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The only viable source for tracking COVID-19 deaths at specific nursing homes in Ohio has undercounted the number of fatalities locally as well as statewide, an Enquirer review of the federal database system has found.
Federal lawmakers are working on a solution but are likely months away from a potential solution.
The Enquirer has discovered at least three nursing homes in the Cincinnati region with a total of five COVID-19 deaths that aren’t in the federal database, as revealed by an ongoing Enquirer review of death certificates since the pandemic began.
The nursing facilities are Pleasant Ridge Care Center, Garden Park Health Care Center in Avondale and Mount Healthy Christian Home, sometimes referred to as Christian Village at Mount Healthy.
Gaps in the system can be traced to when nursing homes were required to provide death information to the federal Centers for Disease Control and Prevention, which made it optional for nursing homes to report COVID-19 deaths before May 1.
Many Ohioans died at nursing homes long before that, and state officials aren’t naming which nursing homes residents have died.
While the three local nursing homes had every right to use the loophole, the transparency flaw that they used might be closed if a powerful U.S. senator has his way.
U.S. Sen. Chuck Grassley, R-Iowa, last month, introduced the Emergency Support for Nursing Homes and Elder Justice Reform Act of 2020, which would require nursing homes to report COVID-19 deaths and other information dating back to Jan. 1 of this year. Grassley is chairman of the Senate Finance Committee, which oversees Medicare and Medicaid.
Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, told USA TODAY in June that she was concerned about the amount of information available to the public and the fact that the federal Centers for Medicare & Medicaid Services (CMS) only required facilities to report numbers going back to early May.
“That leaves almost three months of kind of a black hole where we don’t have data on what’s been happening in these facilities in some cases,” Smetanka said. “We can’t successfully move forward and look at not only what happened, but what we can do to improve, if we don’t have the data.”
Holes in the federal database are potentially troublesome for Ohio citizens who live in nursing homes or have family members there. The reason: Ohio is among the eight states that don’t name congregate-care facilities where COVID-19 related deaths have occurred.
That leaves Ohioans to rely on the porous federal database, which has only 61% of the 2,631 COVID-19 deaths among nursing home residents. Neighboring states such as Kentucky and Indiana reveal the names of nursing homes where people have been ill and have died.
Officials with the American Association of Retired Persons (AARP) this week reiterated that nursing homes should track the deaths going back to the start of the pandemic.
“AARP urges CMS to modify this rule to require facilitates to report data prior to May 8,” the organization said. “This current data gap provides an incomplete national picture of COVID-19 in our nation’s nursing homes and should be rectified. A national surveillance system should include complete and comprehensive data.”
The Ohio Department of Health reported more than 1,244 new cases of the novel coronavirus this week, bringing the total to roughly 118,820 confirmed and probable cases.
Ohio recently surpassed 4,000 COVID-19 deaths. Another 32 deaths were reported between Wednesday and Thursday, bringing the total to roughly 4,080.
Nursing homes were required to report COVID-19 related deaths to CMS by June 6 or face a fine.
The fines range from $1,000 for the first week of delay to another $500 the following week and increases for as long as the delays continue.
It isn’t known if any nursing homes in the region have had fines levied against them for failing to report cases or deaths.
“The list of facilities fined for noncompliance with infection control requirements and for failure to report coronavirus disease 2019 (COVID-19) data will be made publicly available soon,” CMS said in a statement. “Final penalty amounts could be adjusted based on further review and appeal actions. CMS will provide an updated list once this process is complete.”
The Enquirer reviewed three death certificates from residents of Pleasant Ridge, one from Mount Healthy Christian and one from Garden Park, all of which were not in the federal database as of Aug. 29
The Pleasant Ridge residents all died in April at the facility on Verulam Avenue, death certificate information obtained from the city of Cincinnati shows.
