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How many long-term care residents actually died from COVID?

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Christina Langballe via Unsplash
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More than 5,600 residents and 77 staff members of Michigan long-term care facilities have died in the COVID-19 pandemic so far, at least according to state data. But what if that’s a significant undercount? 

That’s what the state auditor will try to figure out. Last week, Auditor General Doug Ringler granted the request of a Republican state representative: his office would step into the political minefield that this issue has become, and aim to put out a “just the facts ma’am” comprehensive study sometime this fall.

Questions over nursing home deaths have been the subject of a lawsuit and Lansing hearings the last few months, with critics alleging Governor Gretchen Whitmer’s pandemic policies put these vulnerable populations at greater risk, and that the state isn’t being thorough or fully transparent when it comes to tracking the resulting deaths. Whitmer’s team says they acted swiftly to save lives, and that the evidence bears this out. 

Did Whitmer “force” long-term care facilities to take COVID patients?

In the spring of 2020, COVID was tearing through nursing homes and assisted living facilities, infecting thousands and killing both residents and staff. (By the fall, 1 in 3 of COVID deaths in Michigan were tied to nursing homes, according to a study from the Center for Health and Research Transformation at the University of Michigan.)

In April 2020, Whitmer issued an executive order, essentially saying those facilities couldn’t refuse to take a resident after they’d been discharged from the hospital for COVID. The state directed long-term care facilities to admit residents after they’d been discharged and were “medically stable,” so long as those facilities had the staff and PPE to create a dedicated COVID unit.

Those that were too full, or didn’t have the staff or equipment, were told to transfer those patients to regional “hubs:” nursing homes designated by the state to temporarily care for COVID residents exclusively.

By August, more than 5,000 residents had been admitted to nursing homes from hospitals and other health care facilities, and about 1,500 of those went to the hubs. 

The Whitmer administration says this was a success, pointing to a CHRT study from August 2020 that found “no significant evidence of transmission of COVID-19 between patients admitted from hospitals to nursing home residents in hub facilities,” and that COVID-19 prevalence in both hub and non-hub nursing homes was tied to the county's prevalence overall. Still, the same study found that hubs had “a lower percentage of deaths among residents with COVID-19 during this time: hubs 17% compared to non-hubs 26%.”

March: State was sued for death records

In March 2021, the Mackinac Center for Public Policy announced it was suing the state health department, saying health officials were refusing to release details about how many long-term care deaths had been added to the official count following a state review of vital records:

“After noticing [in January 2021] that state data was showing a growing number of deaths reported from reviews of vital records, [journalist Charlie] LeDuff submitted a Freedom of Information Act request asking for the ages of those who had died, the date of death, when each death was added to the state total and whether any of those deaths were the results of contracting COVID-19 at a long-term care facility. MDHHS failed to produce the records in response to the request, so LeDuff contacted the Mackinac Center to represent him in a FOIA lawsuit.”

In May, the Mackinac Center and the state announced a settlement, with the state agreeing to release what records it had. But the result wasn’t all that illuminating. “Due to inadequate tracking, the department was unable to provide the dates a specific vital record death was added to the state’s tally, as well as whether the deceased contracted COVID-19 at a long-term care facility,” the Mackinac Center said in an update.

June: Republican lawmaker asks Auditor General to step in

Then last month, Republican lawmakers held hearings on the issue. Michigan Department of Health and Human Services Director Elizabeth Hertel testified, and insisted that while the state was counting nursing home deaths identified by vital records in its overall tally, some 38 facilities aren’t reporting, and those with 12 or fewer residents aren’t required to report at all, according to the Associated Press. 

State Representative Steven Johnson (R-Wayland) submitted a written request to the Auditor General, saying he feared the number of those deaths is “higher than what is being reported” by the state.

What Johnson asked for ranges pretty widely, from a specific review of state health department policies, to “a comprehensive review of all death records to see if nursing homes are correctly self-reporting their death numbers.”

On June 30, Auditor General Ringler said his office would undertake a “comprehensive study of reported and unreported deaths,” estimating it could be completed by late September to mid-October.

It’s too soon to say whether the auditor general's office can actually get all that information. But Ringler’s office has notified two state departments, the Michigan Department of Health and Human Services and the Department of Licensing and Regulatory Affairs (LARA), of its intention to look into the issue.

“From day one, we followed the best data and science from the CDC to slow the spread of COVID-19 and protect Michiganders, including vulnerable residents in long-term-care facilities,” said MDHHS spokesman Bob Wheaton via email.

“When an independent study from the University of Michigan looked at the governor’s protections for residents in nursing homes, they agreed that our state’s nursing home policies were 'right on' and ultimately led to less people dying from COVID-19. We have received the Auditor General’s request and welcome the opportunity to meet with his team.”

A LARA spokesperson says their office “received the request from the Office of the Auditor General and we welcome the opportunity to meet with the Auditor General’s team.” 

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