We are sure every provider is sick and tired of hearing about how many residents have died of COVID-19 in a nursing home or assisted living community. The problem is that the classification may be all wrong.
Unfortunately, there may be a financial reason for such classifications, as in more reimbursement, or more governmental aid. And for those who can profit from making this pandemic seem worse than it is (yes, they do exist), piling up the number of COVID deaths helps to make their case. It has certainly helped the mainstream media and their advertising dollars.
But here is the problem, at least as it relates to the deaths in assisted living, memory care and nursing homes. What the statistics don’t differentiate is those residents who died “of” COVID from those who died “with” it.
Let us explain. Most people who are long-term residents in nursing homes, or assisted living and memory care communities, have multiple health issues, commonly referred to as co-morbidities. It is a word often used in the senior care industry, but particularly during this pandemic.
In its most simple definition, a comorbidity is the presence of one or more “additional” health conditions, usually co-occurring with a primary condition. And we are not talking about minor health problems, but major ones, usually chronic and often cardiac or respiratory related, as well as diabetes. To be un-politically correct, these residents today have several health problems, any one of which could result in their death at some point.
In addition, the average length of stay for these residents is relatively short, even in the best of times, especially compared with independent living communities or CCRCs, not to mention active adult communities with their much younger average age. They have moved into nursing homes or AL/MC communities in a frailer condition than 20 and even 10 years ago. In many cases, they are going to die in six or 12 months even without a pandemic.
So, when a 90-year resident in a memory care wing (true story), on hospice, with maybe three weeks to live gets infected with the coronavirus and dies in two weeks, she is listed as having died “of” COVID. But that is not true. She died “with” COVID. She actually could have died from any of her comorbidities, if not just old age, but that is not how it is recorded. She becomes a statistic as one of the 170,000 and growing deaths from COVID.
The entire senior care industry has to get this message out and the only way to do so is to track what really is happening inside your buildings. The overall number of deaths “by” COVID will go down, and the industry can make a better case to the consumer for what is really happening to seniors under their care. We would love to receive your statistics, on or off the record.
Excellent topic for current political debate. Without accurate numbers its hard to set policy. Conflicting financial alignment makes this harder. Thanks for addressing this head on.
Thanks Alan, and yes, this needs to be talked about more by providers. More than 500,000 residents die in nursing homes every year from non-COVID illnesses, which is why they are living in nursing homes, and somehow this point is missed when the media talks about all the deaths in LTC facilities.
Thanks to both Steve and Alan for this discussion. SNF (and perhaps some ALF) providers might continue to need state/federal dollars to conquer this pandemic, but properly classifying cause of death and required care is essential. I also like to share that several SNF operators are reporting seeing some occupancy boost from new admit COVID-19 survivors that now need long-term care driven by COVID’s impact on their health.
Death certificates are a touchy subject you may want to expand upon, based on this excellent column. The medical examiner, the patients’ physicians and the providers pronouncing the deaths all have a hand in determining the cause/s of death. I like the modifier, “complications of” whatever the major underlying disease or syndrome was known to be before the complications
Thank you John, and yes, it is all in the coding. I just was talking with someone today who has a new staff member from a hospital, and she told him that they were pressured in the hospital to list COVID-19 as cause of death because the reimbursement was higher. Just another example of how the COVID numbers get expanded.
We had 20 residents diagnosed with COVID 19 in our 160 bed nursing home. First resident diagnosed was sent to the hospital on a Friday for an unrelated lab value that needed treatment. Temp was 97.3 when resident left. On the following Sunday hospital reported a positive test. this resident survived. We did have 7 deaths of the 20 with the virus. All seven had significant other health issues and were extremely fragile. I believe the common flu would have resulted in the same outcome.
Health department reports us as having 36 confirmed cases. 16 of those were staff who acquired the virus in the community which is not reflected in the numbers.
Our first case was March 8 and we were virus free on April 8. Health department shut admissions down from March 8 to mid May. Census went from 148 to 109. We are slowly climbing back with census of 118 today.
I estimate we have lost around $3MM due to low census and admissions ban. Thankfully that’s about what we received so far in CARES, PPP and FMAP federal stimulus funding.
I am curious to know how many of these COVID deaths are in designated COVID treatment beds. Various states have required or asked SNFs to open up beds for COVID patients. We had one SNF near where I live that I kept hearing about in the news as having yet another death, only to learn, after some searching on the internet, that the operator made arrangements with the State to take in COVID patients. How much have these designated beds skewed the numbers? How much have these numbers skewered the reputation of operators?
That is just one of the problems. But I agree, the death statistics in skilled nursing have definitely been skewed.
Very good points, Steve. I would add to the concepts of “by COVID” and “with COVID” — maybe “because of COVID?” I just had a window-visit with my 92-year old mother living in Assisted Living. Pre-COVID, she was in pretty good shape but she has definitely deteriorated in mind, body, and spirit. Her caregivers tell me that is pretty common in their facility. It increases my concern that we will see higher than normal mortality rates in the coming months simply due to the stress and strain of isolation, reduced activity and eating. A personal concern and industry concern.
Mark, first I am very sorry to hear that your mother has deteriorated in her assisted living community since the start of the pandemic, but be thankful she has had 92 years. My father died in assisted living in a CCRC at 91, but he had a long, great life. You bring up a great point about what isolation is doing to the elderly in senior living communities during the pandemic. I am not sure I would want their deaths to be recorded as “death because of COVID” only because it would make the numbers seem even worse for senior living, and it is not their fault that they have to abide by state guidelines that result in the isolation. Good luck with your mother and I hope the visitation restrictions are lifted soon so you can give her a big hug.