“Pleasant Ridge Care Center adheres to all COVID-19 reporting requirements from the CDC, state and other regulatory agencies,” said Suzanne Koenig, founder of SAK Management-Ohio LLC, which became the court-appoint receivership of the nursing home in June. “The required information has been reported, and we will continue to do so on a regular basis. We also continue to follow all guidance and safety measures to minimize COVID-19 exposure to residents, families and staff, and are testing frequently.”
Pleasant Ridge officials refused to discuss the deaths of the residents and exactly how they became infected.
Mount Healthy Christian Home, on Hamilton Avenue at the village’s northern border (Photo: The Enquirer)
The resident at the Mount Healthy facility on Hamilton Avenue died on April 9, Hamilton County records show.
“We did not (send it),” said Lisa Cecil, executive director of Christian Village at Mount Healthy, adding it wasn’t required since the death came before May 1.
Asked to comment on the circumstances surrounding the death, she said: “There really wouldn’t be anything I’d be able to say,” citing health privacy laws.
The Garden Park resident died at the facility on Washington Avenue on May 3, city records show. Garden Park officials didn’t return messages for comment.
The five additional COVID-19 deaths are on top of 35 others that an earlier Enquirer analysis found at seven nursing homes.
Ohio officials have released details on which nursing homes have had COVID-19 cases but will not make public the number of COVID-19 deaths at each facility.
They say state privacy laws prevent them from doing so, yet Kentucky and other neighboring states make such information public.
The Enquirer earlier this month filed a complaint in the Ohio Court of Claims to obtain facility-level death information in addition to other records related to the COVID-19 response at long-term care facilities.
The federal database tracks all COVID-19 deaths and cases at nursing homes across the country. It’s updated weekly after nursing facilities send the death totals to the CDC, which then provides the information to CMS.
CMS in June said it was missing reports from 12 percent of nursing homes in America. The database does not include cases of deaths at assisted living, group homes and other congregate living facilities, since they are not subject to the same federal regulations as nursing homes.
The Enquirer review of death certificates from across the Cincinnati region also has revealed deaths at assisted living facilities, none of which are in the federal database.
At least six linked to COVID-19 have happened at the Sheridan at Mason, death certificates reviewed by The Enquirer show. Five of the deaths at the Sheridan occurred over a span of just three days, from April 16-18. A fifth resident died in mid-May.
Here’s some background on each of the three nursing homes where deaths fell into the reporting loophole.
Garden Park Nursing Home
The facility on Washington Avenue in Avondale has had one inspection since the pandemic struck.
A July 13 inspection at Garden Park found nurses talking to residents while wearing disposable face masks and cloth face-masks.
The assistant director of nursing said the masks were special N95 masks that staff members preferred, however, a review of their policy required them to wear an N95 respirator mask, the report said. Not wearing the proper mask could have harmed all 56 residents.
The report added that staff didn’t use personal protective equipment correctly, shared staff between COVID-19 and non-COVID-19 units during the same shift and didn’t ensure hand sanitizer was available.
The facility, with 60 beds and a one-star rating for overall quality from the federal government, was cited for 18 health violations in December of 2019. It was fined $12,775 in October of 2019, records show. It has had two infection-related deficiencies over the last four years. One Garden Park resident died of COVID-19 before July 5, according to the federal CMS database.
Garden Park has had three COVID-19 cases among residents and four among workers, according to state data posted Thursday.
Pleasant Ridge Care Center
The facility, located in the eastside Cincinnati neighborhood with the same name, has a two-star quality rating. The facility, which has 99 beds, had 12 health violations in an October 2019 inspection. Pleasant Ridge Care had 41 residents and seven workers with COVID-19, the state data shows.
Mount Healthy Christian Home
Mount Healthy is a five-star facility, the highest rating possible under the federal government’s quality gauging system. It was cited for five health violations in March of 2019, far less than the state average of nine. The nursing home was 75 beds. The facility has had one resident with COVID-19 and seven workers (one of them currently ill), state data shows.
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