Senior care advocates called huge gaps in COVID-19 numbers reported for long-term care homes troubling.
The Pennsylvania Department of Health is threatening to penalize long-term care operators for failing to report COVID-19 cases and deaths, as new data shows continued disparities.
Pennsylvania long-term care facilities reported nearly 6,800 fewer residents testing positive for COVID-19 and nearly 1,400 fewer deaths among those residents than what Health Secretary Dr. Rachel Levine released publicly on June 23.
State health officials say the discrepancies reflect underreporting by long-term care facilities who have been required to submit COVID-19 infection data daily to the state since last month.
Senior care advocates called such a huge gap in numbers troubling.
"State and DOH (officials) have said they want, and are following, a data-driven response. How can they accomplish that without reliable data?" said attorney Theresa Blanco, part of a team suing the Department of Health for its COVID-19 response in long-term care facilities. "If data drives decisions, how are those decisions being made and on what version of the data?"
State health officials have grappled with data accuracy and reporting problems since issuing a May 14 order requiring long-term care facilities to make daily reports of infections among staff, residents and resident deaths for public release.
The effort followed public outcry from families and advocates who complained homes weren’t providing details about COVID-19 infections, deaths or steps they were taking to prevent its spread.
After the first data detailing infections and deaths by facility was released May 19, some long-term care operators, and a trade group that represents their interests, complained about inaccuracies and inconsistencies.
State health officials blamed errors and omissions on home operators’ failure to submit accurate infection data.
One month later, not much has changed.
Numbers game
On June 23, Levine said 17,294 residents in long-term care had tested positive for the coronavirus, and 4,410 had died during the pandemic.
The same day, reports breaking down the number of infections and deaths in each licensed long-term care facility showed no more than 10,532 residents testing positive and 3,017 deaths.
Health officials maintain the data they are reporting in the state’s daily COVID-19 public update is accurate, since it is based on lab test result submission forms and case investigations.
They used the lab data to determine infections and deaths in long-term care facilities until May 14, when they directed facilities to submit data themselves using a new online reporting tool.
The system was designed to mirror new federal infection reporting guidelines for skilled-nursing homes enacted in April, said Pennsylvania health department spokesman Nate Wardle.
But some facilities have either been unwilling, or unable, to use the new system, Wardle said. Some facilities initially provided infection and death data, but have not updated it, he said.
The state was unable to provide the number of facilities that have not updated infection and death information.
But a review of available facility-level reports support massive underreporting.
Only 220 personal care and assisted living facilities — less than 20% of the nearly 1,200 licensed in the state — submitted infection data for the most recently updated facility reports released June 23.
Among the state’s 693 skilled nursing homes, 96, or 14%, did not report any data for the June 23 update, including five in Bucks County and 13 in Montgomery County.
Among licensed personal care and assisted living homes, only half of the 54 licensed facilities in Bucks and 47 of the 63 in Montgomery County submitted COVID-19 data as of June 23.
Since it released its first facility-level report on May 19, nursing home data has been updated eight times; assisted living and personal care home data has been updated only five times.
The Department of Human Services, which oversees assisted living and personal care homes, temporarily stopped publishing infection data for those facilities after June 2 to correct "some problems" with the reporting system, DHS spokeswoman Ali Fogarty said.
"We transitioned to a new reporting system when the listing was temporarily removed," Fogarty added. "We are still working with facilities to ensure they are reporting under the new system, so facilities will be added as that occurs.
DHS restarted posting facility information on June 16, and most recently on June 23.
In response to "numerous" questions from providers regarding the data reporting, the state posted a Frequently Asked Questions list on its website in early June.
The document outlined the requirements including that facilities should report daily cumulative number of residents and staff testing positive for COVID-19 since March 6, 2020, regardless of their current status. They should also be reporting the deaths of residents who died outside the facility, such as in a hospital.
The FAQ explained the state is also collecting the number of "new cases" in the previous week, something the federal Department of Health and Human Services is requiring nursing homes to provide, according to the post.
No weight
In a June 18 letter posted on the state Department of Health online message board, Levine warned long-term care administrators of potential penalties for failing to comply.
"Unfortunately some facilities have either failed to report accurately or have failed to report at all," she wrote.
The letter outlined penalties for not complying with the order, which is considered a summary offense that carries a $3,000 fine or 30 days in jail. Additionally, administrators could face a maximum $300 penalty each time they fail to report accurately, according to the letter.
Zach Shamberg, CEO and president of the Pennsylvania Health Care Association, said he had no reason to believe that members were not complying with the reporting order. The organization represents the interests of more than 400 long-term care providers in the state.
In a written statement, Shamberg said the organization immediately followed up with the state Department of Health requesting a list of facilities that still need to report. As of Friday, the state has not responded, the organization said.
"The nursing home administrators we’ve spoken with have told us they’ve heard nothing from the Department of Health up to this point, in terms of failure to report, unintentional misreporting or even acknowledgment that their daily reports or submissions ... have been received at all," Shamberg added.
The underreporting of COVID-19 data doesn’t surprise Brian Lee, executive director of Families for Better Care, a national citizen advocacy group focused on long-term care facility conditions.
"What is being asked of nursing homes to complete, you could find a kindergartner to do. This isn’t rocket science. But they’re making it a moonshot and all while our loved ones are suffering and dying," Lee said.
Lee added that he has seen similar reporting discrepancies and large-scale underreporting of COVID-19 to the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention.
"I don’t see any fines imposed. I don’t see CMS cracking down," Lee said.
State and federal penalties also are unclear who would be prosecuted for failing to report data, or provide inaccurate data, Lee said.
He called the Pennsylvania sanctions "laughable," especially since the state had been lax with regulation enforcement against long-term care providers "for years."
"This has no weight behind it at all. No one is going to jail over this data," Lee said. "The lobbyists have to be laughing over this. If they really want them to do it, they have to have strong sanctions and tough enforcement."
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