC and CMS issued guidance telling nursing homes that they could accept COVID-19 patients so long as proper infection controls were in place. Nursing home leaders, later blamed for the high number of deaths that occurred in their facilities, have repeatedly argued that they were underresourced and deluged with changing requirements and guidelines.
In New York, Cuomo’s directive led to more than 9,000 COVID patients being admitted or readmitted between March 25 and May 8, 2020, when the policy was rescinded. More than 15,000 New York nursing home residents died of COVID-19 during the pandemic, and a January 2021 report found the state health department had undercounted residents’ deaths by as much as 50%.
Across the US, more than 170,000 residents died during the pandemic, leading to widespread scrutiny of the sector, as well as new inspections intended to check providers’ infection control practices.
US Rep. Paul Ruiz (D-CA), the top Democrat on the Select Subcommittee on the Coronavirus Pandemic, used his opening statement at Tuesday’s hearing to announce new legislation – The Sustained Allocations for Evaluations and Reviews of Nursing Homes (SAFER) Act – that would provide a permanent source of funding for survey and certification activities in skilled nursing facilities.
The bill calls for $492 million to be provided for surveys and certifications in Fiscal Year 2025, an increase of 21% over the 2023 funding. Similar bills have not gained traction over the last several years, despite lawmakers expressing repeated concerns about lapses in nursing home infection control and workforce standards.
“The driving force behind the infections and deaths that occurred was broader community spread, which led to dedicated staff inadvertently bringing the virus into these settings,” Ruis emphasized Tuesday.
More bad press on deaths
Cuomo’s administration has also been accused of altering the numbers of infections and deaths due to COVID-19, a charge he continued to deny Tuesday.
“We were reporting total deaths every day,” he said. “Those numbers, in my opinion, were very sketchy … and they moved around a lot. I was not going to report inaccurate information.” He added that the numbers from nursing homes were reported without including deaths that occurred in hospitals or other places.
Cuomo explained that the New York State Department of Health was collecting data about where COVID-related deaths and infections were occurring in several subcategories that became lumped into one, large number for public reporting purposes. An audit of that data discovered an error that was corrected, he said.
The subcommittee, chaired by US Rep. Brad Wenstrup (R-OH) collected and reviewed nearly 555,000 pages of documents and conducted more than 50 hours of sworn testimony and concluded that Cuomo ordered aides to clean up the data to make themselves look better.“
The Cuomo Administration used alternating methodologies throughout the pandemic to account for nursing home fatalities—ultimately, making the decision to withhold the number of nursing home fatalities occurring outside the nursing homes,” a subcommittee memo issued Monday stated. “While the Cuomo Administration asserted that the numbers needed to be audited for accuracy, the facts and circumstances tend to show that the decision was seemingly self- serving.”
