State records: hundreds of long-term care facilities underreported COVID-19 deaths

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INDIANAPOLIS – On Wednesday, State Health Commissioner Dr. Kristina Box announced 273 facilities underreported 660 COVID-19 deaths. Records from the Indiana State Department of Health show 49 of those facilities are operated by Health and Hospital Corporation (HHC). That is more than half of the long-term care centers HHC operates.

The government agency controls the largest nursing home chain in the state. American Senior Communities (ASC) operates the homes on behalf of HHC. Along with ASC, HHC operates 78 skilled nursing facilities and five assisted living communities.

During a weekly press briefing with Governor Eric Holcomb, Dr. Box said the 660 COVID-19 deaths were already included in the overall total on the statewide dashboard. The deaths involved 659 residents and one staff member. These deaths were added to the state’s long-term care dashboard on Thursday. The dashboard now shows 5,870 residents have died of COVID-19 so far.

In May of 2020, ASC began publishing its own COVID-19 data on facility websites. Aggregate data for all HHC-owned facilities is updated weekly on the HHC website as well.

“After extensive analysis of the data shared with residents and families, as well as on individual facility websites and the aggregate HHC dashboard, we are confident in our data reporting. We are currently working closely with the Indiana Department of Health (IDH) to determine the cause of potential discrepancies with data reported on the IDH dashboard and will work with IDH to ensure any issues are resolved moving forward,” said HHC and ASC in a joint statement.

This is the second time this month Indiana has added previously unreported deaths in long-term care. A spokesperson for ISDH said about 90 deaths were added to the long-term care dashboard after additional verification. These deaths also had already been included in the state totals but not previously assigned to a facility.

Facilities are required to report all COVID-19 related deaths or suspected COVID-19 deaths to the state under an order Dr. Box issued in April 2020.

“Our primary mechanism for identifying where a death occurred in a long-term care facility is to have those facilities submit information directly to us when a death occurs,” she said. “These deaths were not reported through the system it appears.”

Dr. Box said all of the positive cases were reported through the long-term care portal but it was not until they cross referenced the cases with death records that state health officials determined they had not been included in the long-term care dashboard.

The 660 COVID-19 deaths occurred from April 2020 to the end of January. State records show a majority of facilities missed reporting one or two deaths. The most amount of underreported deaths came from HHC-ASC Allisonville Meadows with 25 deaths.

In addition to an order from Dr. Box in April, the Centers for Medicare & Medicaid Services issued a mandate for long-term care facilities to report deaths to them starting in mid-May 2020.

“In some cases, it appears some of these facilities reporting to CMS and maybe not to the State Department of Health or vice versa,” Dr. Box said.

Dr. Box said the state plans to reach out to facilities that did not report through their system to determine if they were barriers to doing so.

Indiana’s Long-Term Care Ombudsmen, Lynn Clough, was not concerned about this correction to the dashboard.

“They were transparent about it, very forthcoming about how they were going to fix it,” she said.

Indiana Health Care Association, the group that represents facilities across the state, said they will work with the state to determine the root cause of any issues and help implement necessary corrections. IHCA’s president explained data reporting has been complex since there are currently six data reporting systems for all COVID-19 related data.

“In a brief discussion with the IDH since the press conference, it is unclear if the issues regarding allocation of the deaths to the LTC dashboard were a result of reporting issues at the facility level or issues with attribution of already reported data at the state level,” said Cattell.

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