New report: MI nursing home deaths were over 40% higher than state reported

The state's auditor general reported 8,061 deaths while MDHHS reported 5,675
Posted at 6:11 PM, Jan 20, 2022
and last updated 2022-01-20 18:52:57-05

MICHIGAN — A new report by the Michigan Office of the Auditor General estimates that through July of 2021, the state experienced 8,061 deaths in nursing homes — compared to the 5,675 the state reported publicly.

Auditor General Doug Ringler clarified that the report did investigate facilities that weren’t required to report their numbers to the state per federal recommendations as to what defined a "long-term care facility."

“We determined that MDHHS was not requiring adult foster care facilities with 12 or fewer beds, certain homes for the aged facilities, and hospice-only nursing homes to report their information to MDHHS,” said Brittany Simmon, who helped conduct the investigation on behalf of the auditor general’s office.

The squabbling over definitions dates back almost to the beginning of the pandemic, when Gov. Gretchen Whitmer signed Executive Order 2020-50, allowing the treatment and readmission of patients with COVID-19 into nursing homes. Though the idea was to keep patients cordoned off from the rest of the population, many argued it was too risky for a population that was already high risk. The order has since been rescinded.

“This is the most accurate count we have as to date,” said Rep. Steve Johnson (R–District 72), who chairs the House Oversight Committee. “If you don’t count these, what you’re saying is that person’s life in that facility is somehow less valuable than the life of the person in the facility that was required to self-report. In what world would that make any sense?”

From the beginning, the state has said they did everything they were supposed to do in line with federal guidance and definitions of which facilities were required to report numbers.

“Something that is clearly misleading is the application of definitions that do not align with federal and state statutory and regulatory requirements,” said MDHHS Director Elizabeth Hertel in front of the committee Thursday. “The total differences represented in the auditor general’s report are not due to miscounts or misreporting by the facilities to DHHS but by changing core definitions of what the state required for reporting.”

To verify the death count, the auditor general’s office looked at death certificate data from Michigan’s Electronic Death Registration System (EDRS) and COVID-19 case and death data from the Michigan Disease Surveillance System (MDSS).

The office cross-referenced addresses on positive tests and death certificates to addresses of long-term care facilities to get their number. Ringler said it’s very similar to the process and the data the state uses to contact trace.

SEE MORE: Michigan House, Senate Oversight Committees host hearing on underreported nursing home deaths

“We felt that if they could use it for those purposes, we could also rely on it then for the address information,” said Ringler.

“We wanted to make sure that every single one of our 8,000 had an address or name that matched a long-term care facility,” added Simmon.

Despite the roughly 40% discrepancy in the state’s number versus those laid out in the auditor general’s, Hertel remained steadfast in her defense of the department’s data-gathering methods.

“I think it’s important to acknowledge that nowhere in the OAG’s report did they use the word undercount,” she said. “Their report found that we posted all data that we received transparently and accurately.”

Here’s the full statement to FOX 17 from the MDHHS:

MDHHS appreciates the OAG’s recognition of the fact that the department accurately compiled and published the long-term care COVID-19 death data supplied by Michigan’s long-term care facilities, as well as their recognition of MDHHS’s work ensuring the reasonableness and integrity of the data reported. However, we continue to have serious concerns about both the methodology employed to compare long-term care facilities’ self-reported data to death certificate data from Michigan's Electronic Death Registry System and COVID-19 case and death data from the Michigan Disease Surveillance System, as well as the conclusions they’ve drawn from this review.

We are concerned the report will be misinterpreted to question the work and integrity of long-term care facilities, local health departments, coroners and other frontline workers who we rely on to report data. Throughout the pandemic MDHHS has clearly stated what would be included in our COVID-19 long-term care facility death data. We were upfront and clear about what deaths were and were not included in our count. The OAG has chosen to use a different definition of a long-term care death than MDHHS is using based on federal requirements. The analysis combines COVID-19 deaths in facilities that were required to report and those that were not required to report, creating the impression of a larger undercount by long-term care facilities than is warranted.

We feel this review and its findings are doing a great disservice to Michigan residents, especially those who have family members residing in long-term care facilities.

MDHHS welcomes legislative action to improve data collection and reporting in the future by investing in public health infrastructure. Our ability to upgrade and maintain data collection platforms is vital in being able to collect, analyze, and report accurate information during times of emergency or urgency. Clearly, our data platforms are outdated as all verification methods identified rely on manual data entry. Additional investment in our state public health data platforms is essential for us to provide this information quickly and transparently to the public. Further, health care facilities in Michigan are not required to regularly report pertinent public health data. Consistent collection of public health data from providers would improve the efficacy and efficiency of data reporting. Because no reporting requirements exist in law, an emergency order was required to compel reporting followed by education and training to bring facilities up to speed on reporting requirements. Any statutory requirements for minimum reporting from health providers would better position the state to respond to emergent public health crises.

READ MORE: State health director accuses Republican Rep. of using nursing home deaths to mislead the public

